Cervical Spine ACDF after Thyroidectomy for Thyroid cancer

[katbid]

Hello,

Last December I had a double wammie put on me.  I found out that I needed a total thyroidectomy due to Graves disease and then a week later I found out that I need this C4-C6 fushion done on my neck.  Well I had to put the cervical surgery on hold because it was more important to take care of the thyroid issues first.  So I had my thyroid removed and found out a week later that I had cancer.  I was treated with RAI (radio-active Iodine) and just had my first clean scan in Oct.  So I am officially in remission.  Well of course during this year of taking care of the thyroid issues, my neck and the pain and the numbness has gotten worse.  My nuerosurgeon recommends I do this quick because I will have to go back for a low dose RAI a year from now and apparently the radiation can affect how the bones fuse.  So my question;  Has anyone had a similiar situation?  If so, how was the recovery from the ACDF? Were there problems with thryoid levels during or after surgery?  My oncologist said I would have to go off thyroid meds for about two weeks prior to my surgery.  Not looking forward to that.  

Thanks

[philnoir]

Katbid's last post was in 2012 - I don't think she's around, which is perhaps good news.

I don't doubt that its the stenosis causing your neuropathy, ie, the parasthesias in your hands. I have foot neuropathy from moderate lumbar spinal stenosis, and the soles of my feet ache and burn more when I'm laying down. I believe it has something to do with closing down the cord space. I try lying on my side -- it feels better than lying on my back.

Also, make sure you're c spine gets support with a rolled up towel or pillow made for that purpose.

I'm sure you've mentioned these side effects to your doc, but if not, let him/her know.

Any pressure on the dura by disc material or bone can disturb circulation in the spine. The cord receives nourishment from small vesicles that arise in the dura layer and any interference from cord stenosis interferes with this circulation, causing a variety of nervous dysthesia at or adjacent to that level.

Sometimes I consider decompression surgery, but then I remember that without a herniation, there's nothing much to remove in there, and decompression damages essential ligaments, removes bone, and causes other destruction in the spine, adding additional scar tissue near the cord that may cause more pain.

A good physical therapist might help. Traditional PT I've found to be useless, but when  therapist gets in there and works to improve range of motion by having you push into an opposing force just beyond the sensation of pain, then with time, you can move that boundary outward so that pain is not felt in normal activities.

You mention hot flashes. If these are only in the arms and hands, then it is perhaps related to the cord stenosis. If you're feeling hot flashes all over, it could be the thyroid. People with overactive thyroids also tend to lose weight.

Another source of hot flashes comes the hypogonadism caused by long-term opioid therapy. However, at 3-4 Norco and  a few tramadol, you're not going to have this problem.

Best wishes.

[calvindarbonne]

Hi i'm new to this site but am starting my journey now as you have been doing. Last summer July 2014 i woke up and had severe pain in my neck and could not lift my head off of my chest...went to several Drs and it was determined I have cervical stenosis in c3-7 with arthritis growing in the spine at a rapid and dangerous pace. At any rate it was really bad for the first 6 months. I live in Houston so luckily i do have access to some of the worlds best DRS in the TX medical center. I'm on a regimen of 2 lyrica twice daily with tizanidine for muscle spasms, also take 2-3 a day 10/325 narco with about 4 tramadol a day..right now it mostly works...have already done the injections and they work for a little while. Have been thinking about doing the fusion this year but during one of my routine MRI's it was noted i had several nodules on my thyroid gland, and that i should get it checked out. last week a had a fine needle biopsy and it is suspected one of the nodules is cancerous. Today i'm seeing a surgeon to remove the left side of the thyroid and have a full biopsy on the suspicious tissue...like you I have numb hands, sometimes so bad I almost cry at nite. i've noticed mine are really bad when laying down verses standing..is yours the same? prior tho this finding i thought all theses symptoms were related to the spine condition but now I'm wondering if the numbness and hot flashes are due to the thyroid? I'd love to hear more from any of you out there with a similar situation as mine as I'm just now starting my journey...All  of this is scary as I'm a prominent architect - builder and don't really have the time to deal with all of this..I guess this is my new normal...anyone out there with success stories?

[NanmaD]

Have been reading your posts with interest. Have a herniated disc at C5 and C6,and also have a partial thyroid. Due to a genetic condition,had to have a scan of what is left of my thyroid,and they have found it is full of a variety of lumps,and is completely abnormal. It looks like,according to my GP,that they will be operating at both...have been wondering what comes first,and the effects.Thank you x

[katbid]

Surgery went okay.  It took about 4 hours and my throat still hurts.  But I am now 8 days post surgery and I think I will be okay.  I am in a collar and I am currently waiting for someone to come to my house and teach me how to use a bone growth stimulator.  

[mumstar]

Hope you managed ok at the endo yesterday. I will add an extra prayer or two for you on Jan 4th- best of luck to you. My first surgery where they just did 2 levels really wasnt too bad- are you having an orthopedic surgeon or a neurosurgeon to do it? Best advice for now till surgery time; relax, have a great holiday season (if you celebrate at this time of year; i dont want to be insensitive-- i once wished a Muslim "Happy Easter"- purely by reflex!) and get lots of sleep and nutritious food!! All the best to you--Amanda

[katbid]

Thank you!  I am scheduled for surgery on the 4th of Jan.  I am a little apprehensive but also looking forward to hopefully a better quality of life.  All the info you have given me has been very helpful and I will take it with me to the operating room.  I have an appointment with my Endo today to find out what adjustments he will make on my synthroid prior to the surgery.  I just hope I don't have to go "hypo" before the surgery.  My surgeon did not tell me what kind of collar I would be wearing he just said that it would be for at least two weeks and maybe longer due to the RAI.  I did ask the surgeon about loss of movement after the procedure and he said the levels I am having fused aren't the levels used for most of the neck movement so I should be fine.  I don't want to end up looking like a robot. Thank you for taking the time to share your experience and for the encourgement.  I will try to keep you posted.  

[mumstar]

OOPS! pushed submit by mistake...must be my subconscious saying 'enough already'; this has developed into a very long post...my apologies. I will just fininsh my last thought then quit....so, i dont know if they could do more fusions on me/ nor if i would want to have more fused- if i did i would probably have to quit driving and other activities because of the decreased movement. I would love to keep in touch with you, if you are interested, there are few people who understand what we are going through....wishing you all the best, and good luck with your surgery when you have it.

[mumstar]

Sorry for the delay; i had problems with my laptop that have taken a while to resolve! technology is great, but only when it works...How did your MRI go? Have you been booked for surgery yet? As for the choice of cadaver vs self bone graft donor; having had both, i would definetely say that the self graft is much more painful; they took the graft from my hip- so i have another 5 in incision there- that surgical site was much more painful than the site in my neck; i remember the first few days post-op i couldnt move that leg at all, the pain was so great- it took me a week to be able to walk down the hall in the hospital- and that was with a walker! I didnt have a lot of pain from the site in my neck- that wasnt too bad at all. I wasnt given a choice about the donor for that surgery- i think there was some issue about the length of bone required for my surgery because they were basically doing 4 levels- initally they thought they were going to have to take the fibula (small bone in lower leg) as a graft site. I was in a rigid brace for 6 weeks post op- not just the rigid cervical collar. In retrospect that was probably a good thing as iit felt so much more secure- with the 1st surgery i had the type of collar you see them use on tv - it was soft but had firm plastic on it as well- on the drive home after the 1st surgery i felt like my head was going to fall off! the brace i had after the 2nd surgery was uncomfortable to say the least- it had a metal brace from a chest piece to a support for my chin and then the same at the back with a support for the back of my head, plus straps going over my shoulders. It was uncomfortable, but verysecure- my head couldnt move at all- after 10 days or so i was allowed to remove it to shower, but still had to sleep in it. I hope that all this info doesnt scare you...but i think its usually better to have a good idea of what you may be facing; the drs arent always so communicative. Hopefully your experience will be less dramatic than mine was- It was difficult, but i got through it,,,as i am sure you will also. as i said before, the first few months were great after the 2nd surgery (at least after the initial post op period was over) - my problem has been that the fusion puts increased pressure on the adjacent discs, which has caused them to bulge- but luckily (???) not enough for surgery. If they ever got that bad, i am not sure what i would do- having 4 levels fused of 7 already, i dont

[katbid]

Thank you so much for your reply.  And thank God you didn't have the cancer.  That in itself, has been hard to deal with.  Still not sure if my synthroid dose is correct or not.  Because of the thyroid cancer, my TSH is surpressed with a 150mcg of Synthroid.  I was told that I would have to have my TSH elevated prior to having any kind of surgery.  I just hope that doesn't mean elevevated to the point of hypothyroidism.  I dealt with that for a few days prior to my uptake scan and it was pure HELL!!!!.  I also wonder if there is a correlation between the thyroid issue and the cervical stenosis.  I never had a problem with my neck until a month prior to finding out I had a thyroid issue.  Strange!  Of course, I'm sure I would never find a doctor to agree with this.  I will be using a cadaver bone.  My Neurosurgeon said that it is less painfull than using my own.  He said the fusion rate between cadaver and your own bone is not a big enough difference to have a true concern. So he recommended the cadaver bone.  I will also have the Titanium plate and screws.  He said normally a person would be in a colar for about 2 weeks or until the first x-ray.  But I may have to be in it longer because of the radiation treatment.  He said the radiation can soften the bones.  YAY!!!!!  I'm going for another MRI today to see if there has been any changes in my neck since my first MRI a year ago.  Did you wear a collar after your fusion?
Sorry to hear you have had so much pain and having to endure more surgeries.  I know it is frustrating.  Good luck to you.  

[mumstar]

HI; my situation is somewhat similar to yours...i had a sub-total thyroidectomy in 1994 because they had to do several repeat biopsies, each one was more suspicious for cancer; luckily,when they did the thyroidectomy the pathology report was negative for cancer... then in 1996 i developed severe shoulder pain,which prevented my being able to as an ER nurse-when i finally got a diagnosis it was early '97 and i needed to have ACDF of -C4/5-C5/6 i recovered fairly quickly from the surgery, but unfortunately, my pain never really improved. Because of the continued pain, they did more investigations, and by that time there were 2 more levels compressing my spinal cord. I now required another fusion (which i had in early '99); this time of C3/4 and  C6/7, in other words the levels above and below the fusion had herniated. I knew, before the first surgery that the disc at C3/4 was bulging, but at that time is wasnt compressing my cord, but C6/7 was ok. Apparently; having a fusion done puts increased pressure on the surrounding discs; a fact that i wasnt told prior to my first fusion. Initially after the second ACDF I did really well; was taking only one Tylenol#3 maybe once or twice a day- a real victory in my opinion! Then, just as i was starting to discuss my coming back to work, although in a different capacity, the nightmare started all over again! I have had chronic pain ever since..and have been unable to work. I really have to wonder if there is some correlation between the thyroid thing and the cervical disc problem; i have wondered about that in the past...so i found it very interesting to hear of your situation. Hopefully, the fact that your thyroid problem was worse than mine will mean that you will have a better outcome from your ACDF (you had the thyroid bad, and i had the disc problem bad). I dont recall having to go off my thyroid meds before the second surgery...but i only required eltroxin, not calcium, because i still have one lobe of my thyroid left. Are they using cadaver bone for the fusion or taking bone from you? I have had it  done both ways and had solid fusion results from both methods, i also have titanium screws and plates in my neck now. I hope this info helps; it helps just to know there is someone out there that has a similar situation...if there is anything else i can do to help, please dont hesitate to ask...good luck to you--both with the ACDF and with the thyroid cancer!