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alison352 06-26-2007 04:39 PM

5 days post-op acdf...a few questions

I am a newbie and was hoping someone could answer a few questions and a few observations.

I am 5 days post-op acdf, and although my NS went over alot of information with me, some he didn't (or may of and I just don't remember...which is probably the case) and I was hoping for some insight.

My surgery was on C5/C6 due to a herniated disk with severe spinal cord and nerve compression and bone spurs on the vertebraes. My major complaints were muscle spasms across back and shoulders and neck...awful awful awful :( and sporadic shooting pains down my right arm. I was in PT for months before the surgery and it really helped with the spasms.

Post surgery, so far, the shooting pains down the arm are gone, but the muscle spasms are back in full force. I know it's from the surgery, but they are debilitating! The area of the fusion, the incision, and the feeling of swallowing a golf ball everytime I eat something, all put together don't come close to the pain of the spasms.

So my first question is about meds. (I was sent home post-op with dilaudid and have flexeril and soma from before the surgery...none of them help the spams or the pain from them...)

What muscle relaxer (and/or pain killers) do you feel as worked best for you? (I know everyone's chemistry is different and what may work for one person may not work for another but I'm asking anyway...)

I have also noticed that for some acdf level 1 patients, post-op, their NS's have them wearing a hard collar (usually Aspen) or a soft collar or no collar at all! And all for different lengths of time! It's just weird that as a community the Dr's don't have continuity on the recovery process.

What position do you find the most helpful to sleep? (what is sleep anyway? I seem to have forgotten!) Unfortunately, I don't have a recliner which I hear has helped alot of people to sleep... I am usually a side sleeper but I'm afraid that I am putting undo pressure on my cervical spine, even with the soft collar on and pillows galore...I've been able to cat nap propped up but it wreaks havoc on my shoulder muscles for some reason.

One thing I have read that our NS's do concur on and that is to walk. Which is fine by me, I'm just wondering how soon people started walking and did it help with spasms?

And last but not least, has anyone used a tens machine or some sort of electrical muscle stimulator that has helped in healing and fusion? Do they put it right on the back of the neck? And/or a therapy pool and has that helped?

Thank you so much for all your help and advice!

BobM 06-26-2007 06:47 PM

Re: 5 days post-op acdf...a few questions
Hi Alison
If you've made it 5 days and are back on line, you are going to be OK - even if it doesn't seem like it yet!

Can you provide a little more info - do you have a plate and screws that are stabilizing the vertebrae while the fusion gets underway, and did you have donor bone, or did they harvest your own?

I've had two ACDFs - the first in 2004 (C5/6/7) and the second in 2005 (C4/5). My sleep for the first 7 to 10 days was more like a series of short naps. You probably are not at risk sleeping on your side if your Dr didn't advise you otherwise. It might make a difference if you don't have the plate and screws - if you have doubts you should call the Dr and be sure.

As for the pain and spasms - if your meds are not working for you, you should call your Dr right away. I only took hydrocodone (no flexiril), which helped but did not make the pain go away. It gradually got better, and at two weeks post op things were looking a lot better, but it took several months to feel 'normal'.

Then I had the second ACDF, and the first couple of days were easier for pain and spasms than the first time, but about day 4 things took a turn for the worse. I contacted the Dr, and he ordered a follow up MRI to be sure things were as they were supposed to be, and ended up prescribing Prednisone to reduce infammation that was aggravating the nerves (the C4/5 disc had broken into fragments, and there was a lot of extra work to remove the pieces, and this aggravated the nerves).

It's almost two years since my last ACDF, and I have some chronic pain (and I don't take pain meds at this point) and spasms (I now use flexiril from time to time), but am a lot better off than just prior to my surgeries. With one level, you should expect to get back to pretty near normal though it might take more time than you anticipated. But check with your Dr if your meds are not doing the job - it is hard to heal if you are in constant discomfort.

Good Luck!

alison352 06-26-2007 07:14 PM

Re: 5 days post-op acdf...a few questions
Hi Bob!

Thank you SO much for your reply!

I have a titanium plate with four screws and cadaver bone.

Are you taking 5mg of flexeril or 10mg?

Thanks also for encouraging me to call my Dr. It's so funny that I was going to use it as a last resort when it should be my first one!

The Dr. sent me home with dilaudid and I just broke down and took one. To tell you the truth I have a recovering drug addict (over 20 years now...) and I'm still afraid to take prescriptions, even though I know I need them to make life livable after surgery.

Thanks again,


BobM 06-26-2007 08:44 PM

Re: 5 days post-op acdf...a few questions
Hi Alison
I take 10mg of flexiril when the muscle spasms seem like they are going to escalate out of control - over time I have learned to take time and relax - a nap helps a lot, once you get to the point where going to sleep isn't such a problem, so I don't have to take the flexiril unless I really need to.

After my second ACDF, I had a problem with pain (did not have that experience after my first ACDF, so be optimisitc!) and took Hydrocodone and Oxycodone in increasing doses - I wanted to get back to work, and the pain meds made that possible. After about 20 months I had a pretty good dependency going on, and decided I'd rather live with the pain than the narcotics, so I stopped. That was a pretty grim week working through the withdrawal symptoms, so you have my understanding on your comment about not wanting to take the drugs. It has been 7 and a half months since I stopped (yes, I am still counting the days), and I have substituted more rest when I need it, and a massage therapist every two weeks. But the situation with my neck is different than yours, and I believe you have reason to be optimistic. This gets better with time!

Best Wishes for a successful recovery!

sbcatt 06-27-2007 08:21 AM

Re: 5 days post-op acdf...a few questions
Hi Alison,

I am having a 2 level fusion next month and have the same muscle spasm problem that you have. I've been dealing with it for 22 years though.......

I had 2 cervical epidurals (C4-5, C5-6) in February that didn't help but they did start this latest bout of spasms. The Dr. prescribed Zanaflex but it didn't help.

My regular doctor gave me Lidocaine injections last month and they were incredibly effective. No other Dr. or Surgeon (and I've seen a LOT of them over the years) has ever even MENTIONED Lidocaine for muscle spasms. They had been constant since February this time.....(this latest flare was my camel straw.)

He used 8-10 cc's (total) in 4 places in my upper back, in a square pattern around my bra line. I don't know if I would/could have them in my neck but I'll certainly ask about it if my neck goes into spasms after my surgery.

After a couple of hours I noticed a reduction of the spasms by about 75%. Over the next couple of days they subsided completely. Now I notice a blip once in awhile and then it's gone. I had the injections on May 23rd and I'm still spasm free.

I still take a Zanaflex in the evening but it's more to help me relax so I don't wake up in a flare.

I've been reading this board for months now and I've learned a LOT. I just wanted to return the favor.

Good luck with your recovery, I'm going to be imprisoned in a hard collar for 12 weeks after my're so right, it's strange how everyone has a different recovery process.



MargaretM123 06-27-2007 02:40 PM

Re: 5 days post-op acdf...a few questions
Hi Alison:
I just returned from my two week post surgery doctor's visit (ACDF for herniated discs at levels C4/5 and C5/6 with severe cord compression), and was given a bone fusion stimulator to wear, starting today.
I am to wear it as much as possible (24/7 is advised) but I don't think I will mind as its a very small unit with electrodes attached to each side of my neck (in the front). It is painless, but I think the wires will eventually start to get in the way. Thank God for insurance, as this unit's cost is $2,750!!
My neurosurgeon was pleased with the results so far and has taken my collar from me, told me I can increase my activity level and am to start exercising the neck muscles by turning and stretching from side to side.
He showed me the x-rays taken today and compared them to the ones taken before surgery. I couldn't believe the difference and was amazed at the size of my four bone spurs. I now have a titanium plate and 5 screws as well as donor bone.
I had no difficulty with sleeping; I am a side sleeper and was able to sleep on the side that did not have the surgery. I used to have to sleep propped up on 2 or 3 pillows each night, but can now sleep comfortably on one good pillow.
I guess I was fortunate as I only needed to take the Vicadin I was given for pain for the first four days, then was able to switch to extra strength Tylenol.
I also had muscle spasms in my leg and foot for the first three days, as well as what felt like electric currents running throughout my leg, but that has since stopped.
I still have weakness and numbness in my left leg but my neurosurgeon explained that it should improve as time goes on, and if it doesn't, then he will explore the possibility of a pinched nerve in my lower back (I also have herniated discs throughout my T & L spine).
I hope you are feeling stronger every day.

alison352 06-27-2007 05:56 PM

Re: 5 days post-op acdf...a few questions
Hi Marge and Kathi!

Thank you so much for replying! I can't tell you how much it helps!

I spoke with my Dr. today (thanks Bob :) ) and told him that I've tried Flexeril, Soma, and Xanax, even dilaudid (although not a muscle relaxer) but none have worked. He called in a script to my rx store for valium. I'm a little hesitant since it's so close to Xanax but oh well at this point I'll try anything. If the valium do not work then I will ask for baclofen.

Kathi, if I had to suffer 22 years of back spasms...gosh I don't know what I would do!!! Thanks for the info about lidocaine!

Marge, That's great that you were able to sleep. That has been my biggest issue due to the spasms. And I'm the type of person that needs her sleep. Between being stuck in the house (before this I was always on the go) and being sore AND overtired...well lets just say that by the time I am able to get out and go (not just walks), I won't want to get out of bed due do to depression.:dizzy:

Take care Marge and I wish you a great recovery and Kathi good luck! I'll be praying for you!

steveblack 07-02-2007 11:37 AM

Re: 5 days post-op acdf...a few questions
Wow, I will pray for all. I know how it feels.
Soma did good for me.

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