Post ACDF 2-LEVEL Surgery MRI RESULTS

Is this a Normal reading after a hour and 17 minute surgery?
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Yes - 0.0%
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No - 100.0%

 
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BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 6:18 PM (GMT -6)   
Hello everyone,

I'm new to this site, but have a couple of questions and would like feedback/opinions. I had a 2 level ACDF surgery in 2015. Since then I have had multiple MRI's, which all state the same thing. Could someone please explain the findings.


C5-6: Endplate spurring is noted most pronounced at the right subarticular zone producing mild cord flattening. The AP diameter of the spinal canal is mild stenotic A.-9 mm. Mild-to-moderate right foraminal stenosis is noted. The left foramen is mildly narrowed.

C6-7: Subarticular endplate spurring is noted. The midline diameter of the canal is mildly stenotic at 9 mm. Slight cord flattening worse on the right. Extensive right foraminal stenosis is again seen. The left foramen is at least moderately stenotic.

These are the 2 levels that were operated on and I have to most likely have to have a second surgery due to the pain and loss of feeling in the hand. Any input would be greatly appreciated.

Thanks

straydog
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Date Joined Feb 2003
Total Posts : 14995
   Posted 3/6/2017 6:58 PM (GMT -6)   
Hi BillyG & welcome to the forum. You mentioned you have had multiple MRI's, were all of these done since you had your surgery? What about the MRI before surgery, what did it show?

Spurring is a pretty common as we age. Some people can have them & have no issues at all. What I did read is at C5/6 there is mild cord flattening. C6/7 shows pretty much the same thing & this is probably why you are in pain & have loss of feeling in your hand, most likely a pinched nerve. Stenosis is narrowing. Keep in mind I am not a dr, none of us are.

None of us can say if this is normal after a surgery, but reading what you wrote above you have some things going on. What type of dr did your surgery? What is your dr telling you now? If this were me, I would find the very best neurosurgeon & take my MRI's & have a consult. In fact I would see two different ones not affiliated with each other & take it from there. The reason I prefer a neurosurgeon is they have lots of expertise dealing with the nerves in the spine.

Keep us posted. Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 7:13 PM (GMT -6)   
Hello straydog,

All 3 of the MRI's basically say the same as above. I have seen a couple of Neurosurgeons who have stated either they would not have preformed the first surgery since there was no severe cord damage or potential. The other Neurosurgeon stated he will need to go through the back of the neck. The first surgeon basically said "you know you have a lot of arthritis" and that was basically it. He as well was a neurosurgeon. I guess with the little research that I have done and knowing that the first surgery only took the doctor a hour and 17 minutes makes me wonder what did he really do. The problem now is that I have to try to get the Department of Veteran Affairs to pay for a second surgery. I also thought that with a diskectomy they are supposed to clean out the disc material as well as remove the bone spurs. Maybe it is a different procedure for VA Patients.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14995
   Posted 3/6/2017 7:54 PM (GMT -6)   
There is no mention of you having surgery at these levels on this report, I find that odd. Not always do they remove a spur, sometimes that can lead to more issues. Surgery is usually a last resort type of thing for spurring. Do you have a copy of your operative records? If not, I would obtain a copy from the facility where it was done.

A lot of times they will do a series of epidurals to see if they can get a nerve calmed down, thats always an option. I would be obtaining copies of my MRI's & surgery records for my own personal keeping. Since you are going thru the VA they will need a copy too.

Keep us posted.
Susie
Moderator in Chronic Pain & Psoriasis Forums

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 8:23 PM (GMT -6)   
I actually have copies of everything. You will probably laugh at the post-op report. I had a P.A. at Eglin look at it and start laughing. Of course he was not laughing at me, but said that he can pin point 3 items that were not done during the surgery. Here is the info from the post-op report.

Operative detail: The patient was brought to OR. General anesthesia was administered. The patient was placed supine on the operative table. Cervical area was sterilely prepped and draped. Transverse cervical incision was made. Dissection was carried down through subcutaneous tissue. Platysma was divided. Blunt dissection was used to identify the prevertebral space. Prevertebral fascia and longus coli muscles were dissected laterally. Self-retaining retractor was placed. Fluoroscopy was used to confirm localization. Diskectomy was then preformed at C5-6 and C6-7 in the following fashion:
Distraction was placed across the disc space. Diskectomy was preformed with curettes and rongeurs. Anterior and posterior osteophytes and endplates were drilled with a Midas RX drill. Posterior longitudinal ligaament was opened and bilateral foraminotomies were preformed. At this point, the Dura and nerve roots were well-decompressed at C5-6 and C6-7 levels. Two iliac crest allograft was then shaped and fit into the inner spaces at C5-6 and C6-7 under fluoroscopic guidance. An anterior cervical plate was placed, 2 screws each in C5, C6, C7 under fluoroscopic guidance and locked. Wounds irrigated and hemostasis was obtained. The wound was closed using 2-0 vicryl in platysma, 3-0 vicryl subcutaneously and derabond on the skin. There were no obvious intraoperative complications.

That is the complete post-op report. I can already figure a couple of things that might should be removed.

Abilene
Veteran Member


Date Joined Apr 2014
Total Posts : 943
   Posted 3/6/2017 8:25 PM (GMT -6)   
Welcome BillyG,

I did not notice what Susie saw but agree it is unusual to not mention what is seen from your previous surgery. The time factor is not necessarily a problem. Did you have symptoms before your surgery that changed any afterwards?

That surgery report will be interesting to see and keep for your own records. Have you talked to the surgeon who did this for his opinion? Not sure I would, but just curious.

I will be eager to hear more about this.

UPDATE: So we posted about the same time and you do have the report....
Posterior C3 - C7 laminectomy and fusion 2 rods and 10 screws, local bone graft from surgery site-lamina and other bony tissue 12/17/2013; Hyperthyroidism; Sleep Apnea;
Thankful for my husband of over 40 years

Post Edited (Abilene) : 3/6/2017 7:30:45 PM (GMT-7)


BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 8:30 PM (GMT -6)   
I just posted the Post-op report above. The symptoms actually became worse more burning in shoulder blades also now when I eat every time I have the first bite get stuck in my throat so either it is coming back up or I will have a severe case of hiccups. Also loss of feeling in my right hand as well as weakness. I have had a epidural shot in the neck and that just aggravated the shoulder blades with a burning sensation. The original surgeon said I have a lot of arthritis in my neck and that was it. He didn't even have a follow-up appt after 6 months to see if the fusion took. Trust me I have not been back to him.

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 8:34 PM (GMT -6)   
Oh yeah I also had a CT-Scan myelogram which stated at C5-6 there is a posterior spondylotic change with osteophyte including upon right side of the spinal cord and abutting and deforming the spinal cord. This was never reported on the MRI before the surgery. Makes me wonder what he did in the hour and 17 minutes.

Abilene
Veteran Member


Date Joined Apr 2014
Total Posts : 943
   Posted 3/6/2017 8:49 PM (GMT -6)   
I agree and understand not going back to him!

You might find it helpful to read newmanmaple's comments. He is also using the Veteran's Administration. He gives his MRI results and it mentions his previous surgeries.
Posterior C3 - C7 laminectomy and fusion 2 rods and 10 screws, local bone graft from surgery site-lamina and other bony tissue 12/17/2013; Hyperthyroidism; Sleep Apnea;
Thankful for my husband of over 40 years

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/6/2017 8:59 PM (GMT -6)   
Thankful for his service. The VA actually paid a civilian surgeon to do the surgery. The sad thing is that they continue to send Veterans to this guy. I have spoken to the CMO and he basically just turned his head away. It truly is a shame that tax-payer dollars are being abused.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14995
   Posted 3/7/2017 6:48 AM (GMT -6)   
Billy, I am stumped about your recent MRI not mentioning your surgery. If you looked at newmanmaple's report his surgery is discussed.

I would not go back to the original surgeon either. Is there no one at the VA that you can take a copy of your records to & discuss some of this? I know they often refer out for specialist. There has to be something that can be done. Do you have any other insurance besides using the VA?

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

White Beard
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Date Joined Feb 2009
Total Posts : 3667
   Posted 3/7/2017 11:31 AM (GMT -6)   
Hi Billy and Welcome to the Forum. The problem that your having with swallowing and feeling like food is stuck although not common it is not that uncommon either. After my first ACDF I had similar problems, doing this type of surgery it is easy to damage the nerves going to the vocal cords and throat. Sometimes the nerves repair themselves over time and some time not! Personally I try to avoid going to the VA for any major medical problems, just my opinion from my previous experiences with them. For the most part I don't have any good praises for military medicine either, but that is another story! Anyway did the VA also do your MRI's? If at all possible I would try and find a good independent neurosurgeon, preferably affiliated with a medical school teaching hospital and make an appointment for a second or in your case a third or fourth opinion. Bringing you MRI scans with you. If your latest scan is more than six months old they might want a new one. Anyway it definitely sounds like you still have some major problems going on in your neck! I can definitely empathize with you, as I have been through it myself!

Good Luck to You!

White Beard
Moderator Chronic Pain
USAF retired in Sept.1991. I went back to school and became a licensed RN in 1994, I worked on Oncology and Med Surg, Disabled in late 1999, was approved SSD in early 2002! Diagnosed with: DDD and Multiple herniated Disks; Foraminotomy L3/4/5 Jan 2013; Posterior Articular Joint fusion Nov 2010; C5/6 ACDF Sep 2009; C6/7 ACDF 1985; Implanted pain Pump Jun 2014.

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/7/2017 12:07 PM (GMT -6)   
Hello Whitebeard,

I have had multiple MRI's and CT-Scan myelogram. All basically indicate the samething. The original surgeon was a outside surgeon that the VA paid. The swallowing issue has been ongoing since the surgery (2 years ago). I was hoping as you stated for the nerves to relax. I did have a modified swallow test which the speech pathologist stated that my muscle that contracts to open the esophagus is bumping into the metal plate. Of course when I explained to her that I need her to document that she of course didn't. Anyway I'm at this point very skepitical of any surgeons locally and as you really do not trust the VA with healthcare needs. I guess the thing that was a big player other than the numbness and pain was the scare tatic that if i was involved in a fender bender I could have been paralyzed from the neck down. Well I wonder if I'm still in that same position.

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3667
   Posted 3/7/2017 11:54 PM (GMT -6)   
Well BillyG the further up the spine you go the bigger the area of the body that's affected if something goes Wrong! That's the thing that makes severe disk problems in the cervical spine so bad, and Scary! Although maybe rare, total paralysis as in quadriplegic is always a possibility, personally I don't feel like it's worth risking. My first ACDF I was still in the military up in Alaska and when they finally found the problem they took me to a civilian hospital in Anchorage to have the local neurosurgeon do surgery, because they were afraid any severe movement would totally paralyze Me! The weird thing was after the neurosurgeon looked at the MRI and did the Surgery he told I must have had somebody watching over me because with the damage I had, there was absolutely no reason why I shouldn't of been a total quadriplegic! Anyway I'm convinced it's nothing to mess around with!

It's difficult to tell what your risk is now, but it seems obvious something is still not Right! So just be careful until you can get some definitive answers and get it properly Fixed!

I wish you Well!

White Beard
Moderator Chronic Pain
USAF retired in Sept.1991. I went back to school and became a licensed RN in 1994, I worked on Oncology and Med Surg, Disabled in late 1999, was approved SSD in early 2002! Diagnosed with: DDD and Multiple herniated Disks; Foraminotomy L3/4/5 Jan 2013; Posterior Articular Joint fusion Nov 2010; C5/6 ACDF Sep 2009; C6/7 ACDF 1985; Implanted pain Pump Jun 2014.

BillyG
New Member


Date Joined Mar 2017
Total Posts : 8
   Posted 3/8/2017 12:15 AM (GMT -6)   
I wanted to thank everyone for the input. Also I guess I will eventually have a second surgery just not really comfortable with the concept of trusting someone to cut open my neck again after the first go. No feeling in the right hand is starting to get aggravating so I'm sure I will overcome the trust issue soon.
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