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Anyone ACDF without plating?

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Old 01-04-2010, 10:22 AM   #1
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Join Date: May 2004
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Anyone ACDF without plating?

Had ACDF with plating (c5-t1) in 1998. DDD advanced at c3-4 and c4-5. Presently, four docs (2 orthopedic spine specialists, 1 neurosurgeon, and family doctor) tell me I should have 2-level ACDF c3-5. They recommend removing existing plate in order to plate c3-5. I've been to a fifth doc, another neurosurgeon, who recommends doing only one level (c4-5) without plating. That approach eliminates need to remove previous plate. Here's my question: has anyone had ACDF without plating, particulalry at level directly above fused level? What was your experience? There are some new appliances that eliminate the need to remove existing plate; however, not approved for two levels. The need for surgery is clear to me. I have significant neurological deficit caused by spinal cord flattening, e.g. clonus, myelopathy, hand spasm, leg spasm, and other clever tricks. My personal debate is which approach accept. I'm meeting with the orthopedic spine specialist this Thursday for more input into his recommendation. Anyone have comments?

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Old 01-04-2010, 06:33 PM   #2
Join Date: Jan 2005
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Re: Anyone ACDF without plating?

It is common to find doctors who do not plate for one level. However, personally I think I have only heard of this when the patient did not have previous fusions. If I were the patient I think I would be questioning a decision to not plate a fusion adjacent to another larger fusion.

The reason I say this is that when they fuse us it does cause pressure and stresses from us now being in a static position. In my medically untrained mind I would think this larger fusion would put a little stress on the one level and could open the door for a collapse, movement, shifting, etc, of the one level uninstrumented site.

I had a revision and they told me the most prudent method was removal of the existing plate and a new plate to cover the new fusion sites. The new plate did not need to span the previously solid fusion levels.

You already have enough problems - why not take the safest route and not open yourself up to additional issues?!?

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