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Failed Cervical Fusion
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Failed Cervical Fusion

  I am 9 wks post op from C4-5 ACDF; the graft has shifted forward. My hand and arm symptoms have returned, although not quite as servere as before surgery. My neck is more painful than the immediate post-op period and pops when I turn my head. I have had a severe migraine-type headache each day for at least six days. Friday was the worst with nausea and light sensitivity. The pain began in the back of my neck and almost simultaneously in my mid-forehead.
  Next appt with neurosurgeon is a wk away. At my 6 wk post-op visit, he realized I had been taking Relafen, which I assume is why the graft did not take. (I was not instructed to stop the Relafen post-op.) He told me to return if I developed swallowing problems or when my arm pain returned to pre-op level.
  Are the headaches likely related to the failed acdf?
  Is there an optimal time period to wait before undergoing revision?
  The first few wks after surgery were the first I remember in my entire life without neck pain. I'd like to experience that forever!
  BTW, I am a 47 yr old female with fibromyalgia (thus the Relafen).  In June 1997 I had surgery for tennis elbow with radial tunnel release.  Those symptoms returned after 8 mos. and MRI performed in May 1998 revealed cervical bulges, spurring and nerve impingement.  I also had successful L4-5 diskectomy and foraminotomy (no fusion)in 1993.
Dear JK,
On occasion a bone plug will 'pop out' of the disc space after cervical fusion
surgery.  The decision to return to surgery for a revision depends on the degree
to which the bone plug has moved and the symptoms you are having.  Given that
your symptoms were completely gone after surgery, and now they have returned,
your surgeon will likely want to revise the graft with another surgery.  
It is a bit early to say that the fusion itself has failed, as this can take
a few months.  However, if the bone plug is significantly out of place it
should be revised.  Symptoms from this may include a return of preoperative
symptoms as well as difficulties with swallowing.  If your symptoms are not
that bad and the bone plug hasn't moved much, the surgeon may opt to simply
observe for now.
Speak to your surgeon about the severity of your symptoms and the degree to
which the bone plug has moved for his opinion on the situation.  In your case,
a revision may be in your best interest.
Good luck.

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