Complications of cervical spine surgery are in immediate postoperative period or delayed and some of the complications of cervical spine surgery are restricted to approach only.
Early [Postoperative] Complications
Neurologic Deficit
Neurological deficit is the most devastating complication of spine surgery. The cause could be an intraoperative event such as a direct spinal cord injury, posterior strut or graft displacement. Otherwise, failure of the construct could be responsible.
A detailed examination is a key to identification of the problem and it should follow with plain radiographs.
A missed lesion could result in worsened deficit and if this occurs, a full series of cervical, thoracic, and lumbar spine films should be obtained immediately.
Whenever needed, a postoperative CT or MRI should be done. Because of the need for MRI titanium implant is preferred which is MRI-compatible.
Imaging helps to assess screw, plate, and graft placement and any impingement on the spinal canal, nerve roots, or vertebral arteries.
Hardware that appears to be a likely cause of neural deficit should be removed in the operating as soon as possible.
Dural Tears
Dural tears may occur as a complication but usually can be identified preoperatively. Whether traumatic or iatrogenic, should be repaired primarily. If the tear is irreparable, a fascial graft should be sewn into place. Avoid a wound drainage system if the patient has a dural tear and antibiotics should be administered.
In case of a persistent leak, a subarachnoid lumbar drain can be placed. If the leak does not stop, the tear should be re-explored and repaired to avoid the formation of a spinal-cutaneous fistula.
Wound infection
Posterior surgery appears to have a slightly higher rate of infection than anterior cervical surgery.
Superficial infections usually occur within the first 10 days after surgery and may be adequately treated with oral antibiotics and local wound care. Wounds should be closely monitored, however. If they do not respond then early intraoperative irrigation and debridement should be performed.
Aggressive, early surgical debridement of deep infections can help avoid late-onset osteomyelitis, epidural abscess, meningitis, and catastrophic instrumentation failure.
Late Complications
Pseudarthrosis
Pseudoarthrosis means false joint and occurs because of failure of the graft bone interface to unite. Symptomatic anterior pseudarthrosis can be treated with repeat anterior surgery, or, preferably, posterior instrumentation and fusion.
Hardware Failure
If the bone does not fuse the implant would fail ultimately. Events like infection may hasten the process.
Early hardware failure can be associated with insufficiently stable constructs. Multilevel (>2) corpectomies stabilized with anterior fixation alone have a high rate of failure and should be routinely aided with posterior instrumentation and fusion.
Anterior graft or plate extrusion can lead to swallowing difficulty or more seriously, airway compromise.
Late hardware failure, such as screw breakage, is often associated with nonunion, which may or may not be symptomatic or require treatment.
Complications Associated with Anterior Approach
These complications of cervical spine surgery are associated with an anterior approach to the cervical spine.
Dysphagia
Dysphagia or difficulty in swallowing is the most common complication and can occur in up to 50% of cases. Most of the time it is transient and gets relieved in a few days.
Recurrent Laryngeal Nerve Palsy
This present as which presents with dysphonia or inability to produce sound using vocal organs. This complication occurs in 4% to 5% of cases. An exposure below C5 and revision surgery are risk factors.
Horner’s syndrome
Horner’s syndrome is not a frequent complication of the anterior cervical approach. Its cause is the damage to the sympathetic plexus that may occur from overzealous retraction of the longus colli [Prevertebral muscles]. It presents with ptosis [drooping of the upper eyelid, meiosis [constriction of pupil], and anhydrosis[lack of sweating on the affected side of the face].
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I am currently 24 days post op anterior cervical discectomy c5-6, c6-7 with plate and screws. a donor bone was used for the graph. 5 days post op i presented to the surgeon for follow experiencing stabbing pain in the base of my neck radiating through my left scapula to my left bicep, and tricep to my forearm. The nurse and APN at the office told me it was muscle spasms that were normal and they would resolve. The physician was also notified. as of today i am still experiencing the same stabbing pain with radiation, calls to the physician have been difficult as i did not recieve a return call until lat night. I was sent for xrays. which, would probably not show and nerve involvement or compression. my question is the possibility of a brachial plexis injury or involvement a possibility and what wopuld be the treatment for this. please advise. I am considering another physician at this time. thank you, stephen
@stephen r. francz,
You need to talk to your physician. Or talk to someone else for second opinion.
It is unlikely a brachial plexus involvement but if the symptoms persist, nerve root compression needs to be ruled out.
dear sir
my father age 70 having problem with c4-c6 any complecation in the time of surgery and in recavery time
please give your view to me
thanks
karthick
@KARTHIKEYAN.S,
You need to provide me with enough information so that I can answer your questions better.
I had c4-c5 fusion in 2005 and had no problems pos surgery until I fell in 2007 injuring my head,bilateral arms, neck, lower back and legs. My question is I have had problems with my neck and headaches since the fall and now my left arm is going numb with radiating pain. The MRI is showing disc bulging and spondylosis at c6-c7. My question is…Could this have been caused by the fall since I had no problems for 2 years and it started after the fall or is this normal degeneration?
@KAthleen C,
It could be either.
Can you elaborate on your answer? I am curious as to your answer because since I had no problems before the fall, it seems the fall would have caused or aggravated the present symptoms.And if it is the case that this is normal degeneration after a fusion, then the benefits of a fusion could only last 2 years?
@KAthleen C,
Fall could have aggravated the symptoms but it would be hard to prove that since fall occurred long time back.
There could have been natural degeneration and that not necessarily due to fusion per se.
Pointing at the cause would not be possible in my view and you should concentrate more on treatment aspect.
i had a c5-c6 neck fusion in 1992, using bone from my own hip. In 1998 i started having mild headaches. as time went on the headaches got worst. MRI showed some spacing and a bone spur at the point of surgery. My question is ..What may be causing the severe headaches and is the bone spur a problem???
@greg,
Cannot say much with the available info. Did you ask your doctor?
I did ask several doctors but due to the fact it was a job related injury and the fect that the company has most of the doctors on payroll in town none of them will touch the case. They willhow ever go so far as to say there is a problem but not be specific or offer to give any advice other than live with what i have. and i'm sorry but i do need to be able to live life as pain free as possible in order to function on a daily basis
@greg,
At the most I can give you a general advise on your condition. You need to see a doctor for the treatement.
Hello, I had anterior discectomy and fusion of C5-C6 and C6-C7 because of herniation and myelopathy the 17th of November 2011. 2 peek cages were inserted and the fusion was attained with 5 screws and a titanium plate. Previous to the surgery I had no significant symptoms, but the neurosurgeon said that the compression was severe.
After the surgery I developed shoulder and neck pain, my physicians says it is because of muscular spasms and recommended heat pillow and physiotherapy. One week ago I had an X ray where it shows that the plate is in good position at C5, but at C6 the plate stars separating slightly and at C7 it progresses to a maximum separation of 9 mm. My physician was not alarmed at this finding said there was no problem since the cages are in place and that I just should not do "violent" movements. I have not significant dysphagia, but I feel as I had a lump in the throat.
What is your opinion, do I need to wear again a collar, should I get surgery again to get a posterior fixation??
Thank you for your opinion.
I am a 53 y/o WF 6ft/220#, diagnosed with herniated C 5-6 & C 6-7 in the 90's ,experienced severe stabbing pain in neck under R shoulder blade down lateral upper arm into elbow over top of forearm into hand esp 1st & 2nd finger, treated conservatively with NSAIDS & analgesics, improved over several months with mod residual numbness in 1st 2 fingers. In 2009 diagnosed with ruptured L 5 had discectomy, repeat LARGE hernitation with portion of the capsule included, 5 wk post-op to 1st surf. Emerg surg done. Have partial paresthesia in L calf & foot 2+ yr post-op. Fell 3 weeks ago on concrete. Landed on R shoulder, strongly jarring neck, ect. Experienced progressive pain. I related this to the fall & expected it to improve, but it did not. Pain became unbearable. Had MRI 2 wk post fall shows mod herniation C5-6 more extensive C6-7 with displacement of cord to posterior with mild pressure against, mod stenosis noted & some occlusion of nerve path. Had epidural injection with moderate relief of pain for first week, but numbness has worsened including Thumb & 1st 2 fingers to the point of difficulty doing fine motor skills, such as typing turning pages act. Pain has been grad resuming over past few days starting with neck, then under shoulder blade, down lateral upper arm, with stabbing pains occasionally all the way thru affected fingers. Percocet 10 does little for this stabbing pain but does give mod relief from other. Saw surgeon yesterday, he recommends decompressing C 5-7 & a titanium plate. But points out numbness might not be reversible. I have all faith in my surgeon, but I forgot to ask a few questions, and I will pose these to him upon my next conversation with him also. I was rather shell shocked when he said surgery even though I do not know why as this has been an on going prob for years. So for my questions: Is a type of bone or filler always used with the plate? What about a C collar after surg? To be worn how long? In general how long are you restricted & what type of restrictions? And any other info you might provide is appreciated! I realize all situations vary depending on preferences & pt history, I would just like some ideas so I can plan ahead. Of note I am a well controlled type 2 Diabetic, smoked 1- 1 1/2 pk a day for years but am trying to at least decrease for now, I know the negative effects. I have hypertension, hyperlipedimia, gout,( also well controlled with meds) & have been on Vit D & coral Ca since a TAH years ago. Thanks again for your time & thoughts.
Bonnie P
@Anette,
If plate is separating and you have symptoms [lump in throat], one needs to have a careful follow up. If pate continues to move further and symptoms worsen and fusion has taken place, palte removal may be required
@Bonnie P,
I am sorry for the delay in reply.
Decompression is required in compressions not relieved by non operative means. It involves the disc removal and fixation and grafting.
Post operative neck immobilization is generally required for 6-8 weeks but mainly depends on strength of fixation.
One is able to carry out non strenuous daily routines within 2-3 weeks,
What is the latest at your end? Have you undergone surgery or still pending?
ACD at C5/6, post-op 4 weeks. Full remission of arm and shoulder pain, tingling and numbness in my hand immediately post-op. Neck getting better with each passing week. Swallowing fine unless my head is tilted down. 3 days ago, awoke to a full return of symptoms in my right arm. Have yet to call the doc. Hoping the symptoms are temporary, but not abating after 3 days.
@stephen,
How is the situation now?
I had C5 and C6 Anterior Cervical Spine Fusion last October. Having never really been ill before with anything other than controled Asthma, this is a major journey.
Look on UTube soon to see my video called "My Brain Art". It expresses how I am doing as of my entry into the 9th month since surgery.
My heart goes out to all of you under 50, especially those in their 20-35 years. Life shows us turns in the roads we take. This will be a very long road with many turns for me now. Hang in there all of you.
gigi
I had a c2c3 and a c4c5 fusions done in 2008. Have also continued to have pain in ne k and shoulder blade area. Been getting trigger point shots and pain medication to function. I stopped shots a year ago due to insurance. Symptoms got worse with pain and tingling to right arm,hand,fingers. New MRI shows bulging c6c7. Surgeon said bulging discs are not pinching nerve but looks like old surgery srew is tightened down on nerve, he sent me to surgeon who did that surgery. Had ct,MRI and stays done. He states other surgeon is a quack and systems are from bulging discs. He would like to do a fusio on c6c7 but said he would need to remove c4c5 hardware to do new fusion. This does not sound right what do you think? All fusions were anterior.
@Julie,
It is a tough situation. It is important to pin point the cause. Because the screw is in same area, the cause could be either.
The cause needs to be determined before you get any surgery.
Another option is to go for implant removal and see if the problem still persists. If it does, address the other cause.
This sounds like too much but things are not straightforward in your case.
Have you considered another opinion?
I had anterior discectomy and fusion because of hernias in C5-C6 and C6-C7 in november 2011. Recovery went fine until January 2012 when neck pain worsened and Xray showed an anterior migration of the titanium plate, separating about 7mm from C7, peek cages looked fine. The neurosurgeon said not to worry, that recovery would be fine and that pain is because of painful myelopathy. New functional X-rays show some movement in the spinal processe in the fusion area, aslo trabeculae are not complete. A PET Ct was performed where significant "lightening up" from C5 to C7 can be seen. Neurosurgeon says he cannot distinguish if this is a pseudoarthrosis or an intent to fusion. He recommends the use of a cervical- stim for another 4 to 5 months and then see if I need revision surgery. I can tell that the pain is mechanical (musculoskeletal) and not spinal in origin. Is it possible that the fusion still happens?? I find it difficult to believe.
My husband undergone MRI and the results show that he needs to undergo a Cervical Spine Surgery and it will takes 3 to 4 weeks to recover. What are the risks that he might felt after the operation? Please I need your advise because I'm really afraid what will happen to my husband after the operations. Is there's other option aside from operations? Thank you.
Hi Yen,
Whether your husband needs surgery or not is to be determined by the clinician who is seeing him. I can't advise on that. What is the surgery contemplated? What is the diagnosis. Let me know to answer your query further.
I just had c6 c7 fusion on July 1, 2015. My initial symptoms were pain from my left shoulder to my elbow, some numbness in my left hand and pain and spasms under my left shoulder blade. As of today I am having the same pain. I assume the surgery went well and I don’t go back to the doctor until August 18. I have called the office and am currently taking a Predisone taper. I am very discouraged. I have not gone back to work and wear the soft neck brace 24/7 unless I’m showering. I can’t drive and am only to rude in the car to go to the doctor. Does this sound normal or should I insist X-rays, ect. ?
Hello,
I was curious recently about 3 months ago I had surgery ACDF on C5-6 6-7. The surgeon noted in the post-op report that all dura and nerve roots were well decompressed. About a month after surgery more intense pain in the right arm and a MRI was ordered. The report on the MRI indicates that there is residual paracentral disc osteophyte with a mass effect on the ventral right c6 nerve root.Also the 2nd surgeon that I spoke with has indicated to me that he would have been able to take care of it the first surgery and that the disc above the C5-6 should be fused as well. I also see in the report that there is residual stenosis, which I can’t understand why that would be seeing that during the ACDF Procedure I thought they take out the disk and replace it with the allograft. Anyway any help would be greatly appreciated.
Sorry for delayed reply Janie. The question to be asked is if fusion has successfully occurred. If it has and your symptoms are mild to moderate, they would go as you are put on physio.
This is about time the fusion to unite. Has it been explained to you? Most of patients after surgery are symptom free. Some might have mild to moderate symptoms which should become better with time.
What have you been told when you last visited.
Take care.
Bill,
You already have taken two opinions on your condition. With limited info and lack of personal examination, I cannot give any opinion on your condition or treatment. I can provide more knowledge on the topic if that is what you are looking for. In that case also, you would need to ask something specific.
Thanks
Arun
A year ago I had surgery on my c5 and c6 ever since then I have had panic attacks and my throat feels closed. Have you ever heard of this happening after this surgery. The surgery went fine no problems.
Hello Arun,
Any information would be greatly appreciated. Typically how long should you wait until you have a 2nd surgery? As you can see from the previous post I had the 1st surgery on June 11th, 2015. The pain is worse than before the first surgery so I would be willing to get a 2nd one, but after the first surgery and getting the run around and obviously it not going as planned I’m not very anxious about anyone doing surgery in this area. So anyway I guess how soon after the 1st time and does the 2nd surgery as far as your experience goes turn out with better results?
Thanks,
Bill
I have not come across patients with post surgery panic attacks. Have you sought consultation from a specialist.
There I no straightforward rule and method. In any case surgery should be providing relief it intended to when planned
Now we need to find out the reason for symptoms which starts with following questions
1.Has the outcome of surgery been achieved. Like in your case the decompression and fusion are two objectives. Have those been achieved
2. Are the present symptoms due to failure of first procedure or result of something during that procedure. For example hardware irritation.
3. Is it something new,different from first problem
Based on these and patient assessment your doctor would concludes diagnosis and treatment.
The timing would therefore be dependent on these factors.
I hope that helps. All the best.
Hello I had acdf oc c5c6c7 using hip graft and plates in June 2015. Surgery went well no more pain however I have disphonia. Went to an ent Aug who did scope exam and said I had partial paralysis of one side. I’m scheduled to go back in Nov as thye felt i should wait longer however I have worse symptoms can barely squeak out words and sometimes feels it takes ALOT of air to get something out. should I be seen sooner to avoid any further damage or am I not patient enough waiting on recovery.
My Husband had posterior c4-c7 neck surgery on June 29th and everything was going great except that he got pneumonia 6 days later and the local hospital overdosed him and he had to go to the larger hospital where he was treated and taken care of. Now 12 weeks later, he was doing great, weaned off the collar, and was feeling better and he tripped and caught himself and then next day his neck where the incision is, looks like he has a golf ball underneath the skin. We went back to the dr and they took xrays and said that everything was in place and it was just swollen. Well now it is larger and he is running a temp of 100.1. The dr. doesn’t think it is a big deal, but it hurts and we are afraid of a infection. Anyone got a clue?
If dysphonia occurs it should get better by 3-4 months. How are you now?
My reply is late for your query. How is your husband now. Is he better?
I’m doing better. However If I talk for awhile -15 minutes then my voice gets tired and I start sounding raspy, breathy.
Hello once again and sorry about the delay. The last MRI was called a MARS MRI which was described to me that it can see behind the cage. Anyway the results, which I hope will help you understand my situation.
Impression:
1. Post operative changes from Anterior cervical disc fusion of the C5 to C7 disc levels with persistent left foraminal protruding disc at C6-7 resulting in at least moderate left foraminal stenosis.
2. Right Paracentral protruding disc at C5-6 contacting and indenting the right ventral cord and resulting in right foraminal stenosis as well.
3. Mild spondylitic disc disease at C3-4 and C4-5 with small bilateral spurs at each of these levels, particularly on the right at C3-4.
I was wondering if you might be able to assist me with the findings and what do they mean. This was the second mri after my surgery in Juneof this year. It seems that I’m getting the run around. I’m considering driving 5 hours to hopefully get a straight forward answer. The original surgeon dismissed me from his care after I inquired about what wasgoing on at the C6-7 level. One thing that is concerning is the findings at levels C5-6. Before the surgery I was told by 3 different doctor’s that due to the stenosis I was at risk of being paralyzed from the neck down if I was involved in a fender bender. I guess am I still at the same risk since there is contacting and indenting of the ventral cord?
Thank For Your Help
Bill
Hello I was wondering if you received my message from earlier today? If not I can repost. After I posted it the notification said waiting for approval or something like that.
Sounds good. If you are making continuous improvement in symptoms, you would regain the power.
1. There are changes of fusion c5to c7 disc levels. There is still a disc in C6-7 and reducing the space in the foramina [Nerve passes through the foramina]
2. C5-C6 disc is protruding and putting pressure on right side of cord on ventral aspect [the front or anterior of the spinal cord is called ventral aspect.]
The foramina at this level also has reduced space due to protrusion of disc.
3. These are degenerative changes of the spine. You could read more about cervical spondylosis here.
You are concerned because you are worried that something would happen in case of accident. SO the best idea is to avoid the accident. Isn’t it. Nothing makes you foolproof against the injury. People have risk of getting paralysis even in cases where these changes are not there.
So coming back to symptoms. How are you otherwise now.
I just replied Bill.
Hello again and thank you for the break down of the MRI. I was told that a diskectomy meant he would remove all the disc from that area. I guess the other question I would like to figure out is that if there is a bone graft in both the C5-6 and C6-7 why would there be so many complications with disc protruding and impingement. In your opinion do you think that the bone graft is the part that is considered in the MRI as the disc? And trust me I definitely will try to avoid any accident, but as we all know it could be the other person that might cause the accident. I really do appreciate all your input you have been a big help and unfortunately the doctor’s in this area seem to enjoy lunch at the Country Club and no one will give me a straight answer.
Thanks for any input Bill.
No! Disc and graft appear different. So if it says there is disc, it is likely that there is disc. You can ask your treating doctor if disc was removed completely or not.
I know accidents can happen. What I meant that surgery should be done for your problem and not to reduce risk of something during an event that might happen. But that has been done and as I guess you are not symptom free. So the next question is what now?
That is why I asked if you had gone for other opinion.
Take care.
Hello sorry about my delay. I have seen a neurosurgeon and also the original surgeon. The original surgeon came in to the room and spent a total of 1 minute and 40 seconds. He tapped my knees as I sat in a chair with both feet planted on the floor. I guess he thinks I’m a idiot because the other surgeon agreed with me and said you can’t get a result from that with both feet on the ground. The other surgeon stated that with all the residual disc and the indenting and contacting of the cord that I need to have another operation. I then asked him why would my MRI report from 2012 indicate that there is discussed protrusion at C5-6 cord compression and indentation of the right C6 nerve root. He at first looked at me and shook his head and said that the first surgery indicates that the first surgeon did a very sloppy job. So basically to answer your question about how am I doing. A little upset and very leary about having a 2nd surgery.
my 36 year old son was a pedestrian hit by an automobile on 11-11-15 in Dallas, Tx. he had immediate surgery to remove ruptured spleen. he has internal laceration to his liver (that now has a hematoma on it), damage to kidney poles, lacerated bladder, contusions to lungs. He presented in ER with paralysis as well and 2 brain bleeds. e had large leacerations all over his body from windshield penetration. Once medically stable enough mri’s showed damage to c5,6,7. c7 was fragmented and even the ligaments were severed. on 11-12-15 they did anterior and posterior decompression to stabilize in an attempt to at least save his hands/arms, in which they did. e is TBI ( which is improving) and incomplete tetraplegic. After 1 week in ICU he was moved to a trauma step down unit. There the battles began with high white count and pain. After 1.5 weeks in trauma step down he was moved to in patient rehab in this hospital. Presbyterian Dallas is a new level 1 trauma.facility and therefor their rehab accepts trauma patient. I am certain they have never had a patient on this floor with as much injury as he has. The trauma 1 level status hospital is about 10 months old! We have battled the up and down of white count t and elevated liver enzymes. He was on IV vancomycin which stopped last thursday. Approximately 1 week ago, my son was laying in the bed trying to have a BM when something popped in his neck (posterior) and a sharp stabbing pain began. They did x-ray within an hour and no change was noted. The next day the neurosurgeon ( whom he hasnt seen in 3 weeks) wanted additional views which all showed no change ( i am assuming it was the hardware installed). So white count is slowly tracking back up. Last thursday his posterior incision was very painful to touch (still in collar) and red, purple and raised. on friday I could see what looked like a scaley patch on the incision ( which is nor purple) . Saturday it looked like a fistula to me . As of sunday it had exploded draining bloody pus. I have begged for a dr to come see him. his bp is now 83/53. im nervous. in know how serious sepsis is and i know he is susceptible. we have a few more weeks in this hospital and then hopefully transfer to Baylor Institute for Rehabilitation. what do I do. scared to death mom.
Jeannie
Jeannie,
Sorry to know about your son’s condition. I understand your concern. From what you describe, I can understand he has deteriorated after making substantial improvement. He needs to be shifted to a more aggressive care and I hope you and your hospital are working on that.
How is he doing now? Please feel free to share. I cannot do much for you on this platform but if there is anything that I can do, please let me know.
Take care.
Sir,
My husband gone for a surgery of c3-c4 disc because of tear bone last march 2015. Until now he still feels pain on his neck and on his shoulder. After the surgery he never gone for an mri because his doctor told us that my husband is fully ok because he is strong already. The basis of the doctor is only the force of mu husband. Is it right? The pain on his neck until now ia it normal or is it part of the recovery of my husband? How about the pain on his shoulder what is the relation from his c3-c4 operation?
There could be many possible reasons of the pain. If it is persisting, you discuss that with your doctor. It is important to find if the surgical goal has been achieved and that would be told by imaging. Most of the patients become pain free. If there is a pain it needs to be seen if it stems from minor cause or is indicating something more.
Take care.
Hello
I have had two two level fusions. The second surgery was a new fusion and a repair of a non union. I now have another non union in c5-c6. This was determined by a CT scan. The X-ray proved my hardware was still intact. The pain and muscle spasms I have are not relieved without narcotics. I was told by my GP that it will need repair and possible rods and cage. Is that true? I see my surgeon ( head is neuro-surgery ) for his opinion with their MRI scan. My que is do I have to have this fixed if it did not fuse? I know I can’t live with it the way it is but need to know what would happen if I didn’t have a revision? I also have another level that we did not address as I couldn’t have my entire neck fused. That level is c3- I wonder now if that level is adding to my current pain. Please advise?
Failure to fuse does require revision because if not fused, that contributes to instability of the neck. The load then gets transferred to the hardware, which can sustain only to the point it breaks. So when your hardware goes, the load gets shifted to your neck and as it is unstable, it could cause problems.
I can tell you only that much. Whether you need additional surgery or not would be told by your treating doctor. If you are unsure you can always go for another opinion.
Take care.
I Hav done anterior cervical disc excision and fusion c3 / c4 with orthosol cage in 1 week time but my pblm is when I’m sleeping I cannot due to pain in despite of analgesics but when I’m awake I’m pain free is it normal post op difficult even to get out of bed.
Work on your sleeping posture and give it some more time. Should improve.
Dear Dr. Arun,
Thank you for giving us the opportunity to share out thoughts.
I had a Laminectomy surgery done due to Spinal Stenosis on my lower back L4-L5 area. The surgery was a success and imidiately after surgery i could walk very normal and continue with my daily activities without any complication.
Aprox. 5 months after surgery almost ever night my right leg/feet along with my both hands started getting numb and was getting worst day by day. After several visitation and getting advises from different doctors and numerous researches, dealing with orthopadic as well as Neurosurgeons and doing MRIs, it was clear that i had herniated cervical disc and it was showing so severe on the MRI and X-rays that i agreed to do a Cervical disc replacement on 2 levels.
Now the Cervial Disc replacement surgery was done almost 10 days ago.
Although it seems that the entire surgery was very successful as per my Dr. and the X-rays done couple of days ago, I am still having or rather feeling strong numbness and weakness on my right foot and a little bit on my left leg. The hands are feeling much better and almost no pain and no numbness.
Do you think the numbness of the feet will go away after a while slowly but surely and this is normal to still feel the numbness after surgery? Usually how long does it take for the feet to feel normal again after surgery ?
Thank you for your kind attention.
Massey
Can you comment on level of acceptable exercise/strength building following C4/5/6 fusion? Am am 18 months post op and at my one year check up I was given okay to exercise with no formal restrictions. Was told had good fusion and hardware in place. Began exercising, arm extensions, chest presses, etc .. taking it pretty easy. Recently experiencing muscle aches and tenderness in lower cervical area. Usually lasts only 48 hours, but now is going on a week with pain in scapular region and in back of neck. Could exercise injure this area again, after a fusion? Or could it be the erosion of the C7 disc?
Massey Masi,
Numbness and weakness may take a very long time to go. Technically speaking, we need to wait for that up to one year. If the recovery does not take place by that time, it is unlikely.
But as you have shown very good initial improvement, there is greater likelihood of improvement further. All the best.
Take care.
Melissa,
If fusion has occurred, exercise cannot injure. But with hardware in place and the area recovered from trauma, aches and pains can happen. I would advise you to either get trained under a specialized trainer/physiotherapist. Try reducing the effort and do not load the spine too much.
There is no marked level as it varies from person to person. But if body is complaining somewhere, get one level down and see.
Take care.
Thank you! I am continuing to strengthen. Your answer is reassuring.
Hello,
I was wondering if my post operative report says that osteophytes were removed anterior and posterior. Why would a MRI and a CT-SCAN indicate a osteophyte encroaching the spinal cord and dislocating the spinal cord and deforming it. It doesn’t sound like I’m getting the truth about what happened in surgery. Any responses would be great.
William Greenlee,
Osteophytes can encroach upon spinal canal causing narrowing of the space for spinal cord, causing pressure on cord and nerve roots and leading to radiculopathy. Dislocation is always traumatic.
I hope I have elaborated enough. If there is anything you would like to ask further, please do not hesitate to share the details.
Hello Dr. Singh,
I guess I’m a little confused over the concept of of having a ACDF Surgery. I understand that the goal is to resolve the symptoms causing the problem, but with 3 MRI’S and 1 CT-SCAN all the MRI’S indicate large Osteophyte posterior encroachment on the spinal cord and neural Foramina stenosis extensive on the right at one level where the procedure was done. The other level also has posterior Osteophyte formation and foraminal stenosis significant on the other side. So I guess my question would be is this the norm for a ACDF SURGERY? I keep thinking that the Osteophytes are supposed to be removed anterior and posterior and that is what it say’s on the post-operative report. It also indicates that the Dura and all nerve roots are well decompressed. It just doesn’t seem to make much since the first surgery that happened just over a year ago. Can you explain to me why would there be stenosis in a area that say’s all Dura and nerve roots are decompressed? I’m definitely not trying to put you in a awkward position. I have spoken with another Neurosurgeon who has recommended a 2nd surgery but his answer is that he is there to make me feel better and obviously I want that, but I would also like to know why these symptoms and conditions could still possible exist.
Thank you for your assistance.
William
William,
Two things come to my mind-
First the access to structures is limited by the approach the surgeon uses. Usually, neck is approached by anterior approaches, and it could be that intraoperatively, posterior reach was limited without risking other vital structures. It could have been decided to leave that because accessing it was too risky for other structures.
Secondly it is important to know what was aim of surgery. Was the structure you are talking about determined to be responsible for your symptoms when you were taken for surgery.
But all of these are speculations.
Best person who could answer you is the surgeon who operated. Rest all are conjectures.
Take care.
I’m 6 weeks post of acdf surgery and just started having pain in my upper abdomen. The pain occurs several hours after eating which leads me to believe my food isn’t digesting. I than vomit and feel better. Is this from the surgery? It just started about a week ago and has happened twice. Now, I’m scared to eat much.
Micky,
It looks more like local problem rather than being related to surgery. Consult your treating doctor please.
Take care.
Mickey, when that happened to me, I found out it was because of scarring from stomach ulcer.
Dr. Singh,
I had ACDF @C6-7 in 2001. Have had occurrences of temporary paralysis in both left and right arms since, along with a severe sharp pain in left lateral flexion. Finally in 2010, the same surgeon told me that not only is left lower screw cracked, but all 4 screws are backing out & he wanted to remove the hardware right away. Well..my internist wasn’t convinced & sent me to a neurosurgery “guru” at UAB who looked at my MRI’s & declared he didn’t see what my original surgeon saw & didn’t recommend surgery at that time. Haven’t had as many paralysis episodes except right now my right hand is useless (I’m R handed – not fun); neck lost ROM due to pain avoidance. Now a new symptom is that pills are constantly getting stuck in my throat. Should I have listened to my first surgeon? And is this an ASAP thing I need to address? I’m scared because I’m such an infection risk. Maybe I should mention that I kind of avoid going to doctors now because I’ve been allowed to suffer for too many years – not being taken seriously until things became emergencies, which has led to an intractable pain syndrome. But I know there are great, caring medical professionals out there. I used to be one.
Thank you so much, Dr. Singh! You are very kind to read about our problems and answer our questions. Your dedication inspires me.
Dr. Singh.
Should have said severe sharp pain in “left lateral neck flexion.” – Sorry & thanks!
Hi Dr. Singh, I had an anterior fusion of the c5-c6 vertibrae do to a ruptured disc on January 21, 2010. 4 months after the surgery I began to have pain in my neck. I also started having pain in my upper to midback between shoulder blades. My vertibrae at the base of my neck swells up all the time and I get frequent headache’s. It is now November 2016, I tried injections, physical therapy, massage, and acupuncture with little relief. I was put on fentenyl with Oxycodone, nortryptiline, and meloxicam. I made my doctor take me off the Oxycodone and Fentenyl back in 2013. I take curecamin and cure-med. My bowl and batter functions work but it’s like I have to strain. I have times where I pee and Im done and with no warning I owe some more. I am told my fusion looks good. Do you have any advice or observations.
Thank you for your time
Hi Dr. Singh, I had a c5-c6 fusion on January 21, 2010. 4 months after I had the surgery I started having neck pain, headaches and pain between both shoulderblades. I was put on fentenyl, oxycodone, meloxicam, and nortryptaline. I made the doctor takee off of the Oxycodone and fentenyl in 2013 and changed doctors. I take the meloxicam, norteptyline. Plus vitamin store curecumin and cure-med. It is November 2016, the Doctors say my fusion is good. I tried physical therapy, injections, pain management, massage and acupuncture with limited relief. I get really bad muscle knots and my vertibrae at the bottom base of my neck swells up three times the size. My bowl and blatter function is not right. I pee and without any warning I go more. Bowel movements are like my stomach is working I strain more but not do to constipation. My pinky fingers and thumbs go numb at night. Nerve conduction test show nothing. Do you have any advice or observations?
I have been to many doctors mostly kaiser, but it’s like they write it all off to chronic pain.
Thank you for your time
Jerry Riley
I had a 2 level ACDF (C5/6 & 6/7) with no issues at a local BioSpine Spine Surgery Center in my city. Then, 6 months later, when I had better insurance, I had the C4/5 level fixed with a CDR (Bryan disc) at the same facility. The same doctor (DO) performed both surgeries.
He used the same incision point in my neck. He said there was a lot of scar tissue he had to clean up on the 2nd entry. But overall, I was happy not to be in that rigid collar again.
2 weeks after CDR surgery, my left eyelid started twitching/spasming sporadically. Also, my neck was completely numb on the left side L->R Carotid to Trachea & T->B jaw down to collarbone. I went for my followup and told doctor about it, but he was adamant that it wasn’t caused by the surgery. He said he wasn’t anywhere near the nerves that feed these areas and mentioned “Bells Palsy”. He didn’t order followup imaging, didn’t do an XRay, and said that if it didn’t go away, he would refer me to a Neurologist.
It has been 3 months now and no difference. Also when I wake up, my fingers on the opposite side of body from the one I’m sleeping on are numb. (laying on R side, fingers on L hand are numb). Also, sometimes my forearms & hands cramp up like I have cerebral palsy and I have to manually straighten out my arm/hand with my other hand. Most worrying is that often it feels like I am loosing strength or, it’s hard to explain, um… a weakened perception of response in my forearms? Sometimes I move them just to make sure I can. It’s really hard to explain what I’m trying to. What gives?
I made an appointment at USF with an Ophthalmology Neurologist for my eye, but I’m wondering if it might be worse than that. Do I need to have something else looked at concurrently? The Dr. who did the surgery made it clear on the post op visit that he was washing his hands of any issues. I’d hate to wake up one day and find that I can’t use my hands or that the numbness in my neck spread and disabled something critical.
** The incision is on the left side of my neck. Forgot to mention that.
Holly Beth,
From your description it could be made out that there is some compression/pressure on the spinal cord/roots. It needs to be ascertained and if feasible removed. Final decision lies with you and your treating doctor but if the hardware is loose, it warrants removal.
Take care.
Jerry,
If the fusion looks good, has hardware found to be fine? Any impingement?
Hi Dr. SINGH, They say the hardware looks good. I have been told I do have a right shoulder impengement. The doctor who checked my shoulder said that the nerve that runs through from my neck to my shoulder down my arm was causing other problems. He he said there was more going on than just the shoulder impengement. I never get a straight answer from the pain management clinic and they refuse to let me talk with their neck specialist. Saying they only will see you if surgery is needed. The shoulder Dr. Told me to keep pressing the issue and good luck.
Dr. Singh. I went for a modified swallow test and the speech payhologist said the metal plate is hitting the muscle that controls the esophagus. Any suggesyions on how to fix this problem? Thanks for the input.
Bill
Hi, Dr. Singh I’m not sure if you received my last reply, but the pain management Dr. Says the hardware looks to be fine. They do say I have a shoulder impengement and arthritis in my neck and shoulder. My shoulder neck and upper to mid back are always noted up more on the right side. At my C5 and C6 where the fusion is I have a deep dull aching pain like a punched nerve that is alway there. Ive done physical therapy, massage, injections, acupuncture, electro therapy, ultrasound, pain block nothing has phased it. My three vertibrae below the fusion swell up twice their normal size. I constantly have debilitating headaches. My shoulder and neck feel like I have been stabbed with a knife and it be twisted back and fourth. None of this goes away. We have kaiser and the send me to physical therapy which is a 10 minute appointment. I have done most of the other stuff outside of kaiser on my own. I have one question what happens with the nerves that run between the C5 and C6 vertibrae when they are fused together. Are they severed or relocated. Could this possibility be what is causing the pain from my neck through my shoulder and down my arm. I realize my surgery without a doubt had to be done. I am not looking for a lawsuit. I just want a straight answer whether the answer is there is nothing that can be done or there are things worth looking into.
Thank you for taking the time to answer everyone’s questions.
Jerry Riley
I am about to have my third ACDF. This time I am having c-6 & c-7 done. Both previous surgeries I had excessive swelling which required a longer hospital stay. The 2nd surgery Feb 2015, I developed a hematoma which resulted in a respiratory arrest, tracheostomy, and additional surgery and blood transfusions, and a prolonged recovery. Now I need another surgery as the disks below the previous fusions are herniated and impinging on my spinal cord. I’ve tried PT, epidural nerve blocks, nothing is working and numbness and tingling keeps getting worse. What do you think the chances of post op hematoma happening again are?
Jerry,
When I said impingement, I meant impingement of nerves by the hardware and not shoulder impingement. I do not think you have a shoulder problem. The problem is related to your neck. There are enough pointers for that.Insist on seeing the doctor and talk about it. Try and find the cause of pain. If not one then probable causes. Doctors are not just for operating. Their tasks are way beyond that. If you are not satisfied with the pain specialist, you should see the neck specialist. Your healthcare system should not deny you a meeting. Whether it is fruitful or not is another matter.
All the best. Take care.
William,
I tried to look at your previous posts but you have not mentioned symptoms in those. What is the issue that you are having. You had written about an osteophyte in post surgery MRI but never mentioned about the issues you are facing. Why did you go for speech pathology examination. Could you please tell me if your fusion has occurred [healed] or not. If the plate is the cause of problem then removal may be needed to be contemplated provided fusion has successfully occurred. But I am answering based on your inputs only. The best answer would be given by your doctor only.
Jerry,
The nerves are neither severed nor relocated. They are simply off the fusion area. You see fusion is done between vertebral bodies and the cord and nerves are posterior to vertebral bodies. But yes! These nerves can get affected. The reduced exit space in the neural foramina is the first issue. Other issues could be a longer screw, fibrosis around the nerve due to zealous healing response, graft pushing the tissues to cause pressure on the nerve. there are other reasons too but these are common ones.
The first outcome of the surgery is fusion between two vertebrae. If the fusion has not occurred, it could also cause symptoms. if fusion has occurred, we should move towards hardware issues.
Your nerves would be intact but they are under some kind of pressure. What? Why? needs to be determined and accordingly treated. It could be long arduous and often frustrating but worth a try always before we say nothing can be done.
Take care.
Hi Dr. Singh, thank you for your replies. I will push to see a neck specialist. We do have an FSA account and we may look outside of Kaiser. I have heard of a few good neck specialist the in the San Francisco Bay area. I appreciate your feedback, I know there is something more going on with my neck. It is hard not to start questioning yourself when all the doctors look at you like you are an idiot for even thinking something is wrong.
Thanks again for your time.
Jerry Riley
Hi, I had cervical spine surgery about 7 weeks ago. I had an anterior cervical disectomy and fusion with anterior spinal cage instrumentatoin C 3/4 and C6/7: C5 corpectomy and C4 to C6 anterior strut graft and fixation with an anterior cervical plate C 3 to C7. I still have problems swallowing food and have hard lump under my jawline. I did have an x ray done and it showed everything is in place. My internal medicine Dr put me on prednisone and it didn’t clear up. What could have caused this and what can be done?
I am a week post op patient I had acdf on c-5/6 c-6/7 fusion the surgeon said it went well but ever since the surgery my right eye has been drooping I had a bit of blurred vision as well the dropping seems to get better then all a sudden it droops again they gave me steriods in the hospital they said it was just prob from the way my head was positioned during surgery and it should be fine I just don’t think this is a normal reaction for the surgery or is it?
Hi Deborah,
Nothing can be speculated as such. it is better if you get in touch with your previous doctor and try to find out the likely reason. Was it related to your condition or the procedure itself. He would be in better position to answer the particular issue.
All the best for your surgery.
I had my c4-5 surgery 8/16/16. In the last two months I’m having periodic tremors in my head on the side where the hardware is installed. Is this related seeing that it starting happening weeks after?
If I stretch my imagination, it should be some kind of fasciculation – involuntary muscle contraction. If it persists, you should see your doctor, if any nerve is being irritated.
Take care.
Retraction of esophagus to access cervical spine is part of the procedure and is considered to be most common factor though not all the patients of ACDF develop dysphagia. Advancing age, extensive cervical spondylosis, female gender and multiple level fusions are other important factors. Usually it does go with time. If no then you should discuss with your treating doctor.
Take care.
Hi Angela,
Symptoms sound like Horner’s syndrome. Might occur due to irritation of sympathetic trunk in the neck [bundle of nerves]. Is it still persisting?
Hi Dr. on Dec 1, 2016 I had c3-c4 c4-c5 c5-c6 anterior cervical discectomy and fusion surgery. Since surgery the back of my head up to the crown has been numb, with loss of balance, three weeks ago I started getting extreme head pain that will ease of to a dull constant pain then will flair up again, anything strenuous or orgasm makes me vomit/nauseous as well as blacking out with the pain. I also have noticed increased aggressiveness, trouble concentrating. I First went back to the Dr. 2-3 weeks after surgery and he said everything was normal. On Wednesday Feb 8, 2017 was my 2 month checkup and I informed him about everything and he said everything was fine and my head problems was not due to the surgery because there are no nerves for the back of the head that would do this. Please give me your professional opinion, my family doctor does not want to send me for a scan on my head or anything since I had one done last year, I have had to be brought to emerge a few times now with the pain, they tried maxeran, steroids, Maxalt, naproxen, dilaudid, morphine, most through IV and couple times it helped to a tolerable level but I also have a very high pain tolerance, but this pain on a scale of 1 – 10 is 25.
Thanks,
Troy Matchett Numb Head
Troy Matchett,
Numbness and pain point to nerve compression or injury. Cause needs to be evaluated. Occipital headaches spreading to rest of head are known and the area of nerve you describe as numb does point that there is probable compression somewhere of the nerve supplying to occipital area. Because the numbness is post surgery, any nerve injury needs to be considered too.
At least it needs to be evaluated and investigated.
Please discuss that with your doctor and if you feel right, a second opinion may too be sought.
I had ACDF C4-5 and C 6-7 in October 2015. I just had an injury at work one month ago and have a lot of pain and numbness in hands and weakness of my arm and hand. Got into a car accident 4 days ago and was rear ended. The pain is now excruciating and increased numbness and weakness. I went to urgent care two days ago and the doctor read me just a little bit of my MRI results but wouldn’t read it all to me and told me I need to see the doctor who ordered it. She did tell me that I have severe foraminal stenosis at level C3 c4 and at c6 c7. I am wondering how that is possible at my fusion level? Could the work accident have caused this somehow? My neck has been successfully fused for at least 10 months now.
Thank you
Francesca,
Fusion is just related to fusing vertebral bodies. Foramina are different structures and foaminal stenosis can occur due to degenerative processes as well.
Your MRI and your doctor would be able to tell you better.
Take care.
Hello Dr. Singh,
Can you explain what this means on a assessment report from a Dr. [name edited]. He states:
I do not see a good fusion across the fused segment, but there is no evidence of hardware loosening. There was no evidence of good bony formation in between the vertebral body at the site of discectomy.
Obviously this a post-op MRI and CT-Scan he is referencing that was done over year after the ACDF at C5-6 and C6-7. Thanks for any input.
Bill
William Greenlee,
The report says there is not enough fusion seen across the segment where disectomy was done and fusion was intended to be achieved. And the implants have not loosened yet. Not good after one year. Please talk to your physician because lack of radiological evidence on CT means simply there is failure of fusion.
Take care.
Does this mean that eventually the hardware will loosen? And if so usually how long does that take to happen? Also will loosening of hardware create more pain issues. One last question. Why would there be residual disc and osteophytes in the surgical area? I’m currently having more issues with numbness and tingling and burning in the upper extremities and have been told it is due to residual.
Thanks for the feedback,
Bill
I see you stated not good. How not good is it? Does it mean a 2nd surgery. I figured since there is no loosening of hardware that is a good sign. Also from a post a while back in regards to a muscle in the neck hitting the plate. Could that be the cause of not being able to swallow food on the first bite? If it does go down then I get instant hiccups. After this surgery I’m very skepitical about having a second. I guess that is why I’m a little concerned about the “not good” statement above.
Thanks for input,
Bill
I comment here because I am not finding much about my situation elsewhere. I needed cervical fusions both anterior and posterior. The operations went well except with the posterior I developed osteomyelitis from s.aureues (not MRSA). Spent a couple of months in skilled nursing on a PICC line and vanco and keflex. My problem is with the damage caused by the deep debridements done. The doctors took a piece of muscle/tendon/bone out of the back of my neck a bit over 2 inches long and over an inch wide. I have a huge scar and “divet” in the back of my neck. The issue is pain. Inability to hold my head up for any period of time and lots of pain in the wound site if I use my arms, in particular my right arm. Doctors do not give me much hope about getting better. I ask about physical therapy to help with the damage done from the deep debridements. Thanks
William,
If the bone fails to unite, eventually, the hardware does fail because it cannot last indefinitely and would get fatigued. When! I cannot say. Depends on particular hardware, the load on it etc etc. But it is better not to wait for failure.
All the best.
William,
The very purpose of the surgery is decompression and fusion. After decompression, the graft is inserted because we want to achieve fusion. The purpose of the implant is to hold the bones in position till the fusion occurs. Once the fusion occurs and consolidates, the implant is not doing any job and could be taken out.
I elaborated to emphasize the point that implant is a temporary measure to hold the bones together in the desired position, till the fusion occurs. Th FUSION is the ultimate aim of fixation in this surgery.
Why?
Because every other stuff eventually fails out of fatigue but bone, because it is a living tissue gets remodeled and last indefinitely.
Not implant. If implant could do that, there was no reason for grafting.
Therefore when there is no fusion after one year of surgery, it attract concern.
As the fusion has not occurred, implant bears all the load and would eventually fatigue.
There is no emergency though but I do stress to talk to your doctor in great detail and chalk out a course.
If it means a second surgery, then you would have to consider it.
Daniel Rose,
The best person to ask about physical therapy is your treating doctor. Because before you could put yourself in physical therapy, you need to understand what you could do and what you cannot.
Meanwhile, a collar would help you.
Take care.
Hi all. What I was really asking was input from other patients that had to undergo deep debridements (not just a bit cut away) on the back of the neck. I ask if you also have trouble keeping your head up and do you have weakness in your arms? These deep debridements have really take a toll on me and have negatively impacted my life. For the Doctors reading this I ask if you have ever had to debride a patient on the back of the neck?(remove infected muscle,bone, tendons)? how did it work out, does it always work out poorly? I am told it is rare these days to contract osteomyelitis in the way I did, but it still happens. Oh, physical therapy is totally out of the question for my upper body. Same with any type of anesthesia injections as I still take antibiotics and I am told I will take them for the rest of my life, I am 62 years old. I still get out there and walk but it is so darn painful with my head not well supported. I know the result I am experiencing is not the one Doctors want the patient to think about, but it can also happen to you. The Doctors say I have developed dystonia in the large muscle that runs down the side of the neck (always in contraction). They were thinking of botox injections but the “head man” said I would certainly have more trouble keeping my head up after that, It has been 4 years since the operation that gave me my infection. Sure would like to hear from a Doctor that thinks they could help. My Doctors now are all from UCLA.
Hello doctor,
One last question. When you put in a allograft and the fusion doesn’t take then what happens to the allograft. Watching videos of the ptocedure it seems like the graft is actual bone. So if the fusion doesn’t take what happens to the graft bone. What would it look like on a MRI or CT-Scan? Does it just disappear since it didn’t fuse?
On a CT-Scan or MRI would there be any indication that a bone graft was there? It would seem like you would be at that able to see a outline of bone from a bone graft even if the fusion did not take place. Does the bone graft bone just disappear or does it shrink? Just curious I’m trying to identify the bone graft and would like to see if there was anything that would give indication that one was even placed in there.
William,
In rare cases it may be resorbed but it is visible. Even an xray would show it.
William,
When your radiologist comments that there is not enough fusion, he means that graft and vertebrae have not fused.
You see, graft is a block of bone placed between the two vertebrae to be fused [the graft occupies site of removed disc]. Thus, the graft is sandwiched between two vertebrae. For fusion to be successful, each of the vertebra has to fuse with the graft.
I hope that would clear the issue.
Take care.
I understand now. I guess if the block of bone that they put in between the vertebrae doesn’t fuse would you still be able to see that block of bone? Even though it didn’t fuse with the vertebrae. I wish there was a way I could send you a picture of my MRI or CT-Scan so you might be able to identify the bone graft that apparently didn’t fuse.
Hello once again,
Hopefully a quick question. I had a X-Ray done of the cervical region. C5-7 is where the fusion took place. The X-ray indicates “There is change of prior anterior cervical fusion of C5 through C7 with no abnormality in alignment seen. So what kind of change would this mean? Any input is great thanks.
Thanks
William,
Sorry, it does not make much sense. The nature of change is not mentioned. May be you should inquire from the reporting doc. I am not able to deduce anything.
Take care.
I kind of figured that was a odd report. I guess I was wondering is the only way to tell if the fusion took by X-Ray or can a MRI or CT-Scan tell you? And what verbiage would you look for on a Radiologist report to indicate a fusion or Non-fusion.
Thanks,
William
William,
In the x-ray or CT for that matter, one looks for bony continuity from one vertebra to spanning graft to another vertebra. Unless all these three form a bony continuity, it cannot be called a successful fusion. A radiologist would commend on the status of union across the three. If he/she does not, your clinician would be able to tell you better.
Take care.
Hello Doctor:
I am male 35 years old.I had C5-6 & C6-7 ACDF 6 weeks ago. I stayed in hospital for 4 days due to dysphagia and coughing fits that last hours. Back to work at one month. At 6 weeks, I have developed sore throat from talking. I am scheduled for a Fiber Endoscopic Evaluation of Swallowing in two weeks.
Is my throat issue typical given my immediate post-ops issues or is this a symptom of protruding hardware causing irritation?
Thanks
PK,
Sore throat is due an infection. If you have hoarseness then injury to nerve could be thought of but that would occur after surgery typically, not after a gap.
How did endoscopy go. What was the result?
Do let me know.
Is vocal cord paralysis a known risk of the ACDF surgery? Is it something you generally warn your patients about? 6 weeks postop of c6-c7 decompression and I haven’t been able to speak above a whisper.
Thank you!
Jay,
It is risk and often occurs due to stretching of tissues during surgery putting strain on laryngeal nerve. Give it a few weeks and it should go away.
Take care.
Help!! No one will help me with failed ACDF 4 level surgery. I am 68 years old with osteoperosis. and didn’t see the surgeon until a few minutes before surgery, was told he mostly uses PA’s . I didn’t understand what they were going to do or I would have refused the surgery. I went in about my lower back and had no neck pain but simply asked if he knew why my neck grinded and was told, we’ll just do an MRI on both. When I went back, I told that my neck was so bad that it had to be dealt with first and was then told If I didn’t let them stabilize it that if I fell wrong, I could be paralysed from the neck down. I have no relatives and a job, so this scared me to death. I have been in pain and having numbness and mobility problems ever since. I had 2 second opinions and was told that this was very aggressive. Surgery for degenerative.disc disease by both doctors. I saw the doctor that did the surgery a d his PA and was told the same thing that it just didn’t heal right. The PA told me that I needed another more extensive surgery and just recently found out that it was for revision surgery. I do not trust the surgeon that did this to me because I wasn’t even a good candidate for this surgery because he doesn’t even meet and evaluate his own patients. I went back to one of the other doctors I saw after a more recent MRI and was told that the plate isn’t even screwed into the bone. He said the plate should be taken out and I asked him if he could do it and he said he couldn’t do it. I asked him if there was a neurosurgeon in this town that could remove it, he said there was but that no one wanted to clean up someone complication.
I now live in pain 24/7, on a small amount of pain medication because I am afraid of it, so I suffer. I even went out of town and couldn’t get it fixed there either.
I DON’T KNOW WHAT TO DO NOW, can someone give me some kind of advice?
Hello
I’ve had 2 neck surgeries. The first was on I think c2 c3. Disk was pressing on my spinal cord. 1st Doctor said it it well. I went back to him with the same numbness I had. Can hardly walk, right leg and both arms are numb and tingly. My right leg can be in water and I can not tell if the water is hot or cold. All he would say is what he did looked good so I went to another Dr.. The 2nd Dr. told me it did not fuss good and that I had a bone spur growing thru the fuss straight back to my spinal cord. The 2nd Dr. did a surgery in the back of my neck to widen the spinal canal but did nothing to the bone spur. Symptoms are worse, both legs and arms are numb and waist and lower back is tight. The only good thing about all this is that I’m in no pain. I’m basically numb all over. So my question is, can they go back into the first surgery and fix the bone spur or can anything be done?
Hello, I have a c6-c7 fusion surgery with hardware (plate/screws & donor bone) in Aug 2015. Over the last couple of months I have been having tension headaches and neck and shoulder pain and seems to be getting worse with the weather changes.
When I had the surgery I was having server pain down my left arm and numbness in pinky & ring finger. The pain down the arm went away after surgery and had a great recovery with mild discomfort.
Yesterday I had a MRI and just got the results and the report noted “continuing narrow of canal at surgical site) my primary Dr wants me to follow up with the surgeon, but he usually runs 30 days out for appointments.
My question is, how can there still be “narrowing of the canal” if the disc has been removed? I also feel that the pain is in my right should blade area vrs before it was all left should/arm pain.
hello
Technique: Sagittal T1, T2 STIR coronal T2 axial T2, T1 images
obtained lumbar spine. Correlation prior study of 09/08/2017.
Findings: The visualized spinal cord is preserved in signal. The
lumbar vertebral bodies are preserved in height and signal. Axial
images at L1-L2 demonstrate central canal, lateral recess and neural
foramen widely patent.
At L2-L3 disc height and signal preserved. Lateral recess, central
canal widely patent. The neural foramen widely patent as well.
At L3-L4 disc height and signal preserved. Lateral recess, central
canal widely patent. The neural foramen widely patent bilaterally.
At L4-L5 facet hypertrophy, flavum hypertrophy is again noted without
significant lateral recess or central canal compromise. The neural
foramen minimally encroached bilaterally stable since prior study.
At L5-S1 facet hypertrophy noted. The lateral recess and central
canal widely patent. The neural foramen widely patent as well.
There is edema at the facet joint at L4-L5 at the left and also at
the right, to a lesser degree at L3-L4.
Impression
Impression: Facet arthrosis and edema at the facet joint at L4-L5
right greater than left and L3-L4 as well to a lesser degree
unchanged. There is no significant central or foraminal encroachment
noted. The lumbar vertebral bodies are preserved in height and
signal. There is no evidence of fracture. The appearance essentially
unchanged.
Findings and
Minor peri-screw lucency is suggested at C6 on the lateral view. The
anterior plate is slightly separated from the anterior C6 vertebral
body compared to prior examinations. Findings would suggest some
degree of fixation loss.
C4-C5 C5-C6 interbody graft with anterior plate and screw fixation is
otherwise unremarkable. No malalignment can be seen. Atlantoaxial
arthrosis is moderate. It is similar to prior examination of
10/23/2017 and 10/17/2017.
Impression
Impression:
Peri-screw lucency at C6 with slight widening of gap between C6
vertebral body and anterior plate suggesting fixation loss with mild
pre-vertebral soft tissue swelling. Interbody graft and remainder
plate and screw fixation are unremarkable.
Gail,
If your vertebrae has not fused and it is painful and the plate is becoming loose, you should consider revision surgery. It was different when the first surgery was not done. You could have a, and preferred non-operative treatment. But because, now an unstable spine has been resulted, you need the surgery.
You need to work out within your health care system.
Glenn,
With both the surgeons avoiding bone spur, all I assume is that spur may be in a unapproachable area or critical area.
Michael E,
The question to be answered is if the narrowing is affecting you specifically. You can ask your doctor about this.
Take care.
Radio report suggests a loss of fixation of your implant. Please consult you treating doctor.
Dear Sir,
On January 6th 2014 i fell on black ice directly onto my tailbone. I went to the local ER complaint of Severe coccyx pain and headache. I was treated like a drug seeker had three x rays standing only told i had a contusion given 20 tramadol to take every 6 hours for the next 20 days no refills.i was also given a drug screen but was told it was too check for “internal bleeding.” I presented myself to my new pcp who told me id be fine to get a donut. For months i wasin agony then started having pleurisy type chest pain as well that was intermittent and persistent up until September when finally given a chest cat scan that revealed a left anterior 2nd rib fracture. It took 6 months from the date of that fall to get an MRI and 3 years of the run around by the local medical community for a medically necessary surgery to which i finally had to fly to another city for care. Was told that my disc between L4 and L5 was ejected on impact causing a collapse of the vertebra trapping my sciatica and peroneal nerves and fused together with new bone growth. I had surgery to put in a spacer rods screws and cadaver bone were used to repair my lumbar spine last February 2017. Now it’s my cervical soine and once again i was treated like a drug seeker because of the pleurisy type chest pain bilateral radiculapathy in both arms hands and fingers and my legs and feet are affected as well. I have lost fine motor skills have neuropathy and bilateral drop foot. Due to the harm that was dealt to me by that medical community i have relocated across the state and closer to my surgeon. I am now in line on February 28th 2018 to have a 3 level cervical spine fusion. I have often wondered if its possible i suffered a brachial plexus injury when i fell. I told the original hospital ER i was hurt very bad that it felt like my tailbone shoved everything into my skull and i was ignored. I have been diagnosed with severe emotional trauma due to the malicious neglectful and abusive treatment i received in Spokane. I had moved there about 6 weeks prior to that fall (11/09/2013) from southern California. In your opinion will i one day be the almost physically happy women i once was? I was born with spina bifida occulta prior to falling also diagnosed with spondolylothesis and severe Spinal stenosis and arthritis but i Was able to to physically maintain my daily living activities without daily medicating for pain. in fact i take no medication at all. Until yesterday i went to ER because i couldn’t take it anymore. I live in a time where anyone in pain is red flagged and profiled. Even with the extensive evidence to support pain therapy i was treated like a faker. The new city I moved to right after this past thanksgiving is much better but the city that left me damaged has left me scared and intimated to seek help.Any advice would be most appreciative.
Kind Regards
Marguerite Martin II
Where did my Two separate messages go. It off upsetting that they have mysteriously disappeared as it pains me to use my fingers. I wrote them not more than 3 hours ago saw them both here shortly after posting. Seriously i could vey 5 for the time i spent.
Marguerite Martin II,
For obvious limitations of the interface and the multitude of issues you have I myself find in a position where i would not be of much help to you as a healthcare advisor. But on a different level I do wish you very best of health and physical activity. I am glad that your present city is better. It is always good to let things go, difficult though it may seem.
Do not get intimidated because you need to take care of yourself and ask for help whenever required.
For your medical issues, you would be best served by a doctor who could see you in person and not by someone who is just looking at the words in front of the screen and deducing.
All the best.
Hi,
The messages go into moderation. It is automatic.
I have replied to your message. Take care.
Hello aprox. Sept 20, 2017 had posterior lumbar fusion from c2-t1, on October 26, 2017, had to have a revision since screw backed out in c2 which was anterior plate and removal of screw. My question is as swelling has subsided in neck this bony protrusion is evident in the middle of my scar. It has been there all along just getting more and more obvious, it is reddish purple looking, like a rather extermely large angry zit. It is hard like bone not painful to touch, no heat, could it be a displaced bone graft or a screw? All follow ups since 2nd surgery have been good, it just makes a very unattractive scar look Halloween scary.
What do your doctor say about this scar. If internally everything is fine and just scar has the problem, you need to see a plastic surgeon or skin specialist.
Take care.
on a c6 and c7 cervical fusion what happens when the implant appears to be placed properly but the stem which is supposed to be parallel against the rear of the spine is not resting parallel with the spine but say at 25 minutes after the hour (on a clock as a comparrison)
John,
As long as it is working fine, slight misalignment should not be a concern.
For any issue, you can discuss with your treating doctor.
Take care.
Hi Dr. Singh,
I know there are rare complications from multi-level ACDF surgery, but I haven’t really found an answer. My husband had a multi-level ACDF surgery in Dec. 09. (C3-4, C4-5, C5-6) He still had complete range of motion and was active. Pain, numbness in his hands and finally a foot drop, led to the ACDF. Anyway, he had a posterior approach with an anterior plate to support the fusion with allograft. Immediately after surgery, he developed cervical dystonia. It was quite severe. His neck brace, a Miami J collar, did not help because the dystonia kept pulling his chin off the brace. After 5 days, they had to go in and remove the anterior plate because the screws were coming undone from the severe pull which left him with just the brace that didn’t help and no other support for the fusion.. Long story short, he now needs a complete cervical reconstruction because the bones fused incorrectly. His chin is almost on his chest and he has very limited movement of his neck. Almost none, up and down and a little left to right. I know there are rare complications but this is so severe and immediate. What could have happened to cause this? I do know this is your opinion and each case is different but I’m still searching for answers since he was pretty normal before surgery and immediately after, developed severe dystonia. You’re thoughts? Maybe a good case study for a paper? Thank you so much!
Luanne,
Sorry to know that your husband develeoped a postoperative dystonia, avery rare one indeed. Apart from central causes affecting brain, trauma or injury to cord or cervical nerves can cause dystonia.
There are only a few reports on this condition occurring after cervical spine surgery. I could locate only one as of now and that too did not dwell much on causation. So assuming other factors being normal injury remains the probable cause.
I think a discussion with treating doctor can make things clearer.
Hi Dr. Singh,
Thank you for your reply. After the surgery, I tried to talk with the treating surgeon. Directly after the surgery, the surgeon came out to tell me how things went. At some point in the conversation, he mentioned that one of the mastoid muscles was thicker than the other and he said he shaved it down some but later denied he said anything of the sort. To me, who is not a Dr but very knowledgeable about things, that would lead me to think that it could have been induced by the shaving and just irritated that muscle to spasm drastically? Anyway, I wasn’t looking for blame and the surgeon went on the defensive and refused to answer questions pertaining to the dystonia. Let’s just say, after the surgery, there were many mistakes all the way around and had I not stayed with him 24/7 for 3 weeks, he would not be here. I think it would make a great case study. I also only found one published article about cervical dystonia following ACDF. (My husband’s dystonia is so bad that even after only 5 weeks post surgery, Botox could not even loosen anything.