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Neurology (Expert Forum)
Revision Surgery failed ACDF
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Revision Surgery failed ACDF
by mbailey100, Feb 10, 2006 12:00AM
I had an accident at work 2-3-04 resulting in disk herniations at c-4 through c-7. Symptoms started about 2 weeks later, knife between shoulder blades, left then right hands went numb and became weak, I delevoped a terrible gait prob./spastiscity After a little delay by workers comp. I had an ACDF c4-7 w/titaniam plate and donor bone on 4-22-04. Started P.T. approx. 7 weeks post op, quickly regaining strength. about 3 weeks in as I was doing a rowing exercise it felt like my left shoulder and arm were being ripped out. Therapist said just discontinue upper body work for a while and see what happens. No improvement in a couple weeks so Dr. ordered MRI Of thoratic. Neg. No more gains in strength and almost constant pain after that. I was finally sent by workers comp for IME, DR. listened to symptoms and did a series of x-rays that show lucency at c-5 c-7. followed by MRI and CT that confimed little if any union c-5 through c-7. Also new herniation at c-3/4. NS wanted to observe for a while, I went back 2 mos. later and he wants to wait 6 more mos. I'm going for a second on 2-22-06, and I want to know what I should be asking. What I've read says a revision is usually done posterior.
1. What happens to the bone plugs at c-5/7, they've gone lucent and haven't fused properly, can they fuse after all this time?
2. What are the chances the ACDF can be repaired from anterior.
Standing/walking aggravate gait prob and neck pain. There seems to be a relationship between head movement and pain level. I spend alot of time just trying to hold my head straight.
1. What happens to the bone plugs at c-5/7, they've gone lucent and haven't fused properly, can they fuse after all this time?
2. What are the chances the ACDF can be repaired from anterior.
Standing/walking aggravate gait prob and neck pain. There seems to be a relationship between head movement and pain level. I spend alot of time just trying to hold my head straight.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Feb 20, 2006 12:00AM
I cannot give you a formal medical opinion as this forum is purely eductional
Non-fusion is a known complication of spinal surgery and is difficult to resolve - normally your own tissue would bind around the grafts and metal to hold everything together and provide stability of the joints. If this does not occur (and we do not know exactly why unless there is a known infection) then the joints can remain unstable and prone to further injury. I am not an expert on treatment of non-union, but it may require removal of hardware and a re-do operation. The cleveland Clinic spine institute could provide a second opinion. I cannot comment on the xray findings without seeing the films. The new pain may or may not be from the discs or spinal roots - if sustained during exercise it could just as well be ligements or tendons. A good examination might be able to tell the difference.
An anterior approach is usually for pathology that is anterior such as central disc herniations and anterior osteophytes, probable to get at the same area they would need to go through the previous scar (avoiding the need for a new anterior approach and scar). Again I am not an expert on non-union so an experts appraoch might be different.
Good luck
Non-fusion is a known complication of spinal surgery and is difficult to resolve - normally your own tissue would bind around the grafts and metal to hold everything together and provide stability of the joints. If this does not occur (and we do not know exactly why unless there is a known infection) then the joints can remain unstable and prone to further injury. I am not an expert on treatment of non-union, but it may require removal of hardware and a re-do operation. The cleveland Clinic spine institute could provide a second opinion. I cannot comment on the xray findings without seeing the films. The new pain may or may not be from the discs or spinal roots - if sustained during exercise it could just as well be ligements or tendons. A good examination might be able to tell the difference.
An anterior approach is usually for pathology that is anterior such as central disc herniations and anterior osteophytes, probable to get at the same area they would need to go through the previous scar (avoiding the need for a new anterior approach and scar). Again I am not an expert on non-union so an experts appraoch might be different.
Good luck
and for the past three weeks, Neurontin 200mg.per day.
I was also wondering if a bone growth stimulator would help at this late stage.
Best wishes, Mike