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  • ACDF: Effects on other levels

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    Old 03-24-2003, 02:47 PM   #1
    Mike D
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    Question ACDF: Effects on other levels

    Hello - new to this board and found this forum very helpful.

    Advised by Dr. to have ACDF at 6/7, however have moderate stenosis and small herniations at 4/5 and 5/6. Anyone else concerned about the long-term affect of fusion on other troubled levels? I've read that fusion can create add'l stress on other levels.

    Thank you for your thoughts in advance,
    md
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
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    Old 03-24-2003, 04:03 PM   #2
    BWL
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    Hi Mike,

    Welcome to the club. Well, two clubs actually. The the first being the board and the second being those of us afraid of stressing adjacent disks.

    I had ACDF with plating at C6-7 almost two months ago and also have a slight bulge at C3-4. I worry about resuming my normal level of activity and the additional stress this "may" bring. The medical brains are in a little bit of disagreement over whether this is a true phenomenom or not. Logically it makes sense that by altering the structure you might be redirecting some stress, but frankly, what can you do?? You do what you need to do, live your life and hope for the best. That's my plan, it's obviously quite scientific.

    Take care
    Bruce

    ------------------
    ACDF with plating and donor bone C6-7 (1/29/03)
    __________________
    ACDF with plating and donor bone C6-7 (1/29/03)

     
    Old 03-25-2003, 05:46 AM   #3
    Mike D
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    Bruce - I agree that ACDF may be the only option, depending on symtoms and cord involvment.

    I have mild cord compression at 6/7, however, no other compression at this time.

    I'm 29 with a young family and don't want to complicate the problems by doing ACDF. I've seen some information on more conservative "minimally invasive" procedures, however, these do not seem to be the preferred method of treating disk hernations in medical circles. Not sure if this because ACDF is "the was we always do it" or if alternative treatments are not fully developed/researched.

    Has anyone been sucessful with minimally invasive prodcedures?

    Thank you,
    md
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-25-2003, 06:02 AM   #4
    lori1851
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    Mike,
    I am awaiting cervical discetomy and corepectomy April 22nd. I have to ruptured discs C34 C45 I had prior surgery on C67. I guess its just one of those things. They will put a plate over my fusion this time. I know what you mean by making the discs above and below weak. But, hey what can you do? Already tried PT here. Im sick of the pain and limitations. I know one thing for sure my days helping in shipping and handling at school are over. I have lifted things I should have never had. My ortho gave me 3 weeks PT and said no longer than that. I definetly do not want nerve damage. Even though my dr said alot of the upper back is hereditary I say Bull!!!! Just like the lower back I feel we do things sometimes we shouldnt and I am and example. Let me know when you have surgery ok. We are all in the same boat here! Will be praying for you.
    Lori

     
    Old 03-25-2003, 07:32 AM   #5
    Mike D
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    Lori - thank you for you kind words and god bless.

    md
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-25-2003, 01:01 PM   #6
    Saints85
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    Mike D,

    Hello! Welcome aboard! I haven't post on this board in awhile but started having trouble with my neck and decided to check in to see if anyone else was in the same boat as me.

    My name is Kim, I'm 35 and I had an ACDF at C-5/6 back on May 29, 2002. I also had a natural fusion of C-4. So now I have C-4/5/6 all fused as one. When the disc in my neck ruptured it didn't bulge out like most, mine went right down my spinal canal. OUCH!! My decision on surgery was an easy one. Have surgery or live in a wheelchair.

    I'm a pretty active person ( Soccer, running, lifting weights, on top of 4 kids to take care of ) and I don't have many days of rest. I just started having some trouble with the levels above and below. I started to get a numb feeling inside my head. I feel like I've got that beer buzzed feeling all the time. But without drinking a beer! I make for a pretty cheep date!!

    I'm having a hard time keeping my chin up. I want to tip my head down?! My right hand started to go numb along with my feet. After about 3 months of this I finally called my Neurosurgeon. He told me I should expect to feel pain for the next 2 - 3 years. It will take that long to heal. He recommended that I see his Chiropractor that he has on his staff.

    I seen the Chiro last Thursday and he gave me a thorough neck and spine check up. He did say I would have a greater chance of having damage to the levels above and below fusion. I just have to watch for signs of this happening (like I'm having now) and go in and have my neck adjusted to keep my vertebrae in line. I thought for sure he would tell me to stop playing soccer and lifting weights but he just showed me ways to do the things I love to do but to do them without damaging my neck.

    He felt most of my problems we muscle related. The muscles in my back and shoulders are very tight. He did more massage therapy then he did cracking my neck. He did adjust C-1-2-3 and C-7. I'll be honest I was very nervous but it felt great!! I know a lot of you on this board do not believe in a Chiropractors but I have always had good results from them. And knowing that my Neuro trust enough in them to have 3 on his team of staff made me feel very comfortable with my decision to see one.

    My advice to you would be to seek out a good Chiropractor and see what he has to say. I asked before my surgery and they were very honest with me. My herniation unfortunately was to severe for them to help. I do know that in some cases they can help with traction. That's were they just pull back on the neck and hold it which allows the disc to "suck" back into place. Depending on how bad yours is this might work for you. Good Luck! And Have a Good One!! ~~ KIM



     
    Old 03-25-2003, 03:08 PM   #7
    Mike D
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    Kim - I too have had good results working with Chiropractors, however, I'm holding off on any adjustments considering the herniations that I have at two levels, 6/7 and 4/5 - 5/6 is protruding.

    I've had two epidural steriod injections in the last two months - these have helped significantly. 3 weeks after the first injection, I began to feel the pain return.

    This pain is clearly caused at 6/7 by nerve root irritation as revealed on MRI films. I'm not sure that manipulations (other than traction, which I do at home) will help move the disk back in place, rather, I'm concerned that further chiropractic manipulation might further herniate the disk - thoughts?

    md
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-26-2003, 08:02 AM   #8
    Saints85
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    MikeD,

    Good Morning! I see my Chiropractor tomorrow. Cant wait! I will be happy to ask if there is any chiropractic manipulation that would help alleviate or correct nerve root compression.

    Right now he is treating me for what he feels is an aggravated nerve roots at C-3/4 and C-6/7 due mostly to my fusion of C-4/5/6 , and strain on neck while weight lifting which I've made changes. He didn't feel soccer was involved. Thank God because I don't think I could give that up. He's treating me in the form of massage and adjustments.


    I see you have significantly compresses nerve roots at 4/5 and 6/7. Compressed and aggravated are totally different but I will ask and see what he recommends


    You're doing traction at home? How long have you been doing traction and does it give you any comfort? If not to personal how and how long ago was your neck injured? About 8 years ago someone held my neck back in an argument and misaligned my spine. I wish I had the knowledge back then to see a chiro. I feel, if I would have gotten my neck back on track, I know I would not have needed this surgery! Oh well, we learn from our mistakes and I'm seeing one now to keep things in order.

    It sounds like you have/are doing you homework and have really checked out all options. Good for you! http://www.healthboards.com/ubb/t_up.gif Keep up the good work and have a good one!! ~~KIM

    One more thing. I see you had 2 epidural injections. What was your thoughts on them? I have an order to receive them if I would like but I was afraid all they would do was mask the pain and hide a potential problem?

     
    Old 03-26-2003, 09:48 AM   #9
    melanie dawn
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    Hi Mike,
    from most of my research and talking to the different docs. Most do not consider minimally invasive techniques,ADR etc. when there is compression and stenosis from any bony spurs or bars.
    The amount of info out there is overwhelming,as is the differnt opinions. But if you have cord compression, there are only two choices, 1; you manage and monitor the symptoms closely, if any signs of myelopathy=surgery
    2; you can do surgery right off of the bat. Some choices are hard, is your cord compression symptomatic?
    It is all so confusing at times, what to do, what to believe etc. The best way to adress this is to learn as much as you can. Have a neuro who is well acredited, that you have a good relationship with, who you trust and will take time to answer your questions and concerns with full explanations for his reasoning.
    best of luck to you, Mel
    __________________
    Congenital Cervical Stenosis,complicated by:
    Paracentral Disc herniations ,bone spurs C4/5,C5/6,C6/7
    loss of lordotic curve
    Advanced myelopathy inc. walking difficulty, loss of gag reflex with swallowing problems, neurogenic bladder, occipital neuralgia, spacticity

     
    Old 03-26-2003, 11:16 AM   #10
    Mike D
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    Thank you Mel - I have slight cord compression and one level of bone spurs. I would be a borderline canidate for minimally invasive IMHO.

    I'm not a physican, however, it makes common sense that after a one level fusion, added stress would be applied to adjecent levels. Opinions on this vary - my 60 year old GP told me yesterday that a one level fusion will lead to an additional fusion down the road "its a question of when" he said, "could be in 6 months or 60 years." I read some studies that state the contrary.

    There is no doubt that certain situations require fusion, I'm just trying to look at all options first.

    Thank you and kindest wishes,
    md



    ------------------
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-26-2003, 11:53 AM   #11
    Mike D
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    Kim,

    I'll try to answer questions below:

    <<You're doing traction at home? How long have you been doing traction and does it give you any comfort? If not to personal how and how long ago was your neck injured?>>

    Yes, I've had a Saunders home traction device for two weeks - it seems to be working, I've read a study that suggests around 70% of people with cervical radiculopathy are relived of pain within 6 months by using the home based traction. This is one study and I'm sure there are many differing opinions on the effectiveness of traction.

    My "rap sheet" is shown below in the signature - no particular injury noted other than very active in hockey, baseball, and weightlifting. Docs believe problems are from overuse "30 year old with a 60 year old back".

    <<One more thing. I see you had 2 epidural injections. What was your thoughts on them? I have an order to receive them if I would like but I was afraid all they would do was mask the pain and hide a potential problem? >>

    I had my first 2/17/03 - it lasted 3 weeks before symtoms began to return. Had the second last week. These have given me great relief - its been explained to me that these injections are intented to give one the time to heal - as you point out, the pain will return if the anatomy continues to irritate structures after the medrol subsides.

    Take care and best of luck,
    md


    ------------------
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-26-2003, 12:03 PM   #12
    melanie dawn
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    HI Mike,
    my neuro thinks and told me that further surgery is a very strong possibility after fusion. For instance, i have congenital stenosis throughout my cervical column. I have central herniations at C5-6 and C6-7, the cord is compressed at these levels and I have advanced myelopathy.But at C4-5 there is signs of mild degeneration already,, so he says he would never do the other levels and not do 4-5 , because the likely hood of its becoming symptomatic and causing major problems is almost 100%, quite quickly, so he will do all three. also that 4-5 causes some compression with my neck in flexion too. Point is that yes fusion does place increased strain on the levels above and below. This increases the chances for further surgery in the future. I guess the point is if you can live with your symptoms right now? For me i have progressed to using a walker to get around on good days. I will have the three level done ,knowing that in the future i will need a full laminectomy -5level. I could have had this now, but the recovery would be really tough, I would like to go back to work and finish my degree. So I will have the lesser surgery, and hope that it's a long time before I need the other.
    Didn't I see that you already have more than one level with degeneration?
    Best of luck with the decision making, its alot to get your head around isn't it.
    Mel
    __________________
    Congenital Cervical Stenosis,complicated by:
    Paracentral Disc herniations ,bone spurs C4/5,C5/6,C6/7
    loss of lordotic curve
    Advanced myelopathy inc. walking difficulty, loss of gag reflex with swallowing problems, neurogenic bladder, occipital neuralgia, spacticity

     
    Old 03-26-2003, 07:34 PM   #13
    BWL
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    Hi Mike,

    The attached article briefly addresses your question and the reasons for the confusion as to whether or not this phenomenom is real. It is a technical paper, but you can glean some info from it.
    [url="http://www.aero.ufl.edu/~rapoff/reprints/juxtdisc.pdf"]http://www.aero.ufl.edu/~rapoff/reprints/juxtdisc.pdf[/url]

    Feel well,
    bruce

    ------------------
    ACDF with plating and donor bone C6-7 (1/29/03)
    __________________
    ACDF with plating and donor bone C6-7 (1/29/03)

     
    Old 03-27-2003, 08:02 AM   #14
    Mike D
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    Bruce - thank you for passing along - this does support the therory that fusion adds stress to other levels. I understand there are studies that report no link between fusion and increased degeneration.

    My personal opinion is that fusion is required in many cases, however, I'd prefer to try several minimally invasive procedures before fusion.

    md

    ------------------
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4
    __________________
    -6/7 hernation 5mm in AP diameter compresses left side of spinal cord and significantly compresses nerve roots
    -5/6 small protrusion, chronic right sided stenosis
    -4/5 small herniation and osteophytes compression of right nerve root
    -chronic moderate stenosis 2/3 and 3/4

     
    Old 03-27-2003, 04:57 PM   #15
    empi
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    Hi Mike, I've been reading some of your posts and I may be wrong but I don't think you should be having chiropractic manipulations of your neck if you have cervical disc problems. That could spell real trouble. I know. I had an ACD using donor bone in November 2002. Than god everything turned out well but prior to finding (MRIs) that I had such serious problems I was going to my chiro. My neursurgeon said I was lucky I stopped going to have those manipulations otherwise I would have been paralyzed. My symptoms started with numbness and tingling in the hands which graduated to severe numbness and tingling and left foot sticking to the ground, weakness in legs, severe muscle fatigue and wobbliness and shakiness. Falling, stumbling and balance loss. My ACD was at C-4 and C-5. I am no shceudled for a cervical laminectomy ( I have stenosis) spinal chord narrowing between C-4 and C-6). I am not concerned about the surgery as my Neuro did such a great job on my neck.


    I would be careful about any more chiropractic manipulation if I were you.

     
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