Revision Surgery failed ACDF

[mbailey100]

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.

[CCF-Neuro-M.D.-PW]

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

[mbailey100]

A little more info; P.T. released me 1-31-05 saying I had reached MMI. Before injury I could bench press 225 lbs. after I could do about 95lbs. for example. They sent me home with instructions to walk and work out with dumbells which I continued to do through the end of Aug. I was miserble and decided to take a break. In approx. 3 weeks I felt a big difference, left arm, shoulder pain was greatly reduced. That's when I started to believe there was a conection between neck movement and pain/weakness. I couldnt understand how I could feel worse after working out.Mind you, despite complaints the neck was not examined post-op, save 1 xray 6-14-2004.It was right after that I was sent for the IME by workers comp. Also post-op I developed fasciculations on arms, torso, and left leg. Meds. are baclofen 60 mg. for spasticity in right leg. Ibuprofen as needed for pain (I later learned this was not good for fusion) I've been taking it since 8-05
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.

[itsallinmyhead]

I had surgery (Cervical Discectomy w/Fusion on C5-C6) in Aug.2005. Since then pain started 6 days after surgery radiating down both arms very bad.  Muscle weakness can not feel cold on left arm, right arm pain leg weakness and diarrhea for three months now.  I have found no relief with neurontin and skelaxin. Neurosurgeon just thru his hands up in the air and said "I did what I was supposed to do." Sent me to a Neuologist who tested me for nerve damage and said there was none. Pain Mgmt doc said to keep knocking on doors until someone listens.  I have a shock feeling that just zapps me in either arm randomlly.  I am so weak I cannot hold a blow dryer up for more than a few seconds without burning pain in my arms. All x-rays and MRI's are negetive. I have tried to research on the computer my symptoms but there are so many things with the same symptoms that unless I am tested I will never know what is wrong. Please help, does anyone out there have these same symtoms? Thanks for trying to help.

[mbailey100]

I had alot of goofy symptoms too. most have faded with time. It used to feel like I had cold water running down from my neck to the bottm of my ribcage and down to my hands as well, all on the inside! So it doesnt mean it's all in your head. Go through the archives and you'll find as many different kinds of symptoms as there are people, although there are those classics like shooting pain, numb hands, weakness, bladder probs, ect. I would suggest getting another opinion from another neuro doc to be safe. Show him your films. The others might have missed something. I had alot of problems for a long time and finally had an MRI which proved it was for real. I just got a second opinion and he showed me alot of cool stuff, like spinal cord atrophy and resorbtion occuring on c-6 caused by a fragmented bone plug. I have hope again and you should too. I know it's hard, but you're not that far into it, It takes time to heal so give you're body a chance, do research and cover all the bases.
Best wishes, Mike

[itsallinmyhead]

Thank you so much for writing.  I have a second opinion (actually my third opinion)on March 13th 2006 at the Virginia Mason Medical Center in Seattle Washington.  It will take me 6 hours to get there but I just know it will be worth it just for someone else to take a look at me.  I am also on a pain patch now so I get pain medication all the time now.

[mbailey100]

Hey good luck and let me know what happens.     Mike