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  • 4.5 months Post-Op ACDF

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    Old 06-05-2007, 03:28 AM   #1
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    4.5 months Post-Op ACDF

    Hello everyone. I have had bad arm pain since 1999 and finally had an ACDF at C5/C6 with Solis PEEK cage and no plate and screws. I only wore a soft collar for sleeping for about 3 months.

    I have a question which I would really appreciate feedback on. First, please find a brief history in the paragraph below:

    For years my left arm was painful, but this eased up and in June 2006 my right arm also started to be affected but mainly with pins and needles in the fingers and up to the elbow. I also have had a painful bone ache in both lower legs with burning and have a delayed sensation to heat in the feet (takes about 20 seconds to register a hot radiator). This had been present since 2000 and I was hoping the ACDF surgery might ease this up although the neurologist and neurosurgeon did not make any promises.

    Pre-Op MRI
    My initial pre-op MRI said I had disc protrusion at C5-6 distorting but not compressing the spinal cord, C5-6 cervical stenosis and impingement on the left C6 root, and narrowing of the left exit foramina. During surgery the surgeon drilled away the osteophyte and removed the disc. In his operation notes that he sent me he also said he had to 'remove significant free fragments of disc material that had migrated out posteriorly mainly on the left but also to the right'.

    After surgery
    I had bad arm pain in both arms for about 3 months but the arms settled down slowly and for about 2 weeks were very good. Now at 4.5 months post-op they are sometimes painful and I am starting to get pins and needles in hands especially when laying on either side for a few minutes. The leg problem is unchanged and is the most problematic and makes computer use intolerable. I have not returned to work yet as there is no way I can take the leg pain for a day.

    Post-Op MRI
    My MRI at 3 months post-op says 'There is evidence of fusion at C5/C6 with fixed lordosis There is some residual foraminal stenosis'.

    I am a bit concerned about the foraminal stenosis. I am beginning to wondered whether the surgeon has made a mistake. I have read since my surgery that some surgeons open up the foraminal opening with the drill and it looks like this might have not been done in my case. Does anyone know anything about this?

    Also does anyone think it is normal to sill get pins/needles in fingers and arm pain after 4.5 months?

    If I have formaninal stenosis could this get worse or should it remain static now the disc and osteophyte have been taken away.

    I would much appreciate any thoughts. Many thanks in advance.

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    Old 06-05-2007, 12:21 PM   #2
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    Re: 4.5 months Post-Op ACDF

    Sorry you aren't better. Part of my disease is from foraminal narrowing, so I know how you feel.

    I'll start with easy thing first. There are many factors that have to do with osteophyte growth. The extent of bone overgrowth is influenced by mechanical stress, genetic factors, and age. Even when removed, you can continue to grow osteophytes in same place or new places. They don't know how fast these actually grow it varies person to person, but most drs seem to expect the recurrence of them is low, but it does happen and sometimes fast depending on the person. If your disease is limited to that one spot, you might have a better chance, but if you have osteoarthritis (DDD) throughout, there is high chance you will experience continuing symptoms.

    It sounds like you started feeling better, increased your activity again and then started feeling all the symptoms again. This may be a sign that it will either a) take you longer to improve, or b) you may experience some permanent symptoms. Most drs tell you that the expected wait for full improvement is 1 year.

    I personally don't think remaining cervical foraminal stenosis (C5/6) is causing your leg pain, that would directly correlate with your arm symptoms. THe foramins are where the nerve roots exit to the extremity. The level you call out doesn't supply the leg. However, when you had that disc protrusion prior to surgery, you could have permanently irritated the spinal cord and/or nerve supply to the lower extremities. I am not a dr. just sharing on my experience.

    If you have not had a xray and MRI of your lower spine (L's) you might also want that workup for your leg pain. Sometimes we have symptoms that they think are from one thing and actually come from another spot.

    Some people do not get 100% better, there are varying levels of improvement to none, some, all. Sometimes a selective nerve root block at that forminal level a few months after surgery may actually help improve your arm symptoms. THey will inject steriod and it may help any residual inflammation and help flush out irritated cells.

    Old 06-05-2007, 01:48 PM   #3
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    Re: 4.5 months Post-Op ACDF


    Many thanks for taking the time to write such an your informative reply. The info on osteophytes was particularly useful.

    I do have several spine problems. I did not want to confuse matters in my original post but I do have L-spine bulges and have tried injections at L4/5 recently but they did not help the symptoms. I also have a disc touching the cord at T7/T8. My neurologist who is very experienced did confess that it could be any part of the spine causing these problems.

    I have always felt m leg symptoms are related to my neck. Over the years arm pain, computer use and reading seem to trigger the aching and burning in legs. Although the pain never goes in the legs it certainly can get a lot worse with just an hour on the computer, and then it can take a week to 10 days to ease up again. As I am a Analyst/Programmer working 8 hours a day for 17 years on computers I am convinced this type of work has caused my problems, and I really feel there is no way I can put up with the pain when I return to work.

    I also had abnormal thermal thresolds tests to HOT on my legs. I can hold my feet on a hot radiator for about 30 seconds before I need to remove them, whereas I need to remove my hand within 5 seconds. I obviously do not try this too often!

    I think what you said about the spinal cord being irritated makes sense,and I will continue to try and find an answer. I hope you find a solution to your problem. Many thanks again for your advice.

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