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  • acdf follow up xrays/fusion

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    Old 06-26-2012, 07:16 AM   #1
    dukeee
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    acdf follow up xrays/fusion

    hi, new here

    3 months ago fell down embankment, off to emergency room then acdf c5-c6 doner bone with plate 3 days later. residual numbness and weakness but no pain (never was any pain- lucky).

    this was thru workers comp with great doctor BUT...had 6 week follow up xray that showed almost no fusion- 1 small spot. then 3 month follow up xray with no difference at all. no "flexation" xrays. Dr. again pointed out the 1 small fused portion about 1/8 inch long with rest of doner bone clearly not fused or fusing.

    i know this is not a workers comp forum and only bring up that he listed me at "maximum medical improvement" to indicate that my neurosurgeon was now going to be out of the picture and through with me. he said no more follow up xrays and that, not having pain, i would be "allright" . i should mention the residual numbness and leg weakness i have is much better than preop and due to compressed cord per Dr..

    my graft is clearly 90% not fused. my questions to you who are more familiar than i am are 1) should there "normally" be future xrays planned? 2) should there normally now be an attempt to electrically stimulate fusion? before i ask my Dr. these same questions i want to do some research and have already with indications that i have been left hanging (by the neck).

    thanks in advance

     
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    Old 06-26-2012, 11:14 AM   #2
    ANGELINMICHIGAN
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    Re: acdf follow up xrays/fusion

    dukeee....hi there, I am a bit confused, sorry.... I have some questions, first of all, what kind of x-rays did the doctor use to find out that you were "not" fused? You said you never had any pain and the doctor did your surgery on numbness and leg weakness? Where was your numbness if you don't mind me asking? Do you have the results of your first x-rays that the doctor did your surgery off of? You say your doctor said "compressed cord".

    I had fusion surgery many years ago on C5/6 6/7 and found out 15 months that I wasn't fused. My neurosurgeon told me that at 6 weeks a fusion (donor bone) is still like gel (whether that is true or not that is what I was told as I had a car accident and saw him at the hospital) Also it also states many places on many health sites that it takes up to 1 year for actual fusion to take place and sometimes a bit longer for it to "fuse" so how can they be telling you already this early that you haven't fused. This is what I am confused about!!! I know too well from what I have gone through with first hand experience. It took me a long time with a lot of pain to find out. I am still not fused and a non fusion normally comes with a lot of "pain"!!!

    I had a Cat Scan and another x-ray I actually think it might have been the flexion/extension that told my Neurosurgeon that I was in fact "FUSED" and he told me to go to the "pain clinic" that he couldn't help me. I went back any way to him and he couldn't even tell on an MRI because an "artifact" showed up which was a shadow in the way. The only way he could tell that I "WASN'T FUSED" was from a CT Myelogram which they say it has to be a form of "slice scan" because apparently a "non fusion" is very difficult to determine. This I why I don't understand how they are telling you that you are not fused. What kind of x-ray or scan are they looking at to tell you that you are "not fused" and how can they tell so early!!!

    I was told that your doctor should follow up for 1 year to make sure that you are fused!!! I don't know if that is legal protocol but it takes up to 1 year to properly fuse!!!! I have heard of people usually that "bone stimulator to help the fusion along but I find it too soon for them to be throwing you out into the cold so to speak"

    Sorry for all of the questions, just trying to help you. Take care and hope to hear back from you soon. I am sure other people will also like to hear more. I would especially like to hear about your numbness and weakness in leg area.
    Take care of yourself. AngelinMichigan Lyn

     
    Old 06-26-2012, 08:28 PM   #3
    dukeee
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    Re: acdf follow up xrays/fusion

    Hi Angel

    After 25 foot head over heals fall down very steep slope went to ER and could not move legs at all and arms/hands very weak but moveable. Next day MRI showed herniated disc with extreme protrusion into spinal cord. Many positive reflex signs for cord damage and urinary build up beginning to get serious.

    Large dose steroids begun to decrease cord swelling and operation ASAP. Again never was any pain which I was told was atypical. Day after operation could move legs some and in the next 3 days post op got to strength level I have now which is very slight bilateral arm/ hand weakness and severe trunk/hip weakness and moderate upper leg weakness. I use a walker always. Went thru water therapy which didn't do a whole lot as Dr. said it wasn't muscle weakness but cord nerve damage causing my disability.

    Felt ok otherwise and lucky to be getting around at all as Dr. told me it was a
    "mirical" I wasn't in a wheel chair.

    At 6 weeks and 3 months had anterior and lateral neck xrays. 2 images only for each follow up and no flexion. First follow up Dr. said good and showed me a tiny piece of white in the otherwise dark ( radiolucent ) outline around the doner graft bone. Same type outline at 3 month where he told me the bone had not fused anywhere exept the one tiny spot. He had " shaved" my vertebrae so that the graft was in the shape of a wedge and explained for that reason the graft would not push into the cord. In the front was a plate and 4 screws with graft right up to the plate so he said it not going to slide forward.
    He said " you'll be alright " with added inflection as in " don't worry ".

    That was a week ago and as I said he is through with me certifying to workers comp that I was at " maximum medical improvement ". I was released with no follow ups to sedentary work and restricted in EVERY category such as lift, push, pull etc. (9 categories) to 0 ( zero ) pounds.

    Weird thing is he IS a great doctor and oddly the release to work with all the zeros will get me to total disability quickly. But something seems wrong about the lack of further follow up.

    Sorry for all the wordage. I'm not throwing a pity party and truly feel lucky especially when reading of other people's much more serious problems.

    Thanks ( numbness is in hands and from knees down)

    Last edited by dukeee; 06-26-2012 at 08:33 PM.

     
    Old 06-26-2012, 08:34 PM   #4
    WebDozer
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    Re: acdf follow up xrays/fusion

    Perhaps the doc doesn't think that non-fusion is a problem... that the hardware holding everything together is sufficient, and all you really need between the vertebrae is something to hold the space open?

     
    Old 06-27-2012, 08:30 AM   #5
    ANGELINMICHIGAN
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    Re: acdf follow up xrays/fusion

    dukee....Hi again, after reading your post and trying to absorb it in my mind, and now reading WebDozer's post, I am in agreement with WebDozer!!!
    I still don't think that they gave your donor bone a chance to fuse and that it still might fuse as it is early but....I don't think that they are too worried about it fusing by the sounds of it!!!! It sounds like they are thinking that the plate and screws are going to hold everything in place and that everything is going to be OK especially since you didn't have any pain to begin with!!!

    I don't understand the other part of it because of the herniated disc and the complete extrusion into the spinal cord and many positive reflex signs for cord damage, but they seem to think they have fixed that and with time that you are going to get the feeling back in your arms and legs my doing the water therapy, physical therapy etc.!!!

    I just don't know what to say as my "non fusion" causes me pain and you never started out with any pain and the fact that they don't want to see you any more to see if you have fused down the way doesn't make any sense to my case but yours is different!!!

    Have you got all of your paperwork from your doctor's visits. I always go to the doctor's office afterwards or the clinic and get every copy of any doctor's visit/neurosurgeon visit and keep it in my files. If they haven't told you things or you have some questions, I always go over it myself when I have it in front of me. I alway get copies of all x-rays too and the radiololgist reports and read them over again. I understand why these things are questionable in your mind because they don't make sense to you and I understand that!!!
    There are a good group of people on here and I am sure more will come along and maybe will give you some more answers.

    I hope and pray that you get the answers that you are looking for on here and sorry that I couldn't have been more help to you.
    Take care of yourself
    AngelinMichigan Lyn

     
    Old 06-27-2012, 08:56 AM   #6
    dukeee
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    Re: acdf follow up xrays/fusion

    That seems to be and I read that asymptomatic non-fusions can just be left alone.

    But certainly a fusion is better and there are things like external electric stimulation which can promote that.

    Also it is important for the patient to KNOW as that knowledge can alter your entire lifestyle and activity level.

    Finally workers comp likes to settle claims including future medical. My research indicates hardware failure (only 4 screws) and adjacent level problems are significantly increased which one should know as far as a fair settlement of future medical.

    As it stands I will not know and have to assume non fusion.

    Thanks

     
    Old 06-27-2012, 09:03 AM   #7
    dukeee
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    Re: acdf follow up xrays/fusion

    Re: acdf follow up xrays/fusion
    That seems to be and I read that asymptomatic non-fusions can just be left alone.

    But certainly a fusion is better and there are things like external electric stimulation which can promote that.

    Also it is important for the patient to KNOW as that knowledge can alter your entire lifestyle and activity level.

    Finally workers comp likes to settle claims including future medical. My research indicates hardware failure (only 4 screws) and adjacent level problems are significantly increased which one should know as far as a fair settlement of future medical.

    As it stands I will not know and have to assume non fusion.

    Thanks

     
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