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  • Acdf or Foraminotomy? What to do,what to do?

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    Old 01-10-2012, 05:44 PM   #1
    Pwalla57
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    Acdf or Foraminotomy? What to do,what to do?

    I'm getting my C7 fused(thats a given)and then I have to make the decision of getting acdf or a foraminotomy on my c5,6. I have a bone spur poking a nerve in the foramen(foraminal narrowing)My c5,6 are slightly herniated. I'm thinking if I don't get acdf now I will have to go back in a couple years and get it done anyway. I have left arm pain down to my hand and just starting to get right arm pain at my shoulder. It's so hard to make this type of decision. I know my NS will leave it up to me, but I am hoping he would give me his recommendation as well. I have exhausted all options of other treatment. I have severe pain on the right and left sides of my neck, also in back of my neck but that's my c7.
    My MRI c5,6 findings are: C5-6: There is disc degeneration with loss of disc height,
    endplate degenerative changes and marginal spurs. There is a
    small posterior disc osteophyte complex. There is mild
    ligamentum flavum hypertrophy. There is moderate spinal canal
    stenosis measuring 7 mm in AP diameter with near complete
    effacement of the cerebrospinal fluid surrounding the cord
    without cord compression or edema. There is bilateral facet
    hypertrophy. There is a 5 mm perineural cyst in the right
    neuroforamen. There is moderate left neuroforaminal narrowing.
    There is mild right neuroforaminal narrowing.

    Last edited by Pwalla57; 01-10-2012 at 05:51 PM.

     
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    Old 01-10-2012, 07:44 PM   #2
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    Re: Acdf or Foraminotomy? What to do,what to do?

    I think a bi-level ACDF makes sense, but if foraminotomies can clear up C5-6, you could go either way...

     
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    Old 01-11-2012, 08:20 AM   #3
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Anyone else out there have an opinion on my question?
    Thanks!

     
    Old 01-11-2012, 03:38 PM   #4
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Personally I would recommend an ACDF. I found it far less painful than any other surgery I've had. Then 2 yr later I had a posterior foraminotomy and it was extremely painful and my neck muscles have never been the same
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    Old 01-11-2012, 05:59 PM   #5
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    Re: Acdf or Foraminotomy? What to do,what to do?

    If your doc does a laminoplasty(new surgery) you could have that done and the foraminotomies at the same time and fix both areas at once.

    Jenny

     
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    Old 01-11-2012, 06:52 PM   #6
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Yes, I should have thought of laminoplasty, since I have had one. You seem to have a congetically narrow spinal canal, which is more your problem than any one time of the intrusions into the canal. That's the kind of situation that laminoplasties are for...

    Last edited by WebDozer; 01-11-2012 at 06:55 PM.

     
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    Old 01-11-2012, 10:11 PM   #7
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    Re: Acdf or Foraminotomy? What to do,what to do?

    After seeing what laminoplasty is, it looks scarier and riskier than acdf. Please help me understand. What I saw on the MRI with the NS is a bone spur touching a nerve and some herniation of c5,6. I don't think I have cord compression. I do see where a foraminotomy would help. I guess I just wondered if my herniation is bad enough for a diskectimy now or will it just get worse in two years, give or take. Tonight I'm having really bad pain from the ears to both shoulders on both sides. Time to go to sleep and take my meds. I would love to hear any explanations you all might have for getting laminoplasty. Btw even though I have pain in my shoulders and arms, I still have strength, so I pass those tests. On my c7 I'm having anterior fusion(we already know this has to be done). I'm confused. Thank you

     
    Old 01-12-2012, 09:33 AM   #8
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    Re: Acdf or Foraminotomy? What to do,what to do?

    In a laminoplasty, they remove the bone over the back of the cord. They used to just leave it open(laminectomy) and the cord is exposed but now, they have a way to take the bone they remove and reshape it and then re-attach it so the canal is doubled in size. This allows the cord to move away from a herniated disk. And since it is done from the back, they can do the foraminotomies at the same time.....they are very hard to do from the front during an ACDF and most docs won't do them during an ACDF.

    If you want a more technical description.....they cut off the spinous process(the part of the spine that makes us look like a stegasaurus), then depending on the type(open door or French door) the break the lamina bones on one of both sides and reset them at higher angles, holding it open with a small bone graft. If they break only one side, it's an open door and if they break it both sides, it's a French door. If I'm not mistaken, the French door gives you the greatest amount of space as both lamina are reset to 60*+. That is what I have and I've still used up all the room they made!Anyhow, it takes the small v-shaped area at the back of the canal and turns it into a much larger V or U shaped area.

    Anyhow, most docs don't do the surgery. BUT...and it's a huge BUT...no fusion is done with this procedure. And that is huge because it is the fusions that start the endless problems you can have with necks. They do put in a supporting titanium strip but no bone fusion. That was the whole idea behind the surgery.....no fusion. The rest of the world has been doing these non-fusion surgeries for years and years....we are the last country to embrace them but still, way too few docs are doing them. ACDF's are faster and easier but are they best for the patient? According to the latest studies, no. Laminoplasties are better than ACDF's in all areas. Now to get the doc's trained.

    Just a tidbit of info here....once a new surgery or new medication or new technique is found to be the best for the patient, it takes an average of 17 years for the medical community to incorporate the new "whatever" into practice.....basically it takes a whole new generation of doctors to be trained in the new whatever to get it used routinely. Got that from a great book on why the medical community is having such a hard time fixing what ails us! It is what ails their system and not us. An example....did you know that statins(eg. Lipitor) for high cholesterol will save an average of 2 heart attacks per 100 men but they have never, in any study, shown that same correlation in women? And now they find that statins raise the risk 4 fold for developing type 2 diabetes in women. So why are we women getting statins? Because the docs think if it works for men it must work for women. Uh, no. But it will take years and years for the word to finally sink in that statins don't work for women. Another case of the changes taking a generation to get through the heads of the docs. Way too many go to medical school and residency and never change what they do or think after that time.

    Okay....time to get off the soapbox!

    Jenny

     
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    Old 01-22-2012, 02:50 PM   #9
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    Re: Acdf or Foraminotomy? What to do,what to do?

    So if he won't do laminoplasty and my c5,6 are partly herniated but not bulging, would you recommend a ACDF? (remember my c7 needs anterior fusion for sure) and my C5,6 not only have partly herniated discs but a bone spur hitting a nerve. Once a disc starts bulging does it just continue to? Im 55 years old.

     
    Old 01-22-2012, 04:20 PM   #10
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Pwalla - The problem with the C5-6 is that an ACDF would not address the ligamentum flavum hypertrophy or the apparent hereditary canal stenosis. I don't THINK it would address the facet hypertrophy either, although I'm not sure. A laminoplasty would address all three.

    The ACDF WOULD address the disk problem, which the laminoplasty could only address indirectly, by widening the canal space. However, the disk problem at C5-6 is still small, How much good would removing that disk do?

    Which brings us back to the C6-7. You say it's a "given" that an ACDF must be done, but we don't know why that level could not also be addressed by laminoplasty. A disk that is WAY out of place?

     
    Old 01-22-2012, 09:26 PM   #11
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    Re: Acdf or Foraminotomy? What to do,what to do?

    My c7 part slipped over my t1. (sorry don't have the report with me). He said my spine slipped, that I just need a single level fusion there .

     
    Old 01-23-2012, 05:57 AM   #12
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    Re: Acdf or Foraminotomy? What to do,what to do?

    I guess if C6-7 is really a given, then C5-6 also is not unreasonable. You may very well need foraminotomies later. Maybe even soon. Last spring, before I got a laminoplasty done, one surgeon actually proposed scheduling an ACDF with a foraminotomy two weeks later.

     
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    Old 01-23-2012, 11:38 AM   #13
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Two weeks later? That would be torture. But they probably could do an ACDF on c5,6 and fuse c7 and grind off the bone spur on my c5 6 all at the same time?

     
    Old 01-23-2012, 12:35 PM   #14
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    Re: Acdf or Foraminotomy? What to do,what to do?

    Depends on whether they could get at the bone spur from in front...

     
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