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  • ACDF not fusing

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    Old 05-03-2007, 01:45 PM   #1
    laranol
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    Thumbs down ACDF not fusing

    Hello, I was disappointed to hear today that my 6 month series of x-rays (actually done closer to 7 months) show no fusion. I had ACDF with donor bone and plating last July. The plate and screws still look to be in normal position. This series of x-rays was actually ordered by my rheumatologist (I also have lupus) and she's now sending all the xrays and radiology reports back to the neurosurgeon, so I guess I will have to make an appointment with him soon.

    Has anyone had an ACDF where the fusion failed? What was the outcome? The NS had dismissed me after my initial post-op, saying to just go back to activies as I felt like it, but the rheumatologist wanted me to wait to go back to high-impact activities until after we knew there was a fusion. Except it appears now there is no fusion at all. Is this unusual? It really didn't seem to be on anyone's radar that it would not fuse. The radiology report said no sign of bone growth.

    I am generally doing quite well, have regained use of my hand and have much more arm strength. I do still have pain in the area where it was (supposed to be) fused. I have a high pain threshold but still occasionally take ultram -- maybe once/wk it gets to where I can't function.

    Would love any stories about similar situations -- I am at a bit of a loss!

     
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    Old 05-04-2007, 12:35 AM   #2
    PNo
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    Re: ACDF not fusing

    There are people that have trouble fusing. If you smoke stop, if you take ibuprofen or other nsaids discuss this with your drs., there are some studies that indicate these inhibit fusion. They can try bone growth stimulator unit on you, there are a couple people here that had success with them. I am suprised that you don't have several fups with your neurosurgeon like at 3,6, 12 months. That seems unusual that you are not having regular xrays by the person that did your surgery.

     
    Old 05-04-2007, 07:21 AM   #3
    987mom
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    Re: ACDF not fusing

    Hello my scared friend,

    Well, I am one of those "failed fusion patients". I had an ACDF on C5-C6 in Feb 2005 and unfortunately has persistent pain with that. My first surgeon (an ortho doc) did a couple of things that later I found out weren't so great....steroids, ibuprofen, soft collar, and no bone stimulator after the surgery. Last month, when my frustration level hit the highest, I got an appt with a well respected NS and based on the follow up CT and MRIs, he suggested that the ACDF be revised. My previous surgery was also with donor bone.

    Long story short: had my redo 3 weeks ago with bone from my hip, hard collar, bone stimulator, muscle relaxers, pain meds, pretty severe lifestyle restrictions for 3 weeks. I will be in the collar for another 3-4 weeks and have the bone stimulator on for 3 months. I already feel a bunch better. Having neck muscle spasms (from the collar...to be expected).

    My humble advice: get a second opinion and keep optimistic! I feel SURE that this time will be different for me. I work full time as a nursing administrator and my life will be so wonderful when I can return to my job with a smile on my face and NO PAIN.

    Keep the faith and best of luck.

    To your improved health,

    DB

     
    Old 05-04-2007, 10:33 AM   #4
    laranol
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    Re: ACDF not fusing

    Quote:
    Originally Posted by neckpatient View Post
    There are people that have trouble fusing. If you smoke stop, if you take ibuprofen or other nsaids discuss this with your drs., there are some studies that indicate these inhibit fusion. They can try bone growth stimulator unit on you, there are a couple people here that had success with them. I am suprised that you don't have several fups with your neurosurgeon like at 3,6, 12 months. That seems unusual that you are not having regular xrays by the person that did your surgery.
    I was wondering about that. The NS said it was a very basic surgery, and that he does tons of ACDF every month, and with the hardware there was no need for followup. I've never smoked and don't take nsaids, but because of the lupus I take some heavy-duty immunosuppressants and chemo drugs and I'm always on some level of prednisone (hasn't been higher than 10 mg/day since the surgery) but of course the NS knew that and the rheumatologist coordinated with him for a plan to prevent a flare from the surgical stress. Because of the lupus I wasn't a good candidate for autograft -- high risk of bone death at the harvesting site.

    If there is no fusion but the plate is still there, do I just go about life normally, or is there additional risk that the plate will give out? I'm 37 and have kids -- I usually ride horses (but haven't since all this started -- was planning to start back as soon as I got the fusion xrays!) and I spend lots of hours each day driving and doing sports with the kids and carrying things. I know that I have a high pain tolerance, so I think it is possible I'd not realize I'm overdoing (I was jumping a horse while I had a fractured ankle; didn't realize the ankle was fractured until it wasn't supporting me!)

    I know, I need to talk with the NS and I will -- but I'm not sure I was given the full story the first time, so now I'm trying to do more research so I know what to ask about. Thanks for the replies!

     
    Old 05-09-2007, 08:18 PM   #5
    ~Ro
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    Re: ACDF not fusing

    Quote:
    Originally Posted by laranol View Post
    I am generally doing quite well, have regained use of my hand and have much more arm strength. I do still have pain in the area where it was (supposed to be) fused. I have a high pain threshold but still occasionally take ultram -- maybe once/wk it gets to where I can't function.
    I wonder if you took the ultram normally after your surgery? Because I questioned my dismissal orders from the hospital, when I finally reached my NS & told him that I was taking ultram for the pain along with the percacet, he was quite alarmed & told me to stop taking the ultram because it was a blood clotter and fusion prohibitor. Perhaps this has something to do with your sad problem and you can ask your doctor. I feel for you, I'd hate to go through this again. :-(

    Ro

     
    Old 05-10-2007, 05:05 AM   #6
    SKZ
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    Re: ACDF not fusing

    Once again this is really upsetting to hear of surgeons who dont tell patients what NOT to take after surgery. I was told I could take Ibuprofen and NSAIDs at 3 months. I am not going to even attempt anything like that for a year. I am kind of worried because I had a 6 days steroid pack right after surgery due to a bad sinus infection. When I got my Xrays done at 3 months post op, the physician asst. said there was a small amount of fusion. Didnt sound too exciting. And that we would know more when I come in, in July for my 6 month Xrays.

     
    Old 05-10-2007, 11:52 PM   #7
    laranol
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    Re: ACDF not fusing

    The NS knew about the Ultram (tramadol) -- and said that since I tolerate it well, I could use it instead of the typical pain drugs like percocet. However, it's not an NSAID; it's a narcotic pain pill prescribed for chronic pain with no anti-inflam properties. I expect the immunosuppressants (imuran, methotrexate, prednisone and plaquenil) may have affected the fusion more than the NS thought they would. I'm gathering that I'm kind of out of luck on that front, though... the lupus now has kidney involvement, and I can't go off any of the immunosuppressants. I guess I need to find out how risky it is to go about with the plate but no fusion.

    Thanks for the help! It's always SOMETHING, isn't it?

     
    Old 05-11-2007, 10:04 PM   #8
    ~Ro
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    Re: ACDF not fusing

    Quote:
    Originally Posted by laranol View Post
    The NS knew about the Ultram (tramadol) -- and said that since I tolerate it well, I could use it instead of the typical pain drugs like percocet. However, it's not an NSAID; it's a narcotic pain pill prescribed for chronic pain with no anti-inflam properties.
    I took Ultram before my ACDF surgery, I nicknamed it f***itall for it's quality to remove all resemblence of an uncomfortable day. It certainly works well on pain but I didn't realize the post op risks ... ain't my job. I'm glad I learned the dangers before I took it too long post op. The percocet was not good because of kidney/liver damage if too much intake, in my case I was taking them every 2 hours until I saw a pain mgmnt. specialist, (my hero) and he prescribed oxycodone time released & the oxycodone "as needed for pain" type. Have you considered something like that?

    Quote:
    Originally Posted by laranol View Post
    I expect the immunosuppressants (imuran, methotrexate, prednisone and plaquenil) may have affected the fusion more than the NS thought they would. I'm gathering that I'm kind of out of luck on that front, though... the lupus now has kidney involvement, and I can't go off any of the immunosuppressants. I guess I need to find out how risky it is to go about with the plate but no fusion.

    Thanks for the help! It's always SOMETHING, isn't it?
    I'm so sorry you didn't fuse and your lupos made sure it wasn't forgotten. I hope you find a way to heal & fuse anyhow. How about a hug from NY?

    Hugs,
    Ro

     
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