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  • ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

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    Old 01-01-2007, 10:54 AM   #1
    Gina164
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    Question ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Hi All,

    I am happy to have found this board, and am mainly wondering if anyone on here has had a 3 level ACDF, with one level non-adjacent (4 level exposure)?

    Tomorrow, I am having a SNRB (selective nerve root block) to find out if the 'severe left foraminal narrowing' of C3-4 is possibly causing referred pain to my left jaw area (plus the pain in left shoulder).

    Doc prefers to do two procedures - the C5 thru C7 ACDF w/plate and Aspen brace, and then LATER do a procedure on C3-4 if need be....but, hubby got laid off two months back and I have asked doc to do all three levels at once, so that I can go back to work when healed up (by 2008)... We have only spoken over the phone about it...He said it would entail a four-level exposure, but I told him I don't mind a vertical scar, and did not ask him what other risks a 4-level exposure entails....

    He said it is not likely that the C3-4 is causing the bad left TMJ-type pains, etc, but is possible....so, he ordered the SNRB for tomorrow and then we are to talk again afterwards...Still, he noted that my left shoulder is bit higher than right (from behind) during my exam - I now think it's due to the constant muscle spasm on top of that shouldder, from the C3-4 foraminal narrowing?, and now wonder if it's wise for me to want ACDF also at C3-4 (now or later) just to resolve that issue , and the 'moderate canal stenosis' alone? I am relatively young to have these problems, but had a bad bikke acccident at age 20, and have Celiac disease (diagnosed only 2 years ago), which contributed to spurs, etc...

    so, there are 2 questions, really -
    One, anyone here with a 4-level exposure experience and what did doc tell you pre-op and how'd it go post-op...

    and

    Two, is 'severe' left foraminal narrowing at C3-4, with moderate canal stenosis also at that level something I should adddress at some point in time?

    Most of my pain is on right/down arm, with numbness in fingers...recent EMG showed no nerve damage, but ESI's have not been enough, and I don't want to risk worsening of neuro symptoms, so C5 thru 7 ACDF IS something I chose, and doc agreed that it was reassonablee in my case to do surgery.

    I didn't even mention left side shoulder pain at first, as I didn't know it was from neck...and hadn't seen MRI report until after C5-7 surgery was planned... I am the one to have asked doc to do C3-4 ACDF also....

    Well - I found this site today while Googling ACDF and swelling, as I am beginning to worry that the 4-level exposure may not be so wise in terms of swelling...since the doc didn't really explain why a four-level exposure was not prefferable....

    Is there anyone on here for had a four-level exposure? If so, how did it go?
    AND, does the Aspen collar REALLY hellp reduce swelling? ny other suggestions to help keep swelling down? Salt restriction post-op, etc?

    Thanks for any input/sharing.

    Sincerely,
    Gina -

    PS - sorry that the time line was not clear:

    It is:
    Saw neurosurgoen before MRI was read
    He diagnosed two herniated disks at C5-6 and 6-7 with right foraminal stenosis, and scheduled two-level ACDF w/plate w/allograft

    THEN, by PCP (primary care physician) sent a copy of my MRI report to m, where in I read about the C3-4 severe left foraminal narrowing and moderate canal stenosis - it was the only place on the report using the owrd 'severe'...

    THEN, I contacted my surgeon via e-mail, and asked re C3-4

    We had phone consult - that is when he said he'd prefer to do two procedures, to avoid 4-level exposure, and I explained hubby laid off, and not wanting to have to take more time later for surgery...

    He ordered SNRB for tomorrow (1/2), and we will after, to discuss if any pain resolved and where - and whether he'll do C3-4 also on Jan 8th...

    Since all of this, I have begun to worry about risks of four-level exposure...and ended up here

     
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    Old 01-01-2007, 11:52 AM   #2
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    I only had one level done and I've had lots of swelling issues. I wasn't required to wear a collar because it was only one level and I had a metal plate put in to stablize things, but when I would feel really bad, sometimes putting on that collar would help a lot because it keeps you from moving your head which in turn keeps your neck from getting more irritated.

     
    Old 01-01-2007, 02:39 PM   #3
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Thanks for your input. Happy New Year!

     
    Old 01-01-2007, 08:18 PM   #4
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    I did your route, ACDF C4-6 the first time and they thought I could go at least 3-5 years before the 2nd one. Well 9 months later, my second one went worse and by 12 months I had surgery #2 adding (C6-7). Yours is different because you are jumping a level C4-5 won't have anything so I can see why doc is hesitating. What you describe will be a difficult surgery. I don't know about swelling, but do know the more levels the bigger the fusion risks. and now that I have done it all, I would avoid fusions as much as can be avoided. Knowing that some are needed. Fusions do put additional pressure on the rest of your spine. Don't expect 100% pain resolution from all this so is the jaw something you can live with or is that level a candidate for a different type of procedure? If you get 100% relief it will be a blessing, but be realistic, most with multiple levels do not get full relief. We do get better and into a better state than we started. So my advice is although practical because they are in there, if the jaw is something that you could live with but is a nuisance than wait it out. Only you know your situation. Happy New Year.

     
    Old 01-01-2007, 09:53 PM   #5
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Yikes. I am supposed to have 3 levels done and I hadn't even thought about the swelling issue.

    Looks like I am going to have a lot of questions for my surgeon.
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    Old 01-02-2007, 05:24 PM   #6
    Gina164
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Thank you for the add'l replies, and please forgive the many typos in my posts - I never took typing AND hubby's keyboard is super sensitive - so i get too many extra letters...and there's no spell check on here, that I can see...

    So -
    I had the left C4 SNRB (with 2% lidocaine only/no steroid - 1 cc) this morning -

    It showed me that C3-4 will need 'fixin', at some point in time, as I got some pain relief...but due to my continued fears regarding too much swelling post op with a 4-level exposure), and my not wanting to risk the rare need for a tracheotomy if such swelling causes breathing problems, I am now tending towards putting off C3-4...

    I will have another phone consult with my doc any day now, and will know what he fully thinks - but, I at least feel 100% certain about the C5 thru 7 ACDF w/plate and allograft being what I need...

    Since the C3-4 isn't urgent, AND my doc doesn't really think it wise to do that one at same time as C5-7, AND I have too much fear already about swelling issues - especiallly at that level (3-4)- I now feel I will only do what my doc thinks best - to wait and do C3-4 later -

    Perhaps 4-5 will degenerate more anyway, and I'll need another 2 level later? Actually, Doc told me that there's a 4% (avg) chance per year that it'll happen...so, in 20 years/by age 69, that's an 80% chance of C4-5 'going,' too.... perhaps I'll do another 2 level ACDF (C3 thru5) for my retirement gift to myself, and just grin and bear the pain from C3-4 for now? haha...

    Well - it is good to have found a place with others around my age whom are also dealing with early-onset DDD (degenerative disc disease) -

    I have been feeling many mixed feelings pre-op, as I imagine everyone does - some anger, lots of fear, but now it is OK - I know that I am in the driver's seat - AND, I couldn't have done more research -

    I've read two spine surgery books - one entitled, "Do you REALLY need spine surgery?" (written by a spine surgeon), and also a book all about other treatments for spine-related pain...and just about everything on the Net from Googling so much - and'they' all say C5-7 ACDF is supposed to be good for me, at this age...

    Oh well - thank goodness we have the Net and books, and each other, to help us make 'educated decisions' -

    I'll update on my situation as it changes -

    MANY thanks for the replies, and Best wishes, everyone, with your own 'stuff' - Gina

     
    Old 01-02-2007, 07:16 PM   #7
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    I had a C5-7 fusion and will probably eventually have to have C4-5. Though MRI findings showed some disc problems at the C4-5 level I have no symptoms of that yet so my surgeon prefers to wait and hopefully, if needed later, he can do an artificial disc as the experience with those advances.

    My surgery was May 18th and I returned to work 6 weeks later.
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    Old 01-12-2007, 07:45 PM   #8
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    WOW. It's Friday eve - I had my spine surgery Monday am -

    I had: A Foramenectomy and an ACDF at C3-4, and ACDFs at C5-6, C6-7, all with plates and screws and bone from one side of my hip.

    Obviously, my doc found significant bone spurring at C3-4 - so much so that he took out the foramen and disc. I am glad that I did it all 'in one shot,' but would advise others to do it in two....just to avoid a possible tracheotomy, from too much swelling when you add-on layers....

    From the autograft bone transplant, I will have a dent in my hip, I was told, as my doc could not cover it all up with muscle, and he said that my skin was very fragile, due to my celiac disease.

    Well - People on here have been asking what to expect post-op -
    The first few days post-op were SCARY. I had a fever at one point, and they had trouble getting my BP to 'normal' - took three days...

    And, throwing up during the second of three nights in the hospital was REALLY scary - SO much came out and out the nostrils, too....I really didn't know if I'd pull through - and, of course, I had an insane roommate! Seriously - her docs set up a brain scan to find out if she was losing it because of a stroke of something....

    Happy to report that: my swallowing is getting easier - meaning I don't cough out thin liquids now and I can swallow a pill without fear of choking.

    I only hope to get my voice back, in time, as I can barely speak without getting more hoarse from trying - so, I am not going to talk for a week or so and hope it helps...This is the only 'scary thing' left....

    My advice: Do no more than two adjacent levels at one time - I took a chance doing it the way I did, but my doc is a good one, and I didn't want to go through two surgeries. If i could do it over, I'd do two procedures, but hindsight is 20-20....

    AND: Bring ear plugs (in case of loud or insane rommie), eat super healthy pre-op, and go easy on foods post-op, and ASK for an anti-nausea med even if you don't feel any nausea at first...I should have, but I usually would get nauseous right after surgery, not a few days out.

    Of course, I do not know how my recovery will go, long-term, but I 'feel inside' as if I will be well, and much better off for having chosen to proceed with the surgery. My pain is already significantly lessened.

    Thanks to all for the support pre-op, and I'll come back around when I really know 'if it took.'

    Kind regards,
    Gina

     
    Old 01-13-2007, 10:13 AM   #9
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Hi Gina,

    Glad to hear that you are doing ok...Sorry to hear that things were scary there for a bit....

    I was told that during my last surgery where they went in from the front and the back....that when they flipped me over to do the back side....the anesthiologist forgot to put the mouth guard in and I clamped down on my breathing tube and my stats dropped and it took the two of the Dr.s to pull my jaws apart to start me breathing again...I, of course, was asleep the whole time.....but.....the Dr. said it was quite scary for them and thank goodness they didn't have to break my jaw....

    I woke up with a black eye.....huge bruises on my arm......who knows where they came from????? Do you have any strange bruises??? I think once we are out....they can move us around quite roughly at times......

    Also, I too, have that big dent in my left hip.....from my first surgery where they used that bone for two levels as well.....I've found that I have to stretch a lot sometimes to keep it from getting sore....mostly if I am sitting or sleeping on that side too long and it's been about 5 years since that surgery....

    I will keep praying for your recovery.....I know what you mean about the earplugs for the noisey roommates!!!!

    I hope you have a restful and peaceful spot set up at home to recover....Take it easy....like the nauseau medicine....it's good to take your pain medicine before it gets too bad to keep the pain from getting awful....if you have an IPOD....I found it wonderful to have books to "listen" to instead of trying to hold up a book....arms were too tired....

    Thanks for filling us in on your surgery and keep us posted on your progress. Hopefully your swallowing and your voice will get better daily.....although my Dr. said the "Demi Moore sexy raspy voice" was not a bad thing....HA HA.....


    But I will definitely pray that you get your voice totally back....I've had 3 surgeries and it definitely took weeks to get back to normal speaking voice on the 2nd one.....I know it can be scary right now....

    Blessings,
    Ingrid

     
    Old 01-13-2007, 02:06 PM   #10
    Gina164
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    Smile Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Dear Ingrid,

    Thank you for your reply - I almost feel as if I just met a kindred spirit

    About bruises - yes..there was one on my forehead and one on my chest - I wondered if the docs clamped my head/neck into position - They DID, however, 'forewarn' me about tiny small spots from needles they'd be inserting into muscles as they proceeded (I guess to make sure they had the right levels/nerves?), and not to be alarmed by them upon awakening...so this is something else everyone should make note as somewhat routine, apparently.

    About your docs snafu with turning you - I am glad that there are docs/personalities that can do this kind of work, but gee...the 'dumb mistakes' are alarming...

    When I was an undergrad at UCLA (late 70's), I worked as a Unit Secretary on weekends, on various units - each floor had a 'nurses lounge,' in which would be posted a weekly LONG list of medication errors...I am now laughing to myself, as I was a bit perturbed during my stay that one nurse kept checking my ID band before each and every dose- but, looking back, and recounting seeing those error lists, and even seeing a patient end up the the ICU due to a 10 times normal dose of insulin given by a nurse that should have known better, I now feel glad that she was so vigilant...

    NOW - If only they could get a little helper to refill patients' the ice chips/tissues, etc....instead of patients having to use the call bells....the nurses end up making patients call at least 4 times before they take you seriously.... like when I threw up...I called and said I was about to throw up....no one came...I threw up the first time, called again....no one came until the last and final deluge....

    Well, thank you, again, for your reply...it made me smile. You asked if I have a comfy quiet spot to recuperate in...yes, but this afternoon I get to hear my hubby banging on walls (right after I said I wanted to take a nap - which is why I am on the computer now, instead of napping...) ;-) But, he is outside and it's cold, and I'm still in PJs, so the noise will continue...still, it sure beats listening to what came out of the mouth of the crazy roommate I ended up with...

    In his defense, though... he HAS been very good about everything else...making Cuisinart food, tea, changing dressings, etc...

    and, I think, like all men, he got his mind set on 'finally' fixing the deteriorating meter box today, and just didn't think...

    Hmm...were your docs males, by chance? ;-)

    On that final little laugh, thanks again, and I wish you all the best, too.
    Sincerely, Gina

     
    Old 01-13-2007, 03:55 PM   #11
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Gina:

    You would have loved the hospital I was in. It is a small hospital privately owned by a group of neurosurgeons, orthopedic surgeons and podiatrists (soon they'll add some plastic surgeons and some ob/gyn). The procedures they do must require only a few days hospitalization. There is one nurse for every 2-3 patients. When I was on the morophine and had the 'self administered pump' the nurse would come in each half hour to tell me to push the button. If I needed ice chips, help to the bathroom, etc she was ALWAYS right outside my door. Amazing. Made it so easy to recover. I never wanted for anything as she was at my side the minute I needed her.

    At first I was nervous since it's a small hospital but they are fully accredited, authorized by my health insusrance, and have a full agreement with a full-care hospital 1/2 mile away should they need to transfer anyone. It was the BEST hospital experience I've ever had (and I've been in quite a few times).

    Everyone asks "how do they do that?". (1) there is no emergency room so all patients have been pre-authorized by insurance companies for admission (many hospitals loose a great deal of money with uninsured patients who enter via ERs). (2) they use registry nurses. These are nurses who are okay with varied hours and different schedules each week. If they have a 13 patients one evening they'll call in 4-6 nurses for that evening.

    The night I left (a Saturday evening) one patient was staying at least one more night. Yep, one patient with 2 nurses.

    The nurse I had said she loves working there. She was so fed up with standard floor nursing at hospitals due to the workload, etc, but loved the work. Then she found this and says she works when she wants - but generally gets 25-40 hours in any week she wants it.

    Karin
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    Old 01-13-2007, 06:05 PM   #12
    Gina164
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    Wink Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    WOW...I felt better just reading that, Karin

    SO good to know that the hospital system has this alternative in some places - and I'll bet that the insurance companies actually want to get on board, too, since the patients' outcomes are probably better, so... cheaper long-term...

    If I ever need another surgery, I SERIOUSLY may just decide to hire a private 'nurse attendant' to to help my HMO's overworked nurses, and keep me safe.

    Ah...hubby just said, "Dinner is on the table, which means it's getting cold."...ah, at least SOMEONE is looking after me

    Best regards for a safe New Year,
    Gina

     
    Old 01-14-2007, 08:02 AM   #13
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    I have gotten so tickled reading this thread. We all need some laughs. My hubby has been so good also. There every step of the way.... sometimes in the way. He decided to completely rearrange the kitchen to his way and the laundery room. I dread having to rearrange everything back to MY WAY once I am able to lift and go overhead, etc. As to the menu... ah... sometimes I have not quite been sure what it is. At first I could not swallow lettuce in salads. Salads is one of our favorites so my husband decided if he put it in the food processor I should be able to swallow ground up lettuce. Just didn't quite work. I had bought some Boost for the first few days to drink in case I couldn't swallow food. About a week later (I was able to eat 4 hours after surgery) he made a milkshake/smoothie for me. I kept tasting something funny and it ended up he had put one of the Boost (chocolate) into a fruite smoothie (gag!). Then there was the night that he made chicken and rice. He had nice chicken breast in the meal for my son and him but I got lunch meat in mine. He thought l would have an easier time swallowing lunch meat. (Hmmmm). I must say he has been creative. I watched Rachel Ray's 30 minute meals each night as he was fixing dinner. He has decided he is a Rachel Ray (not). But he has tried and I am so thankful he has been so patient with me (like the night I found the knot on the back of my spine and thought everything was falling apart, I kept feeling his neck and my son's neck. My hubby finally got the doc on the phone to reassure me that this was normal.) Again thanks for the good laugh. You seem to be doing quite well after your surgery. That gives everyone a good lift.

     
    Old 01-14-2007, 09:44 AM   #14
    Tucsonlady40
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    Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Hi Gina,

    I have been following your post and just wanted to chime in and say I'm glad that your surgery and recovery are going good.

    I'm sure that you made the best decision for "you", and what was deemed necessary at the time. I think it's great that you've really done alot of homework both before and after in getting ready for your surgery and recovery.

    I found this board about a year or so after my C5-6 fusion. I was scheduled for a L4-5 fusion and coinceidently (sp), on the very day of my surgery, the results from my cervical Mri came in showing severe herniation, with nerve impingment........... Needless to say, everything was stopped right then....... no lumbar surgery that day. Instead, after the surgeon consulted with the other doc's, looked at the actual films, reports, ect., decided I would be coming back the next day for cervical acdf, and the following day for l4-5 plif. Talk about a ruff time..... whew, glad when all was done. I was so scared.

    I do really wish that I could have found this board before though. Your so right that it's great to have others to share with. Glad you shared your experience with us all.

    Take care and please keep posting your updates.

    Bernie

     
    Old 01-14-2007, 09:49 AM   #15
    Gina164
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    Thumbs up Re: ?'s re:Surgery on Jan 8th, C5-6,6-7 w/possible C3-4

    Dear Melinda -

    talk about funny replies ...

    Thanks for the gems about your hubby's efforts at feeding you post-op...should be part of a pre-op 'what not to do' package for spouses...er, I mean, for male spouses...

    Best wishes for a bright and healthy new year,
    Gina

     
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