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    Old 05-30-2006, 05:22 PM   #1
    wdmoor
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    Post ACDF and having disc problems again

    September 2004 I had ACDF on C5-C6 with donor bone and plating. Things were going well until 6 months ago, when I started waking up at night with numb hands and sharp pains in my neck.

    And that horrible dense, thick pain was back in my neck and going up the left side of my head.

    My original NS has retired, so I did the whole testing regimen with my new NS...MRI, X-rays, EMG and nerve conduction.

    I saw the NS today. Turns out I still have a disc in my neck, bulging onto my spinal cord, causing the pain. She wants me to try physical therapy for several weeks.

    I wanted to know, what the heck is a disc doing in my neck when I went through a 5 hour operation to take the damn thing out in the first place?

    She changed the subject to my carpal tunnel problems, I changed it back to my neck and she suddenly became very formal with me in that way doctors do when they are reluctant to talk about something.

    She had a little model of a spinal cord on her counter, I asked her to explain on the model. She showed me she surgically removes the disc all the way until the dura is exposed, but some surgeons only remove so much of the disc. I asked why would he do that? She got annoyed, and told me she couldn't speak for another surgeon, I should speak to him myself. Which she knows I can't do.

    I'm confused, and angry. Has any one had a partial discectomy? Has anyone found out this way?

     
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    Old 05-30-2006, 05:51 PM   #2
    BobM
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    Re: [B]Post ACDF and having disc problems again[/B]

    I'm curious to hear what other responses you get to your question about how much of a disc is removed in a discectomy.

    I have had two ACDFs, about a year apart. It has been a little over a year since the 2nd, and I have some residual pain, but nothing like the pain before the surgeries.

    From what I've read, the usual practice is to remove enough of the disc to relieve pressue on the spinal cord and/or nerve branches. Since the bulging or herniation in our cases typically is to the rear, and the ACDF is from the front. most (or at least a lot) of the disc must be removed to get to the back, where the real problem is. I have found nothing that says the entire disc is necessarily removed - usually only what is necessary to remove the problem areas.

    The bone graft and plating that is used should prevent future bulging or herniation, since there is no longer any pressure 'squeezing' the disc.

    But I only know what little I can get from boards like this one, and from my own NS. When I asked him a question similar to yours, he said he removes enough of the disc to really open up the space and prevent future pressure from the disc.

    The bone graft that is used is typically not the same size (it is smaller) than the actual disc, so there is some space left over, that the body fills with scar tissue, or other tissue. This scar tissue can also eventually put pressure back on the nerves. I haven't read where this is typically a problem, but it probably what has happened in my case and explains some of the residual pain. It also seems like repeat surgeries in the same area tend to worsen problems with scar tissue forming.

    Again, this is only what I can glean from reading and a couple of conversations with my NS. I will be interested to see other responses to you questions.

    Good luck
    Bob

     
    Old 05-30-2006, 07:51 PM   #3
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    Re: [B]Post ACDF and having disc problems again[/B]

    I was a little confused but I guess you mean the disc at C5-6 is still in there and you are not talking about another disc level problem? Which is common for people to have another disc go bad. And 5 hours sounds like a long surgery, I've had 2 different ACDFs, one a 2-level removal and the second a one level removal, with complications , and neither took longer than 3 hours.

    As you could find out if you read years of posts, there are many techniques and procedures, some all called the same thing. Also once they get in there sometimes they have to make decisions on the procedure. I didn't have a partial I had a full discectomy on all 3. The full discs were removed along with bone spurs. Then they shave the sides of the 2 surrounding vertabrae so bone union of the graft can take place. THe bone was to fit exact size of the disc and fills up the space completely. I have seen it myself on the xrays.

    The only person who knows what they did was the original person. Get your medical records if possible from the hospital. They do keep copious records.


    There are some posters from 2004 who had partials, some no longer on the board. You might try searching the archive posts. Good luck

     
    Old 05-31-2006, 05:27 AM   #4
    acdfouch
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    Re: [B]Post ACDF and having disc problems again[/B]

    Quote:
    Originally Posted by BobM
    I'm curious to hear what other responses you get to your question about how much of a disc is removed in a discectomy.

    I have had two ACDFs, about a year apart. It has been a little over a year since the 2nd, and I have some residual pain, but nothing like the pain before the surgeries.

    From what I've read, the usual practice is to remove enough of the disc to relieve pressue on the spinal cord and/or nerve branches. Since the bulging or herniation in our cases typically is to the rear, and the ACDF is from the front. most (or at least a lot) of the disc must be removed to get to the back, where the real problem is. I have found nothing that says the entire disc is necessarily removed - usually only what is necessary to remove the problem areas.

    The bone graft and plating that is used should prevent future bulging or herniation, since there is no longer any pressure 'squeezing' the disc.

    But I only know what little I can get from boards like this one, and from my own NS. When I asked him a question similar to yours, he said he removes enough of the disc to really open up the space and prevent future pressure from the disc.

    The bone graft that is used is typically not the same size (it is smaller) than the actual disc, so there is some space left over, that the body fills with scar tissue, or other tissue. This scar tissue can also eventually put pressure back on the nerves. I haven't read where this is typically a problem, but it probably what has happened in my case and explains some of the residual pain. It also seems like repeat surgeries in the same area tend to worsen problems with scar tissue forming.

    Again, this is only what I can glean from reading and a couple of conversations with my NS. I will be interested to see other responses to you questions.

    Good luck
    Bob

    Bob,

    Good info. I can't comment on the amount of disc removed (I would assume it would be the whole thing however?), but I can talk about the scarring from my info gathering.

    Essentially the granulation (scar) tissue forms with any and every back surgery as you stated. It usually ramps up at about the sixth week and subsides around week twelve.

    Many people do not have problems with the scar tissue. Some do. For some, it recreates the original issue (to a degree, such is the case for me). For others it can make matters worse. There is also a name for the condition - Arachnoiditis.

    Last, on a positive note, I remember reading this... Wish I had the original link but I believe it was spine something.

    The general idea was that if by the time you make it to three months and you are seeing some types of improvments, it is generally thought that you will continue making improvements as you continue out to two years. Not sure how or why that statement was made, but I do remember reading it somewhere. I believe it was a failed back surgery info page.

     
    Old 05-31-2006, 01:55 PM   #5
    BobM
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    Re: Post ACDF and having disc problems again

    Hello ouch:
    Thanks for the new term - Arachnoiditis - it gives me something for more research.

    I also thought that the entire disc was removed, until my 2nd ACDF. 4 or 5 days post-op I experienced a terrible pain in the opposite shoulder from where the worst pain had been pre-op. The NS had me do another MRI even though the images are not ideal so soon after the surgery. He said the disc had fragmented, and the operation took an additional 30 minutes because he was 'fishing' fragments out of the foraminal area. He indicated that not all of the disc was removed., but the MRI showed no loose pieces or shifiting in the remaining disc material

    Live and learn, I guess, I would have thought they would just remove it all. There must be some trade off between the 'extra' time in surgery to remove it all vs. the risk of it causing problems if some remains.

    The scar tissue issue is one I've read about in some studies. Most people don't have long term problems with this, but in some cases enough forms, and either presses back on the nerves, or in some cases it adheres to the nerves, and causes pain from pressure or irritation. It's a hard condition to treat if it happens, because there's no guarantee that surgery to remove the scar tissue won't just result in even more, and if it's adhering to the nerves it's a problem to remove it without risking damage to the nerve itself.

    So much to learn about, don't you agree? I appreciate the encouraging words about the 2 years to improve. I've got 9 months to go yet, and I think there is still some improvement going on. I probably won't get back to 100%, but I'm so much better off now than before the operations.
    Thanks
    Bob

     
    Old 06-01-2006, 06:24 AM   #6
    acdfouch
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    Re: Post ACDF and having disc problems again

    Quote:
    Originally Posted by BobM
    Hello ouch:
    Thanks for the new term - Arachnoiditis - it gives me something for more research.

    I also thought that the entire disc was removed, until my 2nd ACDF. 4 or 5 days post-op I experienced a terrible pain in the opposite shoulder from where the worst pain had been pre-op. The NS had me do another MRI even though the images are not ideal so soon after the surgery. He said the disc had fragmented, and the operation took an additional 30 minutes because he was 'fishing' fragments out of the foraminal area. He indicated that not all of the disc was removed., but the MRI showed no loose pieces or shifiting in the remaining disc material

    Live and learn, I guess, I would have thought they would just remove it all. There must be some trade off between the 'extra' time in surgery to remove it all vs. the risk of it causing problems if some remains.

    The scar tissue issue is one I've read about in some studies. Most people don't have long term problems with this, but in some cases enough forms, and either presses back on the nerves, or in some cases it adheres to the nerves, and causes pain from pressure or irritation. It's a hard condition to treat if it happens, because there's no guarantee that surgery to remove the scar tissue won't just result in even more, and if it's adhering to the nerves it's a problem to remove it without risking damage to the nerve itself.

    So much to learn about, don't you agree? I appreciate the encouraging words about the 2 years to improve. I've got 9 months to go yet, and I think there is still some improvement going on. I probably won't get back to 100%, but I'm so much better off now than before the operations.
    Thanks
    Bob
    I'm pretty sure that is the generic term for scar issues after back surgery (of any kind - not just cervical).

    And that still blows my mind somehow - the whole disc is not removed? I'm not even sure I understand the difference then between a less invasive measure versus the fusion... In the less invasive measures, they take out only the offending portion whereas in fusion, I understood it to be that everything was taken out and then something was to be put in its place....

    I'll have to do some poking around.

    And in terms of the nerve regneration... I've heard those stats a few times.

    And the other issue in the recovery game is so little seems to be known for certain going in .... Even less is known about coming out. Since you can't tap into a patient at the nerve level throught the recovery, no one really seems to know how they recover...

    Fun stuff!

    I feel that in 100 or so years, they will look back on this as a very barbaric approach and make comments as we do today on leeches being used to rid the body of ailment.

    But, for many, its better than the alternatives... I'm finally starting to say that and mean it for myself.

     
    Old 06-01-2006, 09:25 AM   #7
    BobM
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    Re: Post ACDF and having disc problems again

    Hello ouch:
    I will be interested to know if you find out more about this disc removal question, please post if you find something more.

    After my 2nd ACDF and the pain coming back on the opposite side, the MRI report said '...residual narrowing of the neural foraminal by disc/osteophyte complex, right greater than left.' That's what brought up the question about whether the entire disc had been removed or not, since it was referring to the level that had just had the ACDF (C4/5).

    I have a high level of confidence in my neuro surgeon and I'm not questioning whether or not the surgery was done appropriately, but it is hard to get a direct statement about how things were done, which may be why I lurk here the way I do, looking for knowledge.

    Thanks for the response
    Bob

     
    Old 06-01-2006, 09:35 AM   #8
    acdfouch
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    Re: Post ACDF and having disc problems again

    Quote:
    Originally Posted by BobM
    Hello ouch:
    I will be interested to know if you find out more about this disc removal question, please post if you find something more.

    After my 2nd ACDF and the pain coming back on the opposite side, the MRI report said '...residual narrowing of the neural foraminal by disc/osteophyte complex, right greater than left.' That's what brought up the question about whether the entire disc had been removed or not, since it was referring to the level that had just had the ACDF (C4/5).

    I have a high level of confidence in my neuro surgeon and I'm not questioning whether or not the surgery was done appropriately, but it is hard to get a direct statement about how things were done, which may be why I lurk here the way I do, looking for knowledge.

    Thanks for the response
    Bob
    Do you have a copy of the OR report?

    I would hope that would provide the answers you are looking for.

    And I will certainly post what I find.

     
    Old 06-01-2006, 10:53 AM   #9
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    Re: Post ACDF and having disc problems again

    Hey folks,

    You just prompted me to reread my OR report. It left some wiggle room as to whether they removed all the disc material from one of the levels. It was very specific about removing ALL the disc material from the other 2. BTW, my last MRI showed a herniation at the level in question. 3 different Drs said it was nothing to worry about and that it was common. It makes me wonder.....

    WD, I wish you the best.

    Mike

     
    Old 06-01-2006, 12:58 PM   #10
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    Re: Post ACDF and having disc problems again

    Indeed, it is difficult to get direct statements.

    Dr.s are granted a great deal of latitude in making their judgments.

    I can certainly understand why people may become angry or confused.

    I heard this joke the other day:

    A guy awakens from a car accident and finds himself up among the clouds. In the distance, he sees a set of pearly gates and what appears to be St. Peter waving to him. He walks over and is welcomed to heaven. Walking through the gates among scores of people clad in white sheets he notices a man wearing scrubs, who is barking out orders to other people while feverishly attending to a man on a bed.

    "Who is that?" he asks St. Peter.

    St. Peter's answer?

    "Him? That's just God. He THINKS he's a Dr."

    Edit: For clarification, the above is a Dr. joke.

    One need not look far to find a Dr. who believes he/she is the master of the universe.

    Last edited by funny4mony; 06-01-2006 at 01:36 PM.

     
    Old 06-01-2006, 01:59 PM   #11
    BobM
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    Re: Post ACDF and having disc problems again

    I am learning a lot from this thread, so I will risk showing my ignorance by asking another question.

    A couple of people have made reference to an 'OR' (Operation Report?) - can you please give some more info on what this is? It sounds like a record of each particular operation, probably for the surgeon's records? Or is a hospital report, maintained by the hospital? What kind of info is contained in a typical OR?

    And, is it OK to ask for a copy? Or will it sound to the surgeon like it's being requested as some part of a malpractice issue? I admit that the Drs do a good job of keeping me feeling intimidated, whether its intentional or just part of their personalities I don't know.

    What I do know is that I have some residual issues, and I want to know as much as I can about my condition and what I should be expecting down the road, and what kind of activities will worsen the problem. So, thanks for any additional info you can provide about ORs, how much of the disc is removed, and so on.

    I always like to acknowledge how much improvement I have, and how thankful I am to these Drs who work miracles, at least for some of us, even though I'm not back 100% yet

    Bob

     
    Old 06-01-2006, 02:33 PM   #12
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    Re: Post ACDF and having disc problems again

    Quote:
    Originally Posted by BobM
    I am learning a lot from this thread, so I will risk showing my ignorance by asking another question.

    A couple of people have made reference to an 'OR' (Operation Report?) - can you please give some more info on what this is? It sounds like a record of each particular operation, probably for the surgeon's records? Or is a hospital report, maintained by the hospital? What kind of info is contained in a typical OR?

    And, is it OK to ask for a copy? Or will it sound to the surgeon like it's being requested as some part of a malpractice issue? I admit that the Drs do a good job of keeping me feeling intimidated, whether its intentional or just part of their personalities I don't know.

    What I do know is that I have some residual issues, and I want to know as much as I can about my condition and what I should be expecting down the road, and what kind of activities will worsen the problem. So, thanks for any additional info you can provide about ORs, how much of the disc is removed, and so on.

    I always like to acknowledge how much improvement I have, and how thankful I am to these Drs who work miracles, at least for some of us, even though I'm not back 100% yet

    Bob
    Your surgeon will give you a copy of the report. I got mine. It's not the best reading tho

     
    Old 06-01-2006, 03:16 PM   #13
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    Re: Post ACDF and having disc problems again

    Hey Bob,

    I only got mine because my doc left town and they called me to pick up my chart. Also, the chart was a regular file folder and had 6 staples holding it shut. The girl that gave it to me said it must have something in it I wasnt supposed to get because it was the only one stapled, and it wasnt that thick. Nothing remarkable inside, I already had copies of most of it . But the surgery report was a suprise.

    I know what you mean about wanting all the info you can get, we been down the same road, being two timers! I've also taken pains to have all of my films, although I have a few out on loan to my doc, so he could do that surgery thing......

    Mike

     
    Old 06-01-2006, 03:56 PM   #14
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    Re: Post ACDF and having disc problems again

    Quote:
    Originally Posted by BobM
    And, is it OK to ask for a copy? Or will it sound to the surgeon like it's being requested as some part of a malpractice issue?
    I wouldn't worry about anything like that.

     
    Old 06-03-2006, 06:36 AM   #15
    wdmoor
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    Re: Post ACDF and having disc problems again

    I never even thought about asking the hospital for a copy of the OR report. That's a good idea.

    Unfortunately, my original NS was recently forced to retire for falsifying a medical report. So everybody is lawyering up. My new NS became very uncomfortable and formal when I started asking questions about the bulging disc...which I thought had been removed. I was astonished to be told my MRI showed disc problems, but the NS acted like I was trying to get them to blame the original NS. She stiffly told me to talk to the original NS, which she knows full well I can't do. It was an awkward and frustrating moment.

    I'm not interested in lawyers or pointing fingers or blame...I just want to know what to do. The NS wants me to try 8 weeks physical therapy, I'll give it a try, but what is PT going to do for a disc bulging into my spinal cord?

    Thank you all for the comments and advice. This place saved my sanity after the original surgery.

     
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