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Fusion ... 2 be or not 2 be
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Fusion ... 2 be or not 2 be

Hello
I had a fusion surgery on C6/7 just over 6 mos ago.  At first bone was fusing, then next visit we saw some resorption, then next visit seemed to be going in right direction again (was using cervical bone stim).  Last visit still looked okay.  However I am having lots of neck/shoulder/trap pain.  Especially if I reach my arm adn turn my head.   Occasional pain in arm at elbow but much less than before. I had lots of weakness prior to surgery, that has improved greatly.    I am concerned about all this neck pain and it seems to be getting worse then better. I am told 12 mos is the timeline for pain to get better if it ever will.   I am concerned about becoming 100% fused  (I am not yet) and also wonder if once a bone is fused ... can it reverse?   Or if you are say, 80%, can you once again experience resorption>?    Thanks.
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Avatar_dr_m_tn
It is fortunate that your arm pain and weakness have improved a lot - that is great and the main goal of surgery. A single level ACDF operation (cervical fusion) is one the most successful operations that spine surgeons do.

The goal of surgery is to have the neck fuse at the level where the disc is removed. However, there are many methods of doing this. I don't know what you had done - ie. autograft (hip) bone, cortical allograft bone (hard bone), cancellous allograft bone (spongy bone), plastic cage, etc. Also if you had any special bone extender or BMP put in to promote fusion. And finally, did you have a metal plate put in. Typically with most fusion technique, the overall fusion rate exceeds 90% for a single level operation. However, it takes some time to get there.

Bone resorption is not typical unless there was BMP used or some movement around the bone. It can be seen early on. Usually with bone graft, there is evidence of lack of fusion/incorporation early on and at subsequent visits it gets better. Time will tell.

If you do not have bony fusion after 12 months or so AND you have ongoing neck pain, you may be suffereing from a pseudoarthrosis which means 'false joint'. Basically, because the bone hasn't fused, the gap between the bones is now a 'joint' that moves. Usually this is caused by bad luck, smoking, diabetes, moving around too much, and not using a plate. Again, it is pretty rare as fusion is the most common outcome.

Once fused, it is unlikely to 'unfuse'. Its usually a done deal - but you have to get there first. The worst possible outcome is to have evidence of total fusion AND to have neck pain. There often isn't much that can be done in this case.

You should probably continue to be followed out to 12 months and check on the status of the fusion  and hope for the best.
5 Comments
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Avatar_n_tn
I meant to say the neck/shoulder/trap pain seems to be getting worse INSTEAD of better ....
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Avatar_m_tn
pain may be muscular--ie tightness in traps/scms and especially the scalenes.
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268575_tn?1242906671
i had the fusion in neck also so far so good.my hand went a little crippled and i have atrafe,not sure if i spelled that right.im know facing lower lumbar l4 l5......you said in your last post fusions are 90 percent.........you do mean as in everthing goes well.....right
im very worried about my next surgury.my family needs me before we lose everything.i would like to know the success rate in that area...........does anyone know
please help before i make a BIG mistake and do the surgury
ty,alinpain
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Avatar_n_tn
Just my perspective and from having had two cervical fusions.  Six months is really not that far out from spinal surgery.  And I also wore a bone growth stimulator..both times...for 6 months.  Anyway, I don't think it is too unusual to have some pains in the traps, etc.  I know I am solidly fused at C3/C4 and C5/C6 but the other discs are taking on the load.  More recently I have aggravated the C6/C7 nerve root(s).  So, I am in PT now...actually just started because there is pain in my traps, neck and shoulders....yet my MRI and CT scan are fine.  So, Mike has a good point too...muscular and probably some spasms.  And maybe some radiculopathy??  Just saw my Neurologist for an EMG..and it was fine as well.  Soooo...I am thinking as Mike does...scalenes, traps, etc. and probably from weakness.  Hang in there...I hope it gets better.  Mine just seems to come and go and as my Neurologist and Neurosurgeon said...I will probably always feel aches and pains from time to time.  Ooops, and I have found massage therapy on the traps to be extremely helpful.  If and when you can, just try some LIGHT massage therapy.  If it doesn't help, I would get back with the surgeon to ask about PT or maybe even some injections if warranted.
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