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  • Fusions plus replacements?

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    Old 10-08-2014, 11:21 AM   #1
    Lionor
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    Fusions plus replacements?

    Hi everyone,

    Like with most of you it's been a long journey with neck problems and related pain. I went to multiple surgeons last year (wrote about my experience here) and got so many different answers my head was spinning. A year later I did another circuit at the recommendation of my Physiatrist.

    Still got a couple of different answers, #1 said three level fusion (C4-C7) and #2 said wait until I develop more myelopathy, then do a Laminoplasty. Both made me feel a little rushed. I just met with #3 this week - what a difference (maybe because he was a bit younger? maybe because he had spine issues of his own?) but he took a lot of time with me. Together we compared the last 3 MRI's and the deterioration. Based on his opinion, he would like me to wait until I start to show more advanced problems, but that being in pain for so long I could get it now. He explained my pain. No one really had an answer for my pain, neck, shoulder, arm, jaw...but he summed it up and hit the nail on the head. I was very happy (if you're in the Philadelphia area I would be happy to give you his name).

    Anyway, I digress. Based on my age (32) and my severe stenosis, arthritis etc primarily coming from the front. He recommended C6-C7 ACDF, C5-C6 ACDF and C4-C5 disc replacement. No other doctor has given me this option. Ruled out any replacement based on the multi-level. I'm excited about this option as it alleviates the pressure on the above vertebrae. Unfortunately, he is still trying to get replacement pushed through with the hospital - but knows a surgeon who can help (seeing him in two weeks).

    Bloody ell - I digressed again....My question - Has anyone had a fusion/replacement combo? Would you give me your thoughts/experiences please? Also, anyone had a multilevel (3) anterior surgery? Again I would very much appreciate your thoughts.

    The replacement for up to 2 levels is now approved by the FDA. I also realize that pain is not the best reason to get surgery. But I've been assured it's in my future soon based on how I am progressing.

    Lastly - Neurontin? He recommended I give it a try. Does anyone have any experience with this med? More specifically, to guys out there who have tried it, did you notice any changes in libido? T levels etc...? Iíve seen a study on mice, but not humans....any although I do consider myself a bit of a doctor Doolittle those damn rodents refuse to give me any straight answers!

    Thanks as always folks - love having this resource.

     
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    Old 10-08-2014, 01:21 PM   #2
    Ruffdogster
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    Re: Fusions plus replacements?

    Hiya Linor! Can you explain replacement to me? Is he talking about replacing 1 disc? With ACDF they remove the original disc and replace it with either your own bone or a cadaver bone. I don't believe they just do ACDF and leave nothing there.
    I am post op 3 wks. with ACDF C5-6 6-7 surgery using cadaver bone to replace the disc and fuse the spine. I had C 3-4 4-5 done 2 yrs. ago. after 2w theurgeon says all looks good and the C 3-4 4-5 are solidly fused. My next check at the end of the month should show the new surgery fusing, as I expect to be back to work the second week of November (8wks) post op. This surgery was a bit more involved, as he had to remove all the hardware from the first surgery and use all new plate/screws for this second one. I was in the hospital over night and sent home the next day. I felt great with just a sore throat as my vocal cords were moved to the right. I used no pain pills at all and it was just a tad hard sleeping wearing this hard collar 24/7.
    At three wks.out , I feel great! I must say however , I am not a normal patient. I don't let this hold me back, I move on with what needs to be done and I ignore a lot of the pain in my back.
    The pain in my neck and arms has dissipated and I will have to wait and see if the nerve heals, so I can get some of my arm function back, Doctor is very optimistic it will get better.
    When it comes to these surgeries there is no guarantee all pain will go away, however in my case after 6 back surgeries the pain is to the point I can tolerate it.
    Listen to your doctor and research, but remember that once nerve damage starts you want to address it ASAP before it gets to the point it becomes permanent, there is no fixing it.
    I will make this declaration ! I am not a Doctor and my views, decisions are mine and mine alone. Good luck ! feel free to ask more questions we have very good folks on here, that are knowledgeable and willing to help.

     
    Old 10-08-2014, 04:30 PM   #3
    ChuckStr
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    Re: Fusions plus replacements?

    I've heard of mixing Disk replacement with ACDF. A surgeon I've consulted recommended a 3 level acdf because of spondylethesis (slippage of the vertebrae) but said he could address any adjacent segment problems with disk replacement should they arise.

    A disk replacement for those that dont know, is replacement of the disk with an artificial one made of various materials (metal, plastic, ceramic). This allows preservation of movement, and shorter recovery times, and no chance of a non-fusion happening. Of course it is possible that these disks can slip and put pressure on surrounding nerves or the spinal cord. This is why it is imperative to have an experienced surgeon doing this to use the correct size disk replacement and place it correctly to minimize the chances of slippage.

    My surgeon is about as experienced as they come in disk replacement. He was part of the initial trials of 2 of the artificial disks and was one of the first surgeons in the country to do a 2 level disk replacement. This brings up another potential drawback of ADR, which is lack of long term efficacy results. The initial results are very encouraging but they just haven't been in use long enough to have good, reliable long term data as with ACDF and other types of fusion.

    I've never heard of mixing in a single surgery and doing separate acdfs at two levels seems strange. I would be concerned if your spine showed any evidence of instability. Either way I'd get opinions from people who have done a lot of ADRs. This isnt something for a novice to try I don't think.

    As far as neurontin, I've known several people who have had good results with it foe spinal nerve pain. The big obstacle seems to be side effects but if you can deal with those it may help although not everyone gets relief.

    Good luck and let us know how you get on...

     
    Old 10-08-2014, 05:18 PM   #4
    teteri66
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    Re: Fusions plus replacements?

    Lyrica is a newer re formulation of neurontin and has fewer side effects for most people.

     
    Old 10-13-2014, 06:47 AM   #5
    Lionor
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    Re: Fusions plus replacements?

    Hello all,

    Thanks for the replies, very encouraging. Ruffdog - great to hear how well you are feeling after multiple surgeries.

    Chuck - please could you expand upon this statement "I've never heard of mixing in a single surgery and doing separate acdfs at two levels seems strange."

    Wouldn't they have to do two ACDF's for two levels. And why wouldn't they do it all at once? Is it less stable?

    I am seeing another neuro at Jefferson for a consult on the procedure. Aside from preserving mobility, I am told an ADR will lessen the chance of additional surgeries down the road due to the typical additional load caused by ACDF.
    I agree - no novice will be doing my neck surgery. The guy I'm going to see is experienced with mixed multi level C-spine surgeries. It seems a lot of the older generation of surgeons stick to ACDF because it's what they know and they have shown good success over time. ADR's have not been approved in the US by the FDA for long. But in other countries (Germany) they have been in use a lot longer. The findings are promising.

    I will look up Lyrica.

    Thanks again all.

     
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    discectomy, fusion surgery, stenosis



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