Upcoming ACDF C4-7 Surgery

Just joined the group today. I’m having ACDF C4-7 surgery January 26th. My surgeon said I’d be in a hard neck brace 6-8 weeks before he would even consider physical therapy.
I’ve been reading and researching a lot about the surgery trying to calm my nerves. I’ve had knee & elbow surgeries but never a surgery to this extent.
I also told my surgeon I understand the radiologist pointed out where my carotid artery is located because it doesn’t sit in the normal position and to assist the surgeon but it still makes me very nervous.
I know I’ll have initial pain and problems swallowing and talking right after the surgery. I’m not sure what to have my husband tell his work about whether he’ll need to be home to help me or not. We have a single level ranch style home with exception of 2 steps down into the family room. I think I can get from the family room to the kitchen to get coffee, water, food and to the other end of the house for bathroom by myself but I really don’t know how much I’ll be able to move right after the surgery. I know I’ll need my husband to feed and water the dogs and cat. I know I won’t be able to cook or houseclean for a while. Work is anticipating me to be about about 2 months. I’m a claims examiner for federal workers comp so I average about 9-10 hours a day on the computer and about 5 hours a day on the phone.
I’m also wondering if I’ll be able to crochet while I’m recovering. I don’t have a problem sitting (years of knee arthritis got me used to it) as long as my hands are doing something.
I’m also a little concerned about our dogs. We have 3 cocker spaniels (siblings) about 8 1/2 years old and they are definitely mommy’s babies. They don’t leave my side and when I sit 2 are in my lap and the other is as close to in my lap as he can get. If I lay down to sleep they curl up next to me to sleep. Two of them need their FaceTime (I must have my face cleaned) at least once or twice a day and that’s what concerns me the most post surgery.
I think I rambled a lot but I’m really nervous about this surgery. I need it and I’m hoping it relieves the pain. I also have trigger fingers, trigger thumb, De Quervian’s, moderate to severe arthritis at base of thumb, and carpal tunnel all in my left hand. Ortho can’t do anything until I have this surgery because the nerves are being pinched on the left side so Ortho can’t tell how severe any of my left hand issues are. I’m hoping they aren’t severe and it’s the pinched nerves aggravating the left hand issues.

Oh I didn’t think about a grabber. I’ll invest in one for sure. While we have a brand new bed & mattress it’s not adjustable. My couch & love seat in the family room are reclining. I imagine I’ll spend my first week there.

I understand. I’ve tried everything and believe me this is the last resort. I’m now to the point I only sleep a couple hours a night because if my left elbow or hand touch the bed I wake up in pain. I can’t pet my dogs without pain. I can’t type (90% of my job) without pain. I’m now to the point it’s like someone has a death grip on my funny bone, their thumb is constantly pushing down in the middle of my palm and I can’t move my middle two fingers, plus the pins & needles tingling.
I’ve tried epidurals, no relief. Physical therapy, my arm was too sensitive to even do anything they ended up cancelling my appointments because even the minor exercises caused more pain and tingling in my elbow and hand.

I had an EMG which is how they found the carpal tunnel syndrome. I’ve been through pain management they did two epidurals which didn’t help at all. The last one left permanent swelling or hump at the base of my neck. Osteoporosis runs in the family and I’m lactose intolerant so I have to take vitamin D. Arthritis at the CMC or base of thumb also runs in the family. I now have pain in my right elbow and my right thumb and middle finger. I’m not sure that the right side pain is nerve related I suspect it’s probably from over use because I’ve had left sided pain for well over a year.
I am 51 and smoked for 30 years. This Sunday I will be 3 week smoke free.
Our couches recline so I plan to sleep there to begin with.
I’m thinking recovery is going to be slow based on age, former smoker, and arthritis. I already have arthritis in both knees, one foot, lower back, and my neck. Based on the CT scans we know that I have a herniated disc pinching the nerve and I have bone Spurs pinching nerves. I believe both are causing the severe foraminal narrowing or stenosis.

It sounds like you have done your homework on getting prepared for surgery. One tip I will pass on, if you buy a metal reacher/grabber put a drop of glue on the screws where the little suction cups connect. We have bought both plastic & metal ones. We like the metal ones better, however, we kept losing a suction cup. I finally got the idea of putting a drop of glue on the screws & that took care of that issue. I love using them to pick things up.

Good to hear that you have reclining furniture, you will find it much more comfortable. This should also help you with your pups since they want to be close. My husband had back surgery 2 months ago & he used his recliner all of the time.

Keep in mind successful surgeries hinge on a variety of things. The two key elements are the expertise of the surgeon & the what the patient does once they go home. Yes, osteoporosis can slow the healing process down some. We've had members here in the past that has had successful surgeries, including those with osteoporosis. Time & patience is valuable. Several of our prior members recommended this book for anyone having spine surgery; Prepare for Surgery-Heal Faster" by Peggy Huddleston. They all said the book helped them so much & took away a lot of the stress & anxiety. Just wanted to pass this on to you.

I wouldn't be concerned about the surgeon not doing an EMG. A lot of drs have stopped sending their patients for an EMG study because they have less than 75% accuracy in spine cases. The MRI & even a myelogram with CT Scan are much more definitive. However, they are a great test to diagnose carpal tunnel syndrome.

Take care.

Thank you all for the support and information.
I’ve had a long conversation with my surgeons about the possibility of adjacent disc failure and other possible outcomes from this surgery. We even discussed doing only the worst level; however there is a high probability that I would end up having to have the other two levels done sooner rather than later so instead of going into the same location for multiple surgeries and having to go through this ordeal multiple times I opted to do this once and have all three of the levels done. Again we discussed the possibility of adjacent disc failure, the possibility the surgery could affect my ability to talk and swallow long term and the options available if that does happen. We also discussed that I have quite a few issues with my left hand and there is a high possibility that this surgery will not completely take all the hand pain away and I may still have to have surgery(s) on my hand.
My surgeon is with University of Florida Health and it’s at the brand new facility 3 miles from my house (new as in the hospital portion is about 3 years old, the ER and medical offices between 3-5 years old). Ive been very impressed with the physicians at the new UF Health North facility and I really think they took the cream of the crop when they opened this location up. My Ortho, Pulmonary, and Neuro Surgeon are located there and every single one of them explains things in layman’s terms and goes over all possibilities and they make sure to answer all questions. I’ve never felt rushed and have the option to go online or through their app and message them if I think of more questions. I generally get a response that day or at least by the following day. I’m actually really comfortable with my doctors and confident in their ability. It’s calming my fears of a major surgery. Talking with all of you has helped.
Susie, I did look up the book you recommended, I looked at the sample preview on kindle. I can see how it would be very helpful for many people. I don’t think it’s my cup of tea. I’m a very matter of fact person I need the facts and I’m good. I’m finding that if I read articles about the process of the surgery it helps calm my anxiety over the surgery. I look for articles from reputable medical facilities like Mayo Clinic etc.oh and I got a grabber yesterday. Our local cash supply (like a tractor supply/hardware store) had a really good sturdy one.

CSM, I more thing I did think about is make sure you have button up shirts. You will not want to attempt to pull anything over your head or extend your arms to fit into a top.

From what you have posted here you have done very well preparing for your surgery. It sounds like you a very good group of drs that you can communicate with & have confidence in, this is extremely important.

Keep us posted on how you are doing. Take care.

I have an impending ACDF planned for C5 - C6. I've read through everything above and I have been researching stuff on line in advance of the surgery. I appreciate all of the advice given as well as the experiences provided here.

My question(s),
1) What is the percent of people that will require related additional surgery or invasive treatment after ACDF and, what are the associated reasons for this?
2) On average, what is the timeline for additional treatment noted in question 1? 3-4 years, 6-7yrs, greater than 10 yrs?

So far, I have the following reasons for follow-up treatments noted,
- adjacent segment disease (I recognize that this may serve as a generic diagnosis covering many things)
- local Kyphosis
- Risk of Mylopathy

Thank you for your response, it is sincerely appreciated!

I don't have Kyphosis at the moment. I've read, and I'm concerned that, kyphosis could occur as a result of the ACDF procedure. And, I'm further concerned with the potential of other problems occurring as a result as well. I've outline a few concerns in my initial note but really was asking the forum if there are other things that should also concern me long-term or otherwise.

ACDF has not been scheduled yet, pending insurance approval. But likely looking to schedule in early Feb. Procedure will be conducted by Dr. Brummett of Concord Orthopedics in NH.

I've asked him about possible long-term negative problems as a result of ACDF. He's indicated that based on my MRI results, he doesn't anticipate any issues, doesn't see any significant problems with the adjacent vertebrae. But having said that, there is a lot of information to the contrary. I've looked up previous long-term studies on ACDF and they are limited and dated at best. Most report anywhere from a 15 to 25% chance of people requiring additional treatment at about the 3-4 year mark and then the percentage numbers increase after that in parallel with years after surgery. Mostly due to the adjacent vertebrae having to overcompensate for the lack of movement in the fused vertebrae. Therefore causing them to become damaged over time, resulting in additional treatment. This is where my concern lies.

Almost everything that I've read indicates extremely positive results immediately following surgery and even during follow-up. Again, it's around the 3-4 yr mark that you start to see problems.

Post Edited (ACDF21) : 1/21/2021 12:13:57 PM (GMT-7)

ACDF21 it looks like you’ve been doing your research also. I just had my pre-op appointment today and will have my surgery on Tuesday. Right now the best I can say is keep doing research and reading materials and using them to determine the questions you want addressed by your surgical team.
That’s what I did and I’ve gone from being really nervous about the surgery to feeling confident with my surgical team, their knowledge, and I’m comfortable with the procedure were pursuing. My doctors have gone over the procedure, hospitalization, how long I’ll be in a brace etc to include the risks from the minimal risks to the worst case scenario.