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    Old 06-01-2006, 09:29 AM   #1
    CFD050161
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    ACDF multi level Please advise

    Hello,

    First time posting so please excuse the errors. This is all so confusing.

    Have always (15+years) had neck pain but recently started experiencing loss of balance, shoulder pain and weakness in the fingers. Asked my reg physician for a MRI. (I'm 45)

    Have been diagnosed with C2-4 Degenerative Disk disease (DDD) mild-moderate, c4/5 disk osteophyte complex (DOC)(mod)-central with moderate cord compression, DDD (mod) c5/6 eccentric to right, foraminal stenosis (R) with spinal cord compression & deformity (mod/sev), DDD (mod) (high signal at this level), C6/7 DOC (mod) eccentric to right cord compression (mild/mod) and DDD and kyphosis (mod). The balance C7-S1 show DDD (mild).

    I have seen one NS that wants to fuse (anterior & posterior)from C3-C7. One Ortho wants to fuse C4-C7 and one C4-6.

    Have read a lot of post in the last couple of weeks but still uncertain of how to proceed. I am leaning toward one of the Orthos'. Can anyone offer advise on how to chose?

    My Chirpo wants me to try spinal molding. Does anyone have experience with this?

    Thanks Lettie

     
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    Old 06-01-2006, 10:35 AM   #2
    mb100
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    Re: ACDF multi level Please advise

    Hi Lettie,

    Sounds like alot going on in there.

    I've never heard of spinal molding, so I cant speak to that.

    I have had fusion front and back though, they did the front first, C-4/7. that failed at 2 levels so I had C-5/7 fused posterior, I'm 6 weeks post op and feel great considering. My range of motion is good, although I havent tested it to its limit, I'll leave that to the physical therapist.

    As far as which way to go, get as many opinions as you can. I did the 2 out of 3 method, many on here have gotten more. I went with an associate professor from a university hospital and am extremely happy with the results.
    The Dr. I went with spent alot of time with me explaining everything, and since I had done alot of research I knew what to ask. Well, as much as the average guy with a computer.

    I would recommend you take it easy until you make a decision, you dont want to do any more damage. Best of luck to you and let us know what happens.

    Mike

     
    Old 06-01-2006, 11:36 AM   #3
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    Re: ACDF multi level Please advise

    Hi Lettie,

    Indeed, as Mike wrote, it sounds like there is a lot goin on there.

    I'm not a fan of Chiropractors at all, but that's purely one person's opinion.

    I'm don't put much faith into seeing many surgeons and settling on a tie breaker. I know it's common and popular - no disrepect intended. I would be interested in wanting to know how & why each surgeon arrived at his/her opinion. Particularly, what are the risks involved and potential benefits gained?

    Maybe one surgeon is willing to do C3-C7 because he/she is the only surgeon qualified to accept the risks associated with performing what is necessary. Alternatively, maybe one surgeon is confident that your symptoms are only related to what is currently happening at C4-C6.

    Perhaps you already know those answers.

    Surgeons choose patients just as patients choose surgeons.

    I'd play, pardon the phrase, Devil's advocate with each surgeon, not mentioning alternate opinions or being confrontational. I'd want to know each surgeon's reasoning. Then, I'd pick the one whom I agreed with the most and proclaim him/her the best surgeon in the world! Or maybe I'd just go with the one who made the most sense.

    But I'm a different breed of cat.

    Obviously, only you can make the right decision for you.

    I hope you find some relief soon.

    Last edited by funny4mony; 06-01-2006 at 11:41 AM.

     
    Old 06-01-2006, 12:13 PM   #4
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    Re: ACDF multi level Please advise

    Lettie -

    Make sure that you get a recommendation from a NeuroSURGEON as well as the ortho. It does sound as if herniations are pressing on the nerves (weakness, etc.).

    I had a 3 level ACDF C4/5/6/7 and had I known what I do now, I would have gone to see someone like Dr. Jho (a minimally invasive spine surgeon) to see if my problems could have been handled without such a major procedure.

    The reason I say to check with a NeuroSURGEON (not just a Neurologis) is because they are concerned about the nerves, etc., as the ortho is to spine stability.

    wb

     
    Old 06-02-2006, 03:56 AM   #5
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    Question Re: ACDF multi level Please advise

    Thank you for you comments.

    The Neurosurgeon that I saw is who wants to fuse from C3/C7 but have heard that he tends to do things "out on the edge" which is probably why he wants to fuse 4 anterior and posterior The Second surgeon I saw was an Ortho, he was confident that C4-C7 was causing my problems, although he did say at some point in time I might have to have C3/C4 done. The second Ortho I saw said that he would do C4-C6 but that I would need to have C6-C7 done within the next 5(?) years but that he didn't have a problem going back in and doing additional fusing and it was my decision as the whether to have 2 or 3 done. With the DDD that is going on, how likely is it the I will have to have additional fusing done? ETC. ETC. ETC.

    Is it worth waiting to see on the 3rd disk fused at a later date ie 3-5 years (I will not have health insurance then) or should I have all three done now? Will having 3 fused vs. 2 severely limit my range of motion? While I am not overly active I do enjoy golfing, skiing, camping etc.....

    How important is PT after surgery? The 1st Ortho does not do any PT after, the 2nd Ortho requires 3-x week for 6 week.

    Realistically, how soon can I expect to be back to work full time (office duties)?

    ANY advice is appreciated.

    Lettie

    Last edited by CFD050161; 06-02-2006 at 08:46 AM. Reason: Wording confusing

     
    Old 06-02-2006, 04:53 AM   #6
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    Re: ACDF multi level Please advise

    Lettie -

    My 3 level was pretty severe, but I blame it on my choice of a surgeon. I was pretty out of it when I woke up. Thought I had been hit by a truck. I had a major complication of a spinal fluid leak, which kept me in the ICU for an extra hundred grand.

    Being in bed with only a short walk each day really takes a toll on the body. I had to go to an in-patient rehab place for a few days to learn how to function again.

    In total, I was off work for 2 months. But I highly recommend physical therapy as a means to work through the pain and strengthen your head and neck muscles through supervised sessions.

    Sorry to hear about your loss of coverage. If you decide on surgery, it's best to make sure it's covered.

    wb

     
    Old 06-02-2006, 05:07 AM   #7
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    Re: ACDF multi level Please advise

    Lettie -

    My 3 level was pretty severe, but I blame it on my choice of a surgeon. I was pretty out of it when I woke up. Thought I had been hit by a truck. I had a major complication of a spinal fluid leak, which kept me in the ICU for an extra hundred grand.

    Being in bed with only a short walk each day really takes a toll on the body. I had to go to an in-patient rehab place for a few days to learn how to function again.

    In total, I was off work for 2 months. But I highly recommend physical therapy as a means to work through the pain and strengthen your head and neck muscles through supervised sessions.

    Sorry to hear about your loss of coverage. If you decide on surgery, it's best to make sure it's covered.

    wb

     
    Old 06-02-2006, 10:19 AM   #8
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    Re: ACDF multi level Please advise

    A bump for some other people to chime in...

    Last edited by funny4mony; 06-02-2006 at 10:27 AM.

     
    Old 06-02-2006, 10:30 AM   #9
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    Re: ACDF multi level Please advise

    I feel that physical therapy post op is essential in gaining the rotation and motion back in your neck after having an ACDF, especially if you are braced. Braces tend to cause weakness in the muscles over time which is why many doctors are not using them nowadays. Without therapy there'd be no way to strengthen those muscles should you be put in a brace.

    Honestly I would be very leary of the doctor who says you need no post op therapy.

    In all honesty a doctor can't predict when the 3rd disk might fail. It is not uncommon for those who have had multi level fusions to later go back, as soon as a year in some cases, and need a fusion again because the extra stress of the current fusion places on the disks above and below. I am 2 years post op and already have new herniations though minimal in nature.

    A 3 level vs a 2 level fusion will not have a marked difference in range of motion. I found that I lost 5% tops from C4-C7.

    Most individuals report being able to go back to work after about 6 - 8 weeks. I do not work therefor releasing back to work wasn't an issue. I can say at 8 weeks I was feeling fantastic with all of the pain gone from the surgery itself.

    If you aren't going to have insurance when in 3 - 5 years it might be better for you and definately less expensive to have all 3 done at one time.

    Good luck in whatever decision you make!

     
    Old 06-06-2006, 09:14 AM   #10
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    Re: ACDF multi level Please advise

    Hi everyone and thank you for your replys to my questions.

    I have contacted the Ortho who said they did not do post-op PT and questioned the reason. His comment was that they do not do PT right after surgery as they want the fusion to heal. However they do give arm exercises etc. Once 4-5 months have passed, then they will advise to start PT at that time. What point in time (Post-op) do most people start physical therapy?

    Thanks for the advise

    Lettie

     
    Old 06-06-2006, 10:39 AM   #11
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    Re: ACDF multi level Please advise

    Lettie, that makes a ton of sense and makes me feel better about what you said. I started my post of therapy 8 weeks after surgery.

     
    Old 06-06-2006, 12:40 PM   #12
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    Re: ACDF multi level Please advise

    Thanks Kissa!

    I must say that having to "make" the decision on whether or not to have the surgery is very difficult and confusing (although with the cord compression and deformity I'm not sure that I have an option.) What doesn't help is that it is my nature to over analyze things!!

    Lettie

     
    Old 06-06-2006, 05:58 PM   #13
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    Re: ACDF multi level Please advise

    Lettie,
    First of all, it's tough to be unexpectedly faced with such a big decision and to feel as though you're being forced into making a choice too soon. But you're doing the best thing possible for youself - getting educated about your problems, your symptoms and your options for treatment. Lots of people seem to find this board early on, while they're still in "panic" mode, and almost everyone appears calmer as they learn more.

    Second, our fears often worse than reality. Not knowing makes it hard to visualize what might be coming, and of course you can't really, really know what you're in for......until you're actually there. But, again, you'll hopefully find that having some idea of at least the basics makes everything easier to deal wtih.

    It's good that you've spoken to more than one surgeon. You might see some debate here as to whether to go with an orthopedic spine surgeon or a neurological spine surgeon, but both types do this all the time and are familiar with the surgery. I chose a neurosurgeon, but that was just what I felt best with.

    I would tell you to go with whatever your gut tells you. Pick the doc that you feel the most comfortable with. Make a list of questions to ask and take it with you when you see anyone. [REMOVED] I'm thankful I had access to so much information on the internet.

    Your problems sound serious and I hope you find a way to get some relief.

    Last edited by HBMod07; 06-06-2006 at 06:41 PM. Reason: Do not direct members to use search engines

     
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