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Spinal Cord Disorders Message Board

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Hi Jenny,

Thank you very much for your very helpful explanation.

Now, I understand my conditions much better.

I have my first MRI done on May, 2008 and I can hardly walk due to the pain in the legs, numbness of both hands, pain in left arm, numbness and loss of sensation of the left side of the body from chest down to leg, can no longer feel the urge to urinate ie I have to remind myself to urinate 2-3 hours later after drinking water, muscles too weak to push out the faeces. The neurosurgeon urged me to have the two levels ACDF surgery. I did not opt for the surgery as I am worried about the cons of the ACDF and the availability of pain medications for me as I cannot take NSAIDS pain medications as these medications will cause my kidneys to fail. Also, I am considering two other surgery methods ie

(1) artificial disc replacement surgery

(2) fusion of bones but with a special mechanism that enables some degree of flexibilities of the vertebraes ie ACDF with some modifications.

For some unknown reasons, my symptoms disappeared ie I can pass motion and urinate as per normal again, the legs pain are gone and I can walk again. I am fine for more than a year.

Suddenly (ie nothing unusual happens), some of the symptoms re-appear last month. I feel numbness in the left arm, wrist and hand especially the left thumb, lose some sensation too, stiffness of shoulders and back, drop things at times, slight right leg pain, right knee lose support suddenly at times.

I hear cracking sound of bone, when I turn my neck and when I turn myself on bed, coming from the back and the neck.

What could be the possible reasons for the disappearance and re-appearance of the symptoms in my case ?

I have bought my MRI results CD. Dear Jenny, can you kindly tell me where to look for the width of my compressed spinal cord in the MRI results. There are many tools provided in the CD but I do not know how to use them to analyse my MRI pictures in the CD. I only know how to see the different MRI pictures and zoom in and zoom out.

Please kindly advise also how to see the seriousness of the central disc protrusion in the MRI pictures.

The width of my compressed spinal cord is not written in my MRI report.

Another question is the differing intensities of the bone is showing that my vertebrae are not as solid as they should be and I probably have some early osteoporosis, should I ask the doctor for a test of the solidness of my (neck or all)bones ?

Dear Jenny, do you know of any url link, patient's personal blog that provides a very detailed step by step guides for ACDF patients both pre-op and after-op ie what should the patient do exactly to ensure a good and complete fusion ?

Thank you very much for your kind attention, advice and help. I am very grateful for your help.

Warmest Regards,

Sometimes the fusions don't take either because the patient didn't keep their neck in the brace for as long as necessary or the bone just didn't grow like it should. That is why they are using this new stuff called BMP. It helps speed up the fusion of the bone. But sometimes it's the fault of the surgeon as they don't put the plates and screws in properly...they are supposed to hold the vertebrae in place until the fusion is complete. Sometimes the bone is brittle and just breaks...can't be foreseen.

But anyone on the forum will tell you that a second surgery is better than permanent paralysis which is what you are facing if the compression on your spinal cord is not relieved soon.

I always prefer a surgeon that does spine surgery all the time. A neurosurgeon who does this only part-time, is not as preferable as an orthopedic spine surgeon who does it everyday. If one is available, get a second opinion and check the doc out.

The spine is one place where experience is EVERYTHING. It is such a perilous area that you need someone who sees the interior of the neck everyday and knows what to do. Often, an orthopedic surgeon will have a neurosurgeon assist them around the spine itself so you get the 2 anyhow. Every ortho spine surgeon I've talked to does this with the neck. They will do backs by themselves but not necks. So you might be better off with the orthopedic surgeon.

I know you are scared and you have a lot of medical problems on top of it. I also have a lot of bad medical problems and almost died after the surgery to fix the broken neck. But I have experienced paralysis and it is not something I'd want anyone to go through. You don't know if it's permanent or not and the only way to find out is time and hard work. And if one muscle in a group of muscles is paralyzed, the muscles around it don't work well so they spasm and hurt. I am in pain everyday but unlike most here, I don't take pain medications. I am allergic to many of them and I can't afford to become allergic to all of them and have nothing in case I have to have surgery or get injured. So I use methods to control pain I bet you are familiar with. I've used acupuncture in the past and it works well. I meditate daily. I find the meditation works best. I try to tell people about it but most won't listen or don't want to. They like the ease of popping a pill. I prefer the deep relaxation of meditation.

You don't have to spend the rest of your life in pain with an ACDF. Many are just don't see them here. The people who come here are in pain and looking for help just as you are. The ones who are fine, don't post. And the vast majority of ACDF patients are FINE.

On the success rate of a surgeon, if they won't tell you, then you probably should see someone else. They are hiding something. Maybe they don't keep statistics on an individual surgery like an ACDF but they should be willing to give you some info. It sounds more and more like you should see the orthopedic spine surgeon.

I'm going to ask someone who had a good outcome to post to you..okay? She'll be able to reassure you more than I can as I didn't have an ACDF. Mine was posterior.

Hang in there and we'll get you all the info you need.

gentle hugs.............Jenny
Hi Frustratedlor - I heard via Jenny that you could use a positive outcome for an ACDF surgery. I understand the fear and apprehension that you are going thru right now. I spent a good month and about four hours a day researching my MRI results and looking for the best neurosurgeon and/or clinic to treat my problems. Fortunately my pain, numbness, and radiculopathy sent me to my PCP within one and a half months of the onset of my symptoms. My PCP immediately sent me for an MRI. Within two weeks I saw the NS and within two weeks I had the ACDF. I was extremely nervous about who to have do my surgery. Once I met the NS that did my surgery I was completely comfortable and confident in his abilities. Jenny has given you excellent information about that subject.

I had the bone spurs and arthritis that had built so much calcium deposit that the NS couldn't even see the nerve root at C5-C6. I had a very large herniation at C6-C7 that he removed as well. I chose to use cadaver bone for him to use in the fusion. I am now fused at C5 - C7 and have a plate over those three vertebrae on the front of my spine. The surgery itself is absolutely amazing. My scar on the front of my neck is about 5.0 - 7.5 cm long. It has healed very well and with no trouble. I had an added blessing in that I thought that I had rotator cuff injuries in both arms. (I played softball until 45 y.o.) I had to quit due to too much shoulder pain. Anyway, after the ACDF surgery that pain went away as well as all the original numbness, tingling, pain, and radiculopathy. I consider my surgery to be next to, if not, a miracle!!! I have great range of motion and no pain in my neck at all. I am better than eight years before surgery!!!

I would be willing to answer any other questions that you might have. IF I had to choose to do it again, I'd have it in a heartbeat.

I hope that this has given you some encouragement. Ask away if you have anymore questions that I can help you with about the ACDF surgery. Jenny knows more about everything else!!! (Actually, she probably knows more about the ACDF surgery itself than I do. She's just being modest and honest in telling you that she hasn't HAD it. :)

One more thing.........I'm with Jenny on the urgency of your situation. I fully believe from all my readings on the Healthboards that the longer the delay when you have numbness the less likely is a full recovery.

frustratedlor - I am happy to hear that my success story was able to help relieve some of your fear. It is a major and very serious surgery, but if you find a neurosurgeon who has lots of experience doing ACDF surgeries with a great success rate and you feel comfortable with him/her, then that's about the best scenario you can end up with, I think.

There is a thread at the top of the Spinal Cord Disorders board that is a list of things for you to think about when you go home from surgery or even before surgery they might help if you are experiencing enough disabilities.

Just from going back and reading your previous posts with Jenny it appears that you have some very disturbing symptoms going on. I agree with Jenny and hope that you can quickly find a neurosurgeon who does the ACDF routinely and one with which you are comfortable. As far as I can tell, each neurosurgeon handles post-op their own way. In all of my research the type of neck brace, length of time you have to wear one, and even possibly if you have to wear one at all varies from surgeon to surgeon. I had to wear a soft neckbrace for about three weeks. I've seen some people with ACDF not have to wear one at all. I've seen and think this is probably true in my case that the use of the soft neckbrace in the case of ACDF is more to remind the
patient to be careful than for anything else. (There may be plenty of people who disagree with me, I don't know.) My neck felt very stable immediately after surgery.

I did have some restrictions about how to move my neck and also about how much I could lift. Essentially for the first week I was asked not to lift much of anything. After my first week post-op visit I was allowed to lift five pounds. After my month check-up I was allowed to lift 25 lbs. I don't know how much driving you do in singapore, but we are not allowed to drive while in a neck brace in the US and so that is something that you have to take into consideration.

I was on morphine while in the hospital. I stayed for two days. I went home with a prescription for pain and one for a muscle relaxer. I only used them for about three days and quit taking them. All my pain was gone! (Numbness and muscle spasms too.)

My husband made sure that I followed the rules and I really didn't do much of anything except take care of myself for about three weeks. He wouldn't let me do much of anything. Not everyone may be in that situation and so going thru the list I mentioned that is on the spinal cord disorders board will help you out alot!

Hope this helps. Any other questions feel free to ask.

Hi No Change... My Doc gives me a 90% on the surgery. I think I am a candidate for some paralysis without it (either gradual, over time, or more immediate if I suffer another impact) because of the stenosis. I am at 9-10mm now... not much wiggle room there. My disks were lacerated from the accident. I think this is beyond bulging and doesn't bode well for much continued improvement, just more scarring and osteophyte-making. I am not anticipating full recovery of strength, will be happy if that happens, just want to stave off any further losses. My hands were problematic after the first whiplash. But now the numbness, tingling, cramping and spasms are all down my left side, including facial, ear, jaw (no TMJ- had that checked), and buttocks (feels like someone shot me in the ass). Before I started on the Topamax I felt like I had a severed wire dancing around in my head all the time (thus the daily migraines). Topamax was a Godsend for me. I take also Tryptans for when the headaches get around the Topamax. It helps some on neck shoulder and facial pain as well. I can't do narcotics and benzo's only sparingly, so I rely on NSAIDs when I need them, which right now is most days. You are absolutely right about the vitamins. I take 2000 mg a day of Ester-C, more if my inflammation level is high (the Ester-bound C you can take in higher doses without diarrhea), glucosamine chondroitin, a hefty B-complex, a multi, two types of calcium with Mg and zinc, E, D, and a probiotic. I replaced my statin (Zocor) with fish oil and red yeast rice for cholesterol because that drug had my pain level at a 8-9. Amazing how that works. If you are taking a statin (Lipitor, Zocor etc) and also suffering from an injury, look to the drug as a possible source of increased pain... mine was. I got off of it and started the vitamins... big difference! At least I am functional for now. Not sure how long it will last. I would rather have the surgery when my pain and function levels are good, because I think my recovery will probably be better as a result. Try melatonin for your insomnia... it also has some healing and anti-inflamatory effects. First check any contra-indications with anything else you are taking, especially SSRIs or other antidepressants or sleep meds. It works well for me. I have basically 2 possible sleep positions (in my recliner and now with a cervical collar on). One is on my right side with my left arm aligned, or on my back with arms in front. Of late my arms have started pulling together in spasms at night... wierd... what next? If you cet a camping pillow you can mold it to your neck nicely. Works great. Keep in touch! :)

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