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10 Days Post ACDF
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10 Days Post ACDF

Hi all,

I am 10 days post op from two level ACDF surgery. My recovery has generally been quite good. I am walking a mile each day and getting stronger.

However over the last couple of days I have been experiencing some sporadic arm weakness in both arms. I had a little bit of weakness before my surgery in my right arm only. But since the surgery I seem to be getting it in both arms and am a little concerned that the surgery may have done more damage to the nerves I was trying to get some relief on.

Is this normal and just part of the nerve recovery process?

Any thoughts would be greatly appreciated.
Thanks
Iv
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27 Comments Post a Comment
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Avatar_f_tn
I'm 8 weeks post-op (3 level ACDF) and I too experienced similar symtoms (symptoms) about the same time in recovery as you.  Before surgery I had severe pain, tingling, weakness and numbness in my left arm and hand predominately.  About 5 days post-op it seemed everything blew up.  I had the same symptoms not only present in my left arm and hand, but also in my right (not too mention shoulder blades).  (I contacted my surgeon when all this happened since I was very anxious that the surgery failed.  He said that this can happen and should get better). Those symptoms lasted for some time and seemed to come and go at different levels of severity.  Right now, I don't have the symptoms in the right arm and hand at all and symptoms in my left arm and hand are much, much less and seem to be improving all the time.  I know everyone is different, but I think the tremendous swelling in my neck after surgery contributed to having symptoms on both sides.  This is only what happened to me.  You may want to call your doctor for advise and/or reassurance.
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Avatar_m_tn
Hi Katieroc,

Congratulations on making it to week 8. I must admit I am a bit anxious and am seeing my GP on Friday. I have my catchup with my nuero at the end of March and hoping by that stage the symptoms would have improved. I also have some severe pain in the base of my neck but again I am assuming it is only because I am so early post op that I shouldn't worry. I am very happy that I have stopped taking all forms of pain killers.

I have lost the tingling and pins and needles sensation in my left arm. I also had a drawing arm pain which seems to have been fixed with the op.

How are your symptoms now? And did you take on any physical therapy?
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Avatar_f_tn
Hi lvxample,

I notied that you are from Australia. May I know where did you have your ACDF and done by who? And which method and material did you have?

I am also from Australia and recently been advised by 2 Neurosurgeons to have ACDF for C5-6 and C6-7. I was introduced to 3 different techniques, 1.ACDF with P.E.E.K and autograft; 2. ACDF with Zimmer Trabecular metal (TM) and tricalcium phosphate; 3. Artificial disc replacement.

Have not decided on which method yet, still trying to find out more on each pros and cons.
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Avatar_f_tn
Hi "iv",

Post-op I also had considerable pain at the base of the neck and my shoulders were just awful.  I believe that was partially because I was wearing an Aspen collar 24/7 for 6 weeks.  The neck pain is basically gone now, but I still have shoulder pain.  I've just started driving again which is somewhat challenging, but that has also gotten better since I can turn my neck more.  This past Friday I started physical therapy--neck, shoulder and upper body exercises.  I'll be going 3 times a week for 4-6 weeks (also daily exercises at home).  I'm hoping to return to work at the end of the month.  As far as the left arm (predominately symtomatic), it has gotten much, much better.  Everyday is different, though but I believe it will keep improving.  My shoulders do bother me though.  For whatever reason my right shoulder is most painful.  For 3-4 weeks I had pretty bad hip pain (from the autograft), but I don't feel it at all now.  What's troublesome for me now is residual swallowing issues.  I can only hope that improves as well.  I walk 4-5 times a week for about 45 minutes hoping that will help with my recovery.

Just as an FYI--I had 3 level ACDF with autograft, cages, plate/screws.

You seem to be doing well, iv since you are off pain meds.  That's great after only 10 + days post-op.  Good for you.  I wish you continued success on your recovery.
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Avatar_m_tn
Hi SHC,

I am in Melbourne and had my ACDF done by Dr Myron Rogers at Cabrini Hospital, Malvern. Apparently he is the best in Victoria and knows this operation inside out. I had the operation at 1:00pm and was back at home at 1pm the next day.

As for the different options, it is difficult to suggest which one is best. After running through my pre op symptoms ie pain and numbness in neck, shoulder and arms, Dr Rogers told me what his preference was. I ended up getting carbon fibre replacement discs on two levels (the same as yours) and fusion. I believe the bone graft is a little more painful from what I have read as they need to operate on your hip as well. I would suggest being guided by your neuro on that choice. I don't have a medical background so I left the choice up to the experts.

Good luck with your operation. Although I have been in a lot of pain and am only 2 weeks post op, most of the old symptoms seem to have dissapeared.
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Avatar_m_tn
Hi Katie,

I actually spoke too soon about the pain killers. Yesterday was a bad day. Lots of pain in the base of my neck so I caved in and took 2 tabs to relieve it. I am hoping this pain eventually goes away and I can get off those drugs.

My neuro told me not to wear a collar of any sort after the op. I ended up buying a soft collar anyway but hardly use it. You are right about the different symptoms. Today my shoulder is hurting and it never has before but I am sure that this is just part of the recovery process.

Great news that you are driving already. I just bought a new car and my girlfriend is driving it everywhere (so jealous lol). Really looking forward to getting back in the drivers seat but I think I am still 2 or 3 weeks away from that.

How long did your neck pain last for? I find when I go for a walk, 5 minutes in and the base of my neck starts to ache like you wouldn't believe. Did you have this as well? It is really worrying me because it isn't a pain I can deal with. I hope that it starts improving soon :) The other symptom I have had is loss of appetite and nausea. I think this may have something to do with a foreign object in my neck and my body getting used to it.

Was the PT recommended by your surgeon? I still have another 6 weeks before I see my neuro for my first check up.

It sounds like you have made great progress Katie and your positive steps have given me great inspiration. I hope to start working from home next week and gradually build up my confidence and strength to get back to work in a month or so.

Best of luck to you Katie.
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Avatar_f_tn
I read all the other posts and wanted to throw in my two cents. I am from the US and have recently had multi level ACDF with cadaver bone. My doctor said that in the US replacement discs are not approved for more than one level. I was given the choice between hip bone graft and cadaver bone graft. The recovery is much harder with hip bone graft because of the additional pain from the hip. Hope this info helps
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Avatar_m_tn
Hi Sharadale,

Do you know why it isn't allowed in the US? In Australia it is allowed and my neuro said for my case, it was the best solution.

Hope your recovery is going well.
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Avatar_f_tn
Nerves can take awhile to reguvenate and u can expect to feel a wide range of sensations during the recovery period. *hugs*
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Avatar_f_tn
Hi lvxample,

Thanks for replying.
So you have got artificial disc replacement (ADR) done? What’s the make and model of the disc? Or was it carbon fiber disc spacer and fusion? Sorry I am a bit confuse as I was told by my Neurosurgeon in Sydney that ADR is not subsidizing by Medicare so the whole ADR surgery will not cover by private health fund either. How much did it cost you? ADR would be my first choice if I could afford it.

He recommended ACDF with Zimmer Trabecular Metal (TM) and tricalcium phosphate and titanium plate. I will most probably choose this method.
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Avatar_f_tn
Hi lvxample,

Thanks for replying.
So you have got artificial disc replacement (ADR) done? What’s the make and model of the disc? Or was it carbon fiber disc spacer and fusion? Sorry I am a bit confuse as I was told by my Neurosurgeon in Sydney that ADR is not subsidizing by Medicare so the whole ADR surgery will not cover by private health fund either. How much did it cost you? ADR would be my first choice if I could afford it.

He recommended ACDF with Zimmer Trabecular Metal (TM) and tricalcium phosphate and titanium plate. I will most probably choose this method.
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Avatar_f_tn
Hi lvxample,

Thanks for replying.
So you have got artificial disc replacement (ADR) done? What’s the make and model of the disc? Or was it carbon fiber disc spacer and fusion? Sorry I am a bit confuse as I was told by my Neurosurgeon in Sydney that ADR is not subsidizing by Medicare so the whole ADR surgery will not cover by private health fund either. How much did it cost you? ADR would be my first choice if I could afford it.

He recommended ACDF with Zimmer Trabecular Metal (TM) and tricalcium phosphate and titanium plate. I will most probably choose this method.
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Avatar_f_tn
Hi lvxample,

Thanks for replying.
So you have got artificial disc replacement (ADR) done? What’s the make and model of the disc? Or was it carbon fiber disc spacer and fusion? Sorry I am a bit confuse as I was told by my Neurosurgeon in Sydney that ADR is not subsidizing by Medicare so the whole ADR surgery will not cover by private health fund either. How much did it cost you? ADR would be my first choice if I could afford it.

He recommended ACDF with Zimmer Trabecular Metal (TM) and tricalcium phosphate and titanium plate. I will most probably choose this method.
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Avatar_f_tn
Hi lvxample,

Don't feel bad about giving into taking a pain pill!  I do know what you mean, though.  I fought myself when deciding whether I needed it or not.  Soon after surgery, I would take one when I was going to do anything physical, i.e. exercise to try and eliminate severe discomfort afterward.  Eventually, I didn't feel a great need to take them although I would take one before going to sleep since I basically slept in a recliner all night.  The collar was just too uncomfortable to sleep in a bed.

I didn't have a desire to eat much at all initially post-op.  Just swallowing food was a challenge, but it got better and better.  I don't think I was nauseous at home (in the hospital I was from the very stronge IV pain meds), but I definitely had/have bad acid reflux which is still happening.  I went on medication from my GP, but I don't think it's helping much.  As I said, this is very bothersome and I'm not sure why this happened post-op when I never had it before.  I am going to talk to my surgeon about it on my next visit.

I did have neck pain (base of neck) post-op as well as shoulder pain.  My surgeon said to expect it.  It probably was a 50/50 kind of thing half from the surgery and half from the collar.  It was pretty constant, but has greatly subsided since the collar came off.  The shoulder pain continues, though.  If your neck pain continues you may want to talk to your doctor.

My surgeon recommended PT, but I had to wait 2 weeks after the collar came off to start (began at 8 weeks post-op).  My first visit was fine, but my second yesterday was brutal!  Lots more exercises added, weights, bands, etc. for upper body.  I'm sure I will get used to it, though.  Just 5 1/2 more weeks of that!!!  LOL!

I have to say going back to work scares me a little (well more than a little).  I get so fatigued in the afternoon, I'm concerned what I'm going to feel like after an 8+ hour day.  Time will tell.

lv--I think you are doing great in the brief amount of time since your surgery.  I don't even think I went on my computer for about 4 weeks after mine!

katieroc
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Avatar_m_tn
Hi Katie,

Yes I am currently in the process of testing my pain threshold. Right now it's at about 2 days before I need a pain killer. I am hoping to try and extend that out by a day each time and eventually, when I don't have the pain in the base of my neck, I can get off them altogether. In hindsight would you have worn your hard collar for so long? I have heard that your neck isn't strong after wearing one but wasn't sure if you experienced this yourself.

I am not sure what it is with my appetite. I usually love my food but over the last 4 or 5 days, I have completely gone off it. It is a nagging nausea feeling. I still get hungry and feel like i could eat a lot, but when I start eating I find that I don't get through a full meal anymore. I also burp a lot so it might be GERD. If it is, I wonder how long this will last? I hope it isn't a reaction to the hardware in my neck.

While not great for you, it is good to know you had neck pain like I do. It is the only pain I really have right now. I am only 13 days post op and patience is not my virtue so I just wish it would go away but I understand this is part of the healing process and I will need to be more understanding. After one day of no pain killers, it feels like someone has a chisel in the base of my neck and they are chiseling away. Really bad pain.

I am very interested in how you get on with PT and if you find it beneficial. If you find it to be useful, let me know as I am open to all suggestions on improving neck strength. Don't be worried about work. I am sure they will be flexible to your needs and they should understand you have been through major surgery and need to ease your way back in to normal life.

Thankyou for your positive comments and good luck in PT. Keep me posted on how you go.


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Avatar_f_tn
Apologize for multi posting. Didn’t realize I have posted four times! I hit the “Post Comment” button once but the website was hanged for more than 15 minutes with the progress bar stop at half way. So I closed it and reopened it and tried the second time and it hanged again. I thought there was a website problem and just closed it again. I presumed it didn’t go through and was going to give it another go tonight. Luckily I checked first... (Red face) sorry.
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Avatar_f_tn
Hi sharadale,

I agreed with you. I would most probably choose ACDF with Zimmer Trabecular Metal (TM) and tricalcium phosphate and titanium plate since I can’t afford the ADR. I heard it might cost around AUD30K for a disc replacement.

I have also multiple bulging lumbar discs (L3-S1) with annulus tear at L4/5 which have causing me on going pains and referred symptoms down my legs. So I would really like to avoid anymore trauma to my pelvic region.

I heard story about metal implants are sensitive to temperature changes. Recipient would feel pain and discomfort especially when the weather turns cold. Is this true?
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Avatar_f_tn
Hi "lv".  I definitely had a loss of appetite (couldn't finish a cup of soup) a week post-op and when I could get solids down, I really couldn't finish a small portion for 2+ weeks after that.  I'll bet within the next few days you'll be feeling up to eating more and more.  Pain meds can also suppress appetite (and increasing nausea), but you are doing really well with them.  Far better than I at that stage post-op.  But when you have severe pain, sometimes you have no choice but to take your meds.  As far as burping, I find myself doing it so frequently and at really embarrassing moments!  As I said before, the feeling of obstruction in my throat and the GERD are the most bothersome to me.  Yesterday, I had a very good day with my "throat" so that was encouraging.

Unfortunately, I had to wear the collar for the 6 weeks based on my doctor's recommendation.  Probably because I had a 3 level and needed the extra stability.  It very much weakened the neck muscles just like being a leg or arm cast.  When I finally took it off for good I had the feeling I couldn't hold my head up!  That has gotten so much better and I have to believe the PI will help.  I'm actually off there right now.  I will keep you posted on how I make out with it.

I hope you continue to get stronger each day, lv.  Hang in there!

Katieroc
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Avatar_f_tn
I also experience GERD.the doctor told me to take Prilosec everyday to reduce this. The pain meds can interfere with appetite by causing naseau. If you take your meds with a small amount of food this will help with that as well.
Today was a pretty good day for me. I had a lot of pain the last couple of days and was taking pain meds and muscle relaxer. I had stopped taking them and was very upset that I had to take them again. Last night I realized that I was shrugging my shoulders without realizing it, so this morning I took only the muscle relaxer and made a conscious effort to relax my shoulders. This made such a difference in my day.
Hope u all feel better soon.
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Avatar_m_tn
Hi SHC,

Yes I had carbon fibre disc replacements on two levels and fusion. I am not sure exactly what type of steel they used but my neurosurgeon recommended that for my situation, this was the best solution and would result in the speediest recovery.

As for the cover, I have private with HBA (not Blue Ribbon but the one under that) and I still found myself out of pocket around $3000 The hospital stay was around $500 for the excess, neuro was a flat $800, neuro assistant around $500, anaesthetic $750 etc. I don't think it made a difference to my coverage if the surgery was ADR or bone graft (not that I was told anyway).

Because this surgery is elective, expect to be stung especially if you are having it done at a private hospital.

All the best in your decison making :)
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Avatar_f_tn
Thanks for the info ivxample.
I am surprise to see such a big difference with your out of pocket expenses and what my surgeon quoted me. I was told it would be around 30K out of pocket for ADR as there is no cover by neither Medicare nor private health fund in Australia. I shall try contact your hospital and surgeon for more details and check with my health fund again. I am with NIB Gold Top over with no excess.
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Avatar_f_tn
Hi All - I have a prolapsed disc at C5-C6 and am currently considering the operation - a fusion as opposed to a ADR. An ADR is not subsidised by Govt funding and hence no private health care will fund it either. I was also told it would cost $30k-$40k.  A friend of mine had the same operation by Mr Rogers and he recovered in a week. He is already back to work.

One question though for all of you - are you glad you have had this operation? or do you wish you hadn't done it? How is the overall pain compared to before? I would be grateful for your thoughts.
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Avatar_m_tn
Hi Spiderman,

Yes I had a two level fusion. I didn't realise that ADR is not subsidised by the government. My out of pocket expenses were quite reasonable compared to the cost associated with ADR.

My advice regarding the surgery is to consult your neuro and discuss the options. Then discuss the operation with your family. If your symptoms are restricting your lifestyle then it is time to consider surgery. In my case I had severe cord compression and some obvious symptoms that needed to be fixed immediately. I dreaded the thought of an operation but in the end it was quite a simple decision.

Dr Rogers was an absolute star. He is an interesting character. Very matter of fact about everything. He talks about the operation like he is cooking dinner - very simple and in his own way, puts you at ease.

I am now 3.5 weeks post op and am having some mixed results. The terrible neck and right arm pain I had pre surgery has completely gone. I had left side numbness/weakness in my leg and groin area pre surgery which went away for a couple of weeks post op but has returned in the last week. My neck is getting stronger each day and the lateral movement is getting better. I walk around 3km's each day and while in pain on occasions, getting out and about allows me to get some routine back in my life. I am returning to work on Monday for a couple of hours to see how I go. Hope to be driving again in 4-6 weeks. Your mate has done really well to get back to work in a week. Wow!

If I had to write up a pros and cons list regarding the surgery I would say do it. It isn't worth doing long term damage to your spinal cord by waiting around hoping the symptoms will get better. Even though all of symptoms haven't been fixed (yet) I am in a much better place than I was pre surgery. I hope that the left sided numbness will eventually heal over time. Apparently it can take up to a year before the nerves start to repair so I have to be patient.

All the best to you and good luck if you pursue the surgery option.
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Avatar_f_tn
I can't answer that question as I had no choice. My neurosurgeon said that if I didn't have the surgery I would have permanent nerve damage that would leave my left arm paralyzed. The recovery has been longer than I anticipated but the surgery was not that bad.
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Avatar_f_tn
My neurosurgeon also told me that my right hand may suffer permanent nerve damage if I do not go ahead with the ACDF surgery (judging from my MRI scan and symptoms during the consultation). But I am still a bit reluctant to give in to surgery too early. I am concern about the post-surgery side effect which would accelerate adjacent discs degeneration. I am scare to think about down the track there will be more ACDF to be done on the adjacent discs. I have not booked my appointment with my Neurosurgeon yet. May be I should as the nerve symptoms sometimes worried me.

My pain and nerve pinching  symptoms seems to fluctuate and at the moment it has improved a bit and I have a fairly good head movement. I felt that perhaps I should consult a Neurologist first. Except that the earliest appointment I could get to see a Neurologist is in four months time.
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Avatar_f_tn
Just wanted to add that this is not a quick procedure and recovery. I am 6 weeks out and still am not able to get back to work. Can't drive yet and have residual pain as my nerves are starting to heal and activate. Before I had the surgery I spoke to people who said it was the best thing they ever did, however I guess I thought that I would get pain relief right away. I dis not. I found out the the recovery can be around 18 months before the fusion is complete. I cannot tell you whether I would do it again because I really felt like I had tried the other options. consider your options and ask lots of questions.
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Avatar_n_tn
How long have you had the symptoms before deciding for the surgery?
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