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Failed fusion? Bone graft protruding?


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Old 11-16-2013, 04:02 PM   #1
jennaf73
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Failed fusion? Bone graft protruding?

In Dec of 2012 I had a 1 level ACDF at c5/6 for a large herniated disc. Since the surgery, my symptoms have gotten worse as has the pain. I've gone through months and months of PT, tried just about every anti-inflammatory out there, been on all kinds of meds, tried trigger point injections, a medial branch block and even had a surgery on my shoulder because the orthopedic surgeon thought it was frozen shoulder (since nothing else worked). After all of this failed, I was finally sent back for another MRI. To my surprise, it shows a disc herniation at the same level. Now to my question....what's the possibility that this is the bone graft that's protruding? There's no way it can be the disc since it was removed. I'm so confused and frustrated. Anyone have this happen?

 
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Old 11-16-2013, 11:24 PM   #2
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Re: Failed fusion? Bone graft protruding?

I'm no surgeon, but I believe that in the typical ACDF procedure, the entire disk is not removed. Instead, just the ruptured and protruding portions are removed. So there is still some disk remaining that might reherniate on rare occasions.

On another note, usually anti-inflammatory drugs are not allowed after spinal fusion surgeries until there is radiological evidence that fusion has successfully occurred. There are chemical messengers called prostaglandins that are involved in directing the formation of new bone that anti-inflammatory drugs would block out, thus impeding the new bone that must form to solidify the fusion. That means no drugs in the ibuprofen, aspirin, naproxen, etc... families are generally allowed. Please double check with your surgeon to see if its OK for you to be taking these medications as they are thought to be the cause of fusion failures in some patients.

Personally, I had a C4-5 ACDF in 2006 and I did not do well after the surgery. Within that first year we knew it would only be a matter of time before I would have to have my single fusion extended. I held out until Feb 2013 when I finally had my fusion extended to run from C3-C6. During those years in between the 2 procedures, it became apparent that I had more extensive joint issues going on and I was diagnosed with Ehlers-Danlos and with Scheuermann's disease. It was a relief to finally get a full diagnosis as I finally now know fully what I am facing. As long as you are continuing to have problems, keep pushing your providers for answers and explanations for what your on going issues are. I had to learn to be a strong self advocate, should your problems continue, please don't be afraid to advocate for yourself when needed.

Good luck!!
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Severe DDD with multiple herniations and areas of stenosis, 16 affected disks!
C4-5 ACDF 2006
C3-6 ACDF 2013
Chronic Myofaschial Pain Syndrome

 
Old 11-17-2013, 12:19 AM   #3
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Re: Failed fusion? Bone graft protruding?

ACDF procedures do remove all the disk and put a bone graft in the disc's place. I had one 09/2012. I would be asking the surgeon about this. If the bone graft shifted he would know. Then I would be taking my MRI to a second neurosurgeon for a second opinion.

 
Old 11-17-2013, 05:00 AM   #4
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Re: Failed fusion? Bone graft protruding?

Maybe consider a whole new set of docs? Putting you through all that - especially the surgery - before ordering an MRI makes me thing that those docs are either incompetent at treating you or all too competent at sucking money out of you.

As for only part of a disk being removed in an ACDF, that's something I haven't heard before. It could happen sometimes, but I don't really see how. It'd be like removing part of a jelly donut. All the soft inner filling would be gone, and there'd be nothing left to herniate out later.

 
Old 11-17-2013, 10:58 AM   #5
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Re: Failed fusion? Bone graft protruding?

I don't think we are allowed to link to other references on this website, or I would be more than happy to reference my statement that the entire disc isn't necessarily removed during an ACDF procedure. But I was able to verify for myself with a simple search that several common spine disorder information sites confirm in their discussion of ACDF that the entire disk is not removed. Evidently it isn't usually necessary to remove the whole disk and by avoiding its entire removal the cord is protected from exposure to any more stress than necessary during the procedure. Again, I'm not a surgeon and if I am misunderstanding what I have read I apologize. I am someone who has had ACDF procedures done twice, and I am facing a thoracic surgery in the near future. In discussing the second ACDF I had in Feb 2013, my surgeon specifically discussed the fact that I did NOT have any reherniation at my original disk removal site. When I expressed surprise that such a thing could even happen as I thought that disc was gone, my surgeon explained to me that it isn't really ALL gone. And he further confirmed that what remains is capable of herniating further in rare instances. That was big news to me at the time too.

Leanne
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Ehlers-Danlos Syndrome Type 3
Scheuermann's Kyphosis
Severe DDD with multiple herniations and areas of stenosis, 16 affected disks!
C4-5 ACDF 2006
C3-6 ACDF 2013
Chronic Myofaschial Pain Syndrome

 
Old 11-17-2013, 12:25 PM   #6
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Re: Failed fusion? Bone graft protruding?

Interesting.... let's hope that, in Jenna's case, it really is a herniating disk fragment, as that would seem to be preferable to a protruding bone graft. My guess would be that the MRI would allow differentiation between disk material and bone...

 
Old 11-17-2013, 07:00 PM   #7
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Re: Failed fusion? Bone graft protruding?

Thank you all for your responses. I see my spine surgeon on Tuesday, and he'll hopefully have some answers for me. As for the MRI, I had one before the first surgery, so they didn't go in blind, this is just the first one I've had since then. I also was unaware that they didn't remove the entire disc, but I thought that was something he said while explaining the procedure. Again, I have lots of questions for him on Tuesday. I'm just confused and now even more frustrated. Again, thank you all!

 
Old 11-19-2013, 01:06 PM   #8
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Re: Failed fusion? Bone graft protruding?

A quick update, there is no herniation, it's scar tissue that's causing the bulge. Good news! And he did confirm that the entire disc was removed during the ACDF. Bad news is I'm going to have to have surgery on my shoulder, off to the shoulder boards I guess Thank you all!

 
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