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Old 08-22-2011, 02:01 PM   #1
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7 months post level 3 ACDF (C4-C7)

I'm seven months out from level 3 cervical discectomy and fusion (C4-C7), with hardware. My experience is that this is a difficult surgery to recoup from. I had herniated discs and severe spinal stenosis at every level that was fused. I also have severe degenerative arthritis in my neck at each level. I was having the typical pains in my arms, hands, etc. I had pain along my spine from the stenosis. I had numbness and lack of bowel/bladder control before surgery. I was told that there was no guarantee this would improve post surgery.

The Surgery was done Jan 19, 2011. I returned to work July 18,2011. Immediately following surgery, (within the first 48 hours) I had severe muscle cramps in my neck. This was extremely painful. These cramps continued for 4 weeks, although as time went on they gradually lessened, until at the end of the first month I no longer had them. The symptoms in my hands arms and shoulders were not affected by surgery. They are unchanged from prior to surgery. The stenosis pain I had down my spine, and the numbness I had in my lower extremities, went away immediately post surgery. Bladder and bowel control returned to my 'normal' (much to my relief!). I did not wear any sort of collar post surgery. I did several months of physical therapy to restore some range of motion in my neck. Don't be surprised at the loss of range of motion. If you have this kind of surgery, your neck is not ever going to be the same. Pre-surgery, I had an active lifestyle. I played sports, hunted fished, you name it. If it was outdoors, I was out doing it. One level that I have problems with, C7-T1, was not fused. I guess it is because what I would lose from that fusion might not be worth what I would gain. In either case, it's still messed up and it still causes me problems. To be fair, the problems with my hands arms and shoulder might be related to that unaddressed issue. My surgeon told me that "I would be fixed for 5-15 years" before I needed more surgery (C7-T1) which wasn't exactly what I was hoping to hear. I have some permanent nerve damage, which I guess is to be expected. Who knows how much. Everyone seems awfully cavalier about what has happened to my body.

I guess what I am wondering is, does anyone have any experience with how long the joint immediately below a big fusion lasts after a fusion? I'm concerned whats going to happen to me if I have that c7-t1 junction fused. I don't know what to expect from such a surgery, and maybe I shouldn't worry about it, but having an idea of the effect this fusion would have on me, would be a load off my mind. C7-t1 already has a prominent protrusion, and i have mild stenosis at that level (according to the mri I had before my fusion surgery). I'm taking every precaution I can, within reason, to prevent injury to the area, and prevent any excess stress on the joint (per the surgeons instruction) Any idea what I can expect?

 
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Old 08-24-2011, 02:39 PM   #2
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Re: 7 months post level 3 ACDF (C4-C7)

In talking to my doc about this same issue(destruction of the level below a fusion) he told me that the size of the fusion has more to do with it than anything else. The longer the fusion, the higher the chances of it "rocking" on the vertebra below and causing herniations and arthritic changes.

I doubt the doc was thinking about how much you'd lose by adding the T1 vertebra. And just so you understand how they do these things...you are actually 4 levels, not 3. When they look at the spine, they list it by the area of the disks....and they are in between the vertebrae so 1 level for the spine pics in C4-5 but that includes 2 vertebrae(C4 and C5) and 1 disk. So when they fused you, they fused 4 vertebrae and 3 disk spaces.

So when you start with a 4 vertebra fusion, adding a 5th by adding T1 means a larger fusion and increases the possibility of destroying what is below it. That may be why he is waiting.

I am 4 1/2 years out from a 6 vertebra fusion...C3 to T1 and it's the top of the fusion that really determines how much movement you lose. I lost about 50% of my head/neck movement. Had he only gone to C4, I would have lost about 25% and it goes lower and lower as you go down. But I am ready doing yearly testing to see if T2 will need to be added. So far, so good.

Some of the things I am doing to keep it that way is constant exercising to keep my muscles strong. And I got tested for osteoporosis and subsequently treated as I was in the early stages of it. My doc didn't want to wait for it to get worse. I have reversed the osteoporosis over the past 4 years so now I take 3000 IU's of Vit. D a day and calcium supplements as well. My vertebrae are testing well and I think that helps to slow the degeneration.

So just keep on healing(it takes a good 2 years to really heal) and take care of your spine with PT, exercise and seeing if your bones are in good shape and hopefully, you'll never need to have T1 added.

Jenny

 
Old 08-24-2011, 04:47 PM   #3
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Re: 7 months post level 3 ACDF (C4-C7)

There's a lot of confusion about the extent to which fusion at one level CAUSES the need for fusion at an adjacent level. Fifteen years ago,the surgeon who did a C3-4 ACDF on me told me that it was just a matter of time before I needed another at C4-5. I think he said 6-10 years.

15 years after that I finally did need a C4-5 ACDF, but the two surgeons who recommended it both said they didn't think much of "adjacent segment syndrome". They both quoted a study that found a 3% annual chance (25% compounded over 10 years) of an ACDF at one level necessitating an ACDF at the next level down. This would indicate a correlative, rather than a causative relationship.

So.... "adjacent segment syndrome" makes a lot of sense. It's perfectly logical, and easily explained. And certainly there will be abundant anecdotal evidence in favor of it. However, the one study that I know of that was specifically designed to test it found no real basis for it.

Probably better to believe that you'll be OK and, as Jenny suggests, take measures to improve your odds....

 
Old 08-26-2011, 06:09 AM   #4
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Re: 7 months post level 3 ACDF (C4-C7)

Hello daner51. Welcome. Thanks for sharing your experience here.
So you say it is better not to do a neck surgery?I don't have bladder problems. "only" severe neck pain. No arms pain and leg pain.
By the way, how were you injured? I am asking this cause you are very young for so many herniated and bulging disks.

 
Old 08-29-2011, 01:59 PM   #5
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Re: 7 months post level 3 ACDF (C4-C7)

I played football through high school, and ice hockey into my early 30's. In both sports I had some fairly heavy impacts involving my head. I can recall as far back as 8th grade football, taking a big impact and having it radiate down my arms, making my arms go limp They called it a 'stinger' and the coaches acted like it was nothing. I am guessing those kinds of things helped cause this. I also have a very heavy skeleton, and my surgeon told me my large bone structure caused me to have a smaller than normal spinal canal, which made it easier for herniated discs and bone spurs to push on my spinal cord.

As far as anyone out there that is looking at surgery- I'm no expert, however, I would do it again in a heartbeat. I was in a no-win situation and I had to get this fixed. My surgeon told me "don't have surgery to fix your arm pain". He said he couldn't help me with that, but he could fix the stenosis. That is what he did! He wasn't lying to me, and I really appreciated the honesty.

Pre-surgery, I only had symptoms on my right side. Since surgery, I have symptoms on both sides. I dont know if that would have occurred naturally or if surgery somehow caused it to get worse, but either way, it's what I have to deal with.

My only real concern is that "adjacent segment syndrome" is real and that C7-T1 level will end up having to be fused. If that happens, how much Range of Motion will I have? Physical Therapist made it sound like I wouldn't have independent shoulder and head movement. This scared me a bit. I've lost enough ROM that I REALLY don't want to lose more.

I appreciate all the replies! Any information is helpful It's so hard to get real answers from doctors on some of these topics. I'm sick of the 'everyone's experience is different' answer.

 
Old 08-31-2011, 05:38 AM   #6
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Re: 7 months post level 3 ACDF (C4-C7)

Daner51, I hope you get better!

 
Old 09-01-2011, 06:13 AM   #7
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Re: 7 months post level 3 ACDF (C4-C7)

Pre-surgery I had zero symptoms on my left side. It's 7 months later, and I have all kinds of radiating pain down my left arm, tingling, numbness, etc. It's not AS bad as my right side, but its catching up awfully fast! Is this normal? I know that arthritis continues unabated by surgery, and of course, further degenerative changes are to be expected in my neck due to the severe arthritis I have. Still, it seems like it's progressed to my left side awfully fast. Anyone else experience this?

Last edited by Daner51; 09-01-2011 at 06:26 AM.

 
Old 06-16-2012, 01:28 PM   #8
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Re: 7 months post level 3 ACDF (C4-C7)

had this done several years ago. NS warned me about possible issues with C7-T1 and now I am having those issues. May 12th woke up in morning felt kink in neck and couldn't even stand up. Went to emerg rm then in hosp for 2 days being pumped full of pain meds, finally got up and walked out AMA and made appt to see my NS. I am now going to get an epidural steroid injection right at C7-T1 and see how that works. I was on roids for a few weeks and responded well but now weaned off them and in lots of pain. Trying very hard not to reach for those 10/650's. Injection scheduled for Monday.
Has anyone else had the injection?

 
Old 06-16-2012, 02:01 PM   #9
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Re: 7 months post level 3 ACDF (C4-C7)

Orlando - I can't answer your question, but it's more likely that someone else will if you make it more visible by starting a new thread.

 
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