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  • Posterior Fusions anyone?

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    Old 05-28-2013, 02:15 PM   #1
    Kissa
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    Posterior Fusions anyone?

    Hi All!

    I have had 3 ACDF's from C3-C7, the last two surgeries failed, one completely, and have severe neck, shoulder, arm and hand pain etc. Typical failure symptoms as well as new herniation's the operating doctor failed to correct, broken hardware and many other issues.

    My new neurosurgeon is suggesting, due to the multiple failures and complications, to fuse me from the back from C2-T2. He said that this would be the last time I would ever be able to have my neck operated on and feels confident that fusing me in this manner would be quite successful compared to past surgeries.

    I was wondering if anyone here may have had fusions done from the posterior and what your experience was like. How painful was it? If you had an ACDF then the posterior surgery would you say it was more difficult to mend from?

    I was told I will be hospitalized 2-3 days and that it is far more painful than the ACDF due to the muscles they cut through. I didn't do bad with any of the surgeries post op, other than with the last one the doctor damaged the muscles in my tongue and my tongue was literally hanging out the side of my mouth for months. I did have some throat swelling and swallowing issues on the last two fusions with the last fusion being the worst. I had to use applesauce to swallow any kind of pills as I would choke on them as well as other foods.

    Painwise it took a few weeks to get over the initial pain with the ACDF's and none of them were as painful as several hip replacements I had in the past.

    He said I have the option of using a brace if I feel unstable, something he does for all his patients, and the choice was mine. I did have to wear a brace for nearly 6 weeks with my last fusion.

    I am concerned that he is doing 8 levels and he does plan on using hBMP which I don't know a lot about other than they are not supposed to use it for ACDF's. I've never been fused more than 3 levels at one time. I'm not worried about losing range of motion, which he believes I will not.

    The doctor did indicate he allows his patients to pick up items as long as they weigh no more than 20lbs, past surgeon only allowed 10. The reason I mention this is I do sometimes babysit my grandaughter who is only 2 months old right now. I do not plan on babysitting for weeks after the surgery and am planning on being in pain.

    If you have had a posterior cervical fusion I'd be interested in hearing how you faired as this one does make me nervous. I know what to expect with the acdf but not this one, particularly when it comes to the severity of the pain and the amount of time it might take for me to feel better.

    Thanks in advance!
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    Old 05-28-2013, 09:01 PM   #2
    teteri66
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    Re: Posterior Fusions anyone?

    I usually hang out on the back board and don't usually comment on cervical spine questions as my personal experience has all been with lumbar problems, including two fusions.

    I can see why you would be especially concerned about the possibility of this big surgery. Have you consulted with more than one surgeon regarding this particular problem? Fusing seven levels is a formidable undertaking. I would urge you to do some reading about using BMP off-label as is being proposed. As I'm sure you are aware, there have been several large, class-action lawsuits due to adverse affects. One of the worst adverse reactions in the cervical area has been swelling...causing death in some patients (I don't remember how many -- whether it was a couple or many more....) Another problem that arises is that the cells do not turn off and the bone continues to grow, sometimes encasing a nerve, or causing other issues.

    I had BMP with my first fusion, which was one level at L4-L5. At the time it was only approved for an anterior surgery. Mine was posterior, with a cage, and I did not have any problems. I fused very quickly and my surgery was "medically" successful. It just didn't resolve my radiculopathy.

    If I were you, I wouldn't worry too much about the pain. I would imagine you'll be able to handle it OK. But the issue of using BMP and of fusing so many levels, particularly after your other surgeries have not been successful, would be of greater concern to me.

    I would really encourage you to get several more opinions before proceeding with such a risky surgery.

    Good luck. I hope you this works out for you.

     
    Old 05-29-2013, 09:17 AM   #3
    Kissa
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    Re: Posterior Fusions anyone?

    Thank you for your response. I am aware of the swelling and did do research on that, it is only during an ACDF that this occurs, there's been no evidence I can find indicating it causes problems posterior. I know of someone who did have it done using the BMP in the front and he ended up back in the hospital for days because he couldn't swallow. Ironically the same surgeon who did my surgeries in the past did his.

    I do agree getting another opinion and am looking into that. The reasoning behind all 8 levels is because the last CT showed new herniation's in areas that were supposed to have been addressed ( these perhaps could have been there before and the previous doctor failed to take care of them) Additionally, as mentioned, the fusions from c5/c4 and then c3/c4 failed. The latter with 0% healing and a fracture at C3.

    Herniation's range in size but the average grade was 2mm + depending on the area last time checked, which was last year.

    Additionally the disks are now overlapping each other by on many levels, the average grade is probably a 2+. Retrolisthesis is what it is called. I have a genetic disease called Ehlers Danlos Syndrome which causes subluxation and dislocation of joints in addition to other issues. Basically my neck is unstable but not in danger at this time. The idea is to prevent more severe damage.

    What I didn't mention was two years ago I did go back to the original surgeon who admitted he "must of missed" some of the herniation's and was in fact going to re-fuse the area's not fused posteriorly . He was all ready to do the surgery, not at all the levels indicated, but then my husband went through a difficult situation due to a pharmacy prescription error. The doctor told me after finding out that "There is nothing wrong with your neck, do not ever let anyone touch it again and fix your marriage". Let me add I have a wonderful marriage and it has nothing to do with the state of my health. I thought that was a rather odd comment considering only weeks before he stated there was in fact several problems going on. It has been eluded by two different surgeons that my last two procedures may not have been been done optimally.

    In fact, when I had my second fusion the doctor should have ordered a bone stimulator and failed to do so among other things. We'll just leave it at that.

    I do definitely agree, a second or third opinion is in order and I'm not in a super rush to have it done but I can say things have gotten worse of the past months. At times I can barely use my hands they are so numb and burning. My shoulders are in extreme pain along with my neck of course. I had a recent increase in pain medications which are helping minimally. What scares me the most though is sometimes if I turn my head left there will be a severe pain shooting from my neck to my spine and I'm stuck in that position for a few minutes before I can move my head again. This is recent and I've not reported to the doctor yet.

    Thanks again!

     
    Old 05-29-2013, 11:29 AM   #4
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    Re: Posterior Fusions anyone?

    I was referring to the swelling as a reaction to the BMP.

    I'm sure your options are limited. Just be very careful and be sure you are entering into this with eyes wide open.

     
    Old 05-29-2013, 01:44 PM   #5
    Kissa
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    Re: Posterior Fusions anyone?

    Yes, the reaction I had read about but it all referred to from the front not back. Yes this does concern me either way. I had found some documents on the very limited research that has been done and how some doctors are in fact using it for off label use and it truly concerns me. I was not aware of the bone overgrowth so I will be asking many questions indeed.

    I just saw my PM and he strongly suggested that I get a second opinion as well, which I plan on doing. He thinks that I will not be able to move my head from left to right if the thoracic levels are done so I really don't know.

    Thanks again, your response has been thought provoking and helpful.
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    Old 05-29-2013, 06:25 PM   #6
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    Re: Posterior Fusions anyone?

    There's quite a bit of information on-line regarding the various class-action lawsuits and settlements pertaining to BMP. I just checked the Medtronic website and it clearly states that BMP is approved for a one level fusion with no more than a Grade 1 retrolesthesis from L2 to S1. Any other usage is considered "off-label" . Also, it must be used with an Infuse cage or similar to contain the BMP.

    I'm surprised your surgeon is willing to risk using BMP in a patient such as yourself who has already had several failed surgeries. I would ask him many questions before proceeding.

     
    Old 05-30-2013, 12:32 PM   #7
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    Re: Posterior Fusions anyone?

    Wow... you got a surgeon to admit that he "must have missed" something? That's a serious accomplishment. Was a gun involved?

    I'd suggest three opinions. If it's going to be your last cervical surgery, you should not have any doubts.

    What did he tell you about range-of-motion when it's all done?

     
    Old 05-31-2013, 09:34 AM   #8
    Kissa
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    Re: Posterior Fusions anyone?

    I did more research. I did not do much more research beyond what I had done when first hearing he was planning on using bmp so that's my goal for the weekend. Most of what I found was related either to the lumbar or cervical during an ACDF. I've not found much on posterior.

    The original doctor really screwed up bad but decided that since my husband was ill it was a good scapegoat to say nothing was wrong during a later visit. He later went on to fuse a former family member at least 6 levels in one shot, I believe he used bmp on him that resulted in him being hospitalized for several days unable to swallow anything. The doctor then retired about two months later.

    I do have an appointment in two weeks for another surgeon who a family member used for a lumbar procedure and my husband had seen for lumbar issues. He was rather nice. Problem is he is in the same group of doctors who the one who wants to do the surgery is in and also in the group of doctors the original surgeon was in. Can't wait for him to read the witty comment in my chart about my relationship LOL.

    New doctor suggested I'd lose little to no range of motion, my PM said "are you sure? you will not be able to move your head left to right". So the question is has anyone else lost range of motion? I've not lost much from all the fusions and what is lost is mostly because my muscle are so stiff (yes did I tell you the story about how I was told during the last two surgeries I didn't need therapy?)

    I am greatly concerned about this surgery and am not moving forward until I get at least one more opinion. I am doing what I can to manage pain but it is frustrating since I've been a PM patient for a really long time and have issues with taking medications (sensitivities). I'm more concerned about the loss of use of my hands at times and when my neck gets "stuck" and can't move it.

    I've yet to hear from anyone who has actually had a posterior fusion on several levels. I am quite curious to hear from anyone who had multiple levels done posterior.

    Last edited by Kissa; 05-31-2013 at 10:15 AM.

     
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