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    Old 01-04-2005, 09:28 PM   #1
    Sam43
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    Post-Posterior Cervical Foraminotomy

    Hereís a followup on my procedure, a Posterior Cervical Foraminotomy.

    I was diagnosed with a cervical herniation, C6-C7 in September. Two different surgeons recommended a ACDF to remove the disc and fuse the bone. I elected to try physical therapy for a while to see if that improved the symptoms. Although it did seem to help at first, I was still having enough trouble by December that I was ready to agree to surgery.

    After a second MRI on Dec. 22, my neurosurgeon changed his recommendation to the PCF approach. He felt the disc degeneration on other levels was advanced enough that he didnít want to add more stress by fusing this level. Although he has said more than once that there isnít good data on whether ACDF causes more stress at other levels, his recommendation made me believe that he feels this is the case.

    This approach is considered a less invasive surgery. It takes a posterior approach, from the back of the neck. The herniated part of the disc is removed but the disc is not removed, so fusion is not necessary.

    The surgery took place on Dec. 30. Although I had some trouble with the aftereffects of the anasthesia (nausea and grogginess) by the next day I was feeling fairly comfortable. I went home on Jan. 1. I am currently on pain medication and not trying to do a lot, but if I continue to feel better, I expect to be back to work in two weeks (knock wood). I do have soreness and stiffness from the incision area, but it is manageable with the meds.

    The surgeon said the operation went well. I still have the same symptoms I had before the operation, including weakness in the arm, numbness in two fingers and some pain. As I understand it, the symptoms are a result of pressure on the nerve, and as the nerve heals, the symptoms should decrease. Or, if the nerve is permanently damaged, the symptoms could be permanent. I suppose now I wait and see. I do have a follow up in a week and half.

    I feel lucky in a way to have avoided ACDF, altho it certainly could still be in my future. But it does raise the question on whether there are other cases out there where the PCF approach could be done instead of ACDF, and why isnít it recommended more often. As I understand it, posterior approaches were once the most common surgery for disc herniation, but now for cervical cases the vast majority are done via ACDF. I see little downside to the approach, except that it is possible the disc could herniate again. But in that case an ACDF is still possible.

    Anyhow, I have gotten some good feedback on ACDF and related issues on this board and thought it would be good to share my experience. I will try to update on this thread in the future.

    I am still interested in hearing from other people who have had the procedure (PCF) and how long it took their symptoms to clear up, if they did.

     
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    Old 01-07-2005, 07:53 AM   #2
    MacG
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    Re: Post-Posterior Cervical Foraminotomy

    Hiya Sam43 -

    sorry, i cannot answer help you regarding the PCF. I am seeking answers to know what were your c6-7 symptoms specifically. I had a ACF c5-6, still feel the same pain, and some different ones. A myelogram showed that there was a slight bulge at c6-7 and i want to know if that level is now being affected. i was told that the c5-6 level symptoms is comparable to c6-7. i don't know what is going on ... except i'm in pain!

    thanks

     
    Old 01-07-2005, 09:06 AM   #3
    Sam43
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    Re: Post-Posterior Cervical Foraminotomy

    Hi MacG.
    My symptoms were mainly pain in the left arm, numbness in my pointer and middle finger on my left hand, and weakness in my left arm in the triceps area. I also had diminished reflex on that triceps nerve (Back of the upper arm. They tested the reflex with a hammer on my elbow, it was pretty dead).
    When the disc first herniated, I had severe pain in the neck (left side), left shoulder, left upper back, and left arm. The pain subsided considerably after a week or so. The numbness started shortly after the pain. I noticed the weakness in the arm maybe a couple weeks later.
    Hope that helps...

     
    Old 01-07-2005, 03:51 PM   #4
    MacG
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    Re: Post-Posterior Cervical Foraminotomy

    Hiya Sam

    Thanks for the info. I think thats the level that is being affected now.

    Take care

     
    Old 01-07-2005, 07:29 PM   #5
    BunnieRabbit
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    Re: Post-Posterior Cervical Foraminotomy

    C56 pinched nerve here. I was wondering if anyone else has tensed up shoulders with this condition. I have the lower back of the head to neck to clavical to shoulders to arm/hand to shoulderblade pain and or numbness (mostly on the left side). I wake up with my shoulders tensed up. I have to make a conscious effort to lower my shoulders. Pain medication relaxes my shoulders and I begin to feel better. In addition, could this be a result of something other than a pinched nerve?

     
    Old 01-09-2005, 04:40 AM   #6
    rob_zzz
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    Re: Post-Posterior Cervical Foraminotomy

    Sam,

    Its interesting to hear of an alternative approach to fusion. I'd be curious to hear how your pre-surgery symptoms are in a few weeks - i.e. whether you start to see an improvement. Also what were your expectations/hopes pre-surgery? - were you looking for an improvement in pre-op symptoms or a halt to the deterioration?
    It will also be interesting for you to see another MRI a bit further down the track as well to see if you can visibly see the decompression. If your arm symptoms don't show some recovery will you still then consider ACDF to see if you can get a reversal of the symptoms? I guess this could also depend a bit on an MRI (i.e. if the MRI shows the decompression etc. was succesful then I suppose its quite possible acdf wouldn't add any improvement).
    Anyway - thanks for posting about your surgery - I'll be curious to hear how it all progresses - it'll be great if you start to see some improvement in the pre-op symptoms. I've got a bit of narrowness in my cervical canal and the two discs above the level I've got the herniation are also bulging so have some similar concerns about fusion.

    thanks
    Rob

    Last edited by rob_zzz; 01-09-2005 at 04:42 AM.

     
    Old 01-09-2005, 07:10 PM   #7
    NYFUSED
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    Re: Post-Posterior Cervical Foraminotomy

    Hi,
    Unfortunatley I had a posterior lami/foraminotomy at c6-7- in June 2003. It was done to remove bone spurs that grew immediatley after my ACDF C5-6-7 and it was causing spinal stenosis. I had a terrible pain 24/7. This was found by having a myelogram.
    The posterior aproach is a more painful surgery recovery and surgery itself. I ended up with a staph infection after the surgery and was hospitallized for 1 week. Even without the staph infection, recovery is longer due to all muscles being cut in that area.

    Good luck on your recovery
    Lori

     
    Old 01-10-2005, 08:52 AM   #8
    Sam43
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    Re: Post-Posterior Cervical Foraminotomy

    Thanks Lori and Rob for your comments.
    I was indeed hoping for an improvement in my symptoms after the procedure, and my NS seemed to think it was likely, tho no guarantees.
    One definite improvement is that before, I had persistant, often mild-to moderate pain right in the area of the neck where the herniation was. I have noticed that that pain is no longer there. So that's one improvement.
    I was very much hoping for improvement in the left arm muscle weakness and the numbness in two fingers. The jury is still out. Immediately after the surgery I was pretty sure that at least one of the fingers was back to normal, but within two days both fingers felt the same as before. The weakness sometimes feels a little better, but strength tests have shown my left triceps to still be weaker and prone to "buckling".
    Some symptoms, such as muscle tremors, have seemed the same or worse. I also get some left leg pain for some reason.
    However, it's only been less than two weeks. On the whole I feel pretty good and although I get tired easily, I think the recovery is coming along. It's still possible that many of the symptoms will improve with time and I am trying to stay positive.
    I will not consider ACDF unless things take a big turn for the worse. I consider the herniation "fixed" and will be hoping that my other discs behave themselves.
    Lori, I had heard that the posterior approach is more painful. I don't have anything to compare it with, but in my experience, it hasn't been too bad. My incision area continues to be sore and tender, especially if I'm active, but I am managing to get by with only ibuprofen. I expect the pain to ease with time.
    I am sure not all foraminotomies are the same, yours probably was more complicated. And I had the good fortune of not having an infection.
    I am back to work half-time this week, so we'll see how it goes. I have an appointment with the NS on Wednesday, and will report back then.

     
    Old 01-10-2005, 04:12 PM   #9
    rob_zzz
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    Re: Post-Posterior Cervical Foraminotomy

    Sam,

    Thanks for the info. Good to hear that pain has gone away as a result of the surgery - like you say its very early days so hopefully you might also see improvement over time with the other things as well. Its also good you are able to start working again so soon after the surgery - sounds like it went well.

    cheers,
    Rob.

     
    Old 01-13-2005, 08:35 AM   #10
    Sam43
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    Re: Post-Posterior Cervical Foraminotomy

    I saw my neurosurgeon yesterday for a followup on my foraminotomy. The surgery was two weeks ago today.

    Although I am still having some symptoms, the left triceps nerve that was dead seems improved, there is now a good reflex there. I also have improved strength in the left arm. The doc said these developments are a good sign. It definitely is the most improvement since I started having problems in September.

    I still have numbness in two fingers and occasional mild pain in the left arm and hand. The NS said the numbness will probably be the last thing to resolve. It may not, of course, but if it does it will be within 12 months, he said.

    Overall I am noticing less neck pain and better strength in the arm. Iím happy with the results of this surgery so far.

    One thing I like about my NS is that he takes plenty of time to answer questions. I asked him about artificial cervical discs. My thinking is that I probably will have more cervical disc problems down the road (based on my MRI findings), and the artificial discs may be an option by then.

    His reaction was interesting. "Sometimes I think this industry is too driven by medical device manufacturers," he said. (I am not quoting exactly). "For years theyíve told us Ďfusion is the thingí and now that they have a new technology they say the artificial disc is the thing." He says itís still very early to judge how well the artificial discs will do for people. He notes that no one really knows how long they will last.

    I thought that reaction might be of interest to people on that board, since there has been some discussion of artificial discs here.

    I am back to work half time this week and full time next. My wife thinks I'm pushing it, and some days at 5 pm I tend to agree, but overall I am doing well, and my deadlines aren't going away! We'll see how it goes.

     
    Old 01-19-2005, 06:01 PM   #11
    pete0735
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    Re: Post-Posterior Cervical Foraminotomy

    I am new to this board and if anyone has any experience in Foraminotomy, I would appreciate adivce or their experience. My story is I had a ADCF C6/C7 in Jan. 2002, broad based herniation. I did have minor formanal narrowing from spurs both sides of C4/C5 and right side C6 which where apparent at the time of my fusion. Since then symptoms of C4/C5 and right side C6 have appeared. I had a mylogram and MRI, and they match my symptoms. My Ortho surgeon feels a posterial foraminotomy is a good possiblity, but should I should get advice from a neurosurgeon. With limited activity my C4/C5 issues are controlled. My C6 problem occurs most frequently when I sit with my head striaght up and my right arm at desk level. This produecs pain from my bicep to my index finger and thumb. I'm not sure what to do or push for? A 3 area foraminotomy (c4/c5 left and right side, C6 right side), a single formainotomy at C6 right side, or leave things alone and live a 70 year old life style at 43? Iknow I will avoid a fusion right now, don't want to make matters worse. Any advice is appreciated.

     
    Old 01-19-2005, 09:12 PM   #12
    rob_zzz
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    Re: Post-Posterior Cervical Foraminotomy

    Sam - glad to hear its going so well - thats great news that strength is coming back in your left arm. Thanks for the update.

     
    Old 01-20-2005, 04:59 AM   #13
    Esmo77
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    Re: Post-Posterior Cervical Foraminotomy

    I had ACDF 5-7 w/corpect. in Nov.03. Suffered arachnoid hemorrhage and was in hosp. for one week. Now due to non-union I am scheduling posterior Cervical Surgery (Not foraminotomy) to correct the non-union at c5-6. I am having bone shaved from rear hip area, 2 rods and 6 screws placed along rear of spine. I am in alot of pain now due to non-union and feel this is my only choice. Anyone have any feedback on this compared to ACDF?? Thanks so much.

     
    Old 01-25-2005, 05:04 AM   #14
    Esmo77
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    Re: Post-Posterior Cervical Foraminotomy

    Please respond. I am unsure as many of us are regarding a new procedure. Lorirat and Sam43 especially, my surgery is Feb. 23 and I need some feedback on your recovery time and outcome of surgery. I am in alot of pain right now but I am willing to live with this in lieu of what might lie ahead with another surgery. 2 Ortho's are doing the operation. Titanium rods and screws are anticipated. Please help if you can with a response.

     
    Old 01-26-2005, 07:31 AM   #15
    Sam43
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    Re: Post-Posterior Cervical Foraminotomy

    Esmo, my apologies for not responding sooner.
    I was unsure how to respond to your and Pete's posts because the situations seem so different than mine.
    I don't know if I can be of much help. Esmo, your surgery sounds much more complicated than mine. I did not have any rods or other hardware put in. They simply drilled out a piece of bone, removed the part of the disc that was pressing on the nerve and freed up more space, and closed it up. My recovery was fast, I was back at work full time in just over two weeks. However, I probably came back a little sooner than I should have, and I still have fatigue, other symptoms, etc. that I'm dealing with. On the whole, my recovery has not been too difficult, but I suspect your case will be different because it sounds much more involved.
    If the first union failed, you're in a lot of pain, and your drs are recommending it, then it seems reasonable that this is a good course. However, if you have doubts, it may be good to get a second opinion. That's the best advice I can give as nonexpert.
    Pete, my NS said since my MRI shows some significant problems, I could get a multi-level ACDF, with the thought that it may prevent another surgery in a couple years. Or I could get a single-level ACDF, or the forminotomy. However, my pain was not terrible, my symptoms were managable, and I just had some doubts about ACDF in my particular case. So I went with the less invasive surgery and hoped that they would moderate the symptoms enough and that my luck would hold out. So far it looks like a good decision. I don't know enough to know how to advise on a multi-level foraminotomy.
    Wish I could be of more help.

     
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