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Spinal Cord Disorders Message Board


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[QUOTE=Precious55;4745109]I had a neck fusion with bone graft from my Ileac region on March 30th of this year, so I'm about 5 weeks post-op. I'm having a terrible time from the fusion with my hip bone still so swollen,(I ended up in icu for 3 days to get bleeding under control) but now I've been noticing something with my neck. I have to wear my hard brace when I ride in the car, and my soft one around the house. I've been doing without the soft brace sometimes because it gets too hot so I take it off. The last couple of days I have noticed pain at the lower back of my neck. Sometimes I have to put the soft brace back on so it settles down. I'm also on Lortab and Gabapentin which helps some. How important is it that I wear the soft brace "all" the time?:confused:[/QUOTE]

I had my acdf March 16th and I wear a hard Aspen collar 7x24 and will do until the end of June. I'm wondering if the material is different as I don't get hot although it took me a long time to get use to it! I just keep telling myself it's not an option to take it off! I do NOT want this operation again!!

I have a question that I'm not sure either of your NS mentioned to you, however here it goes.... I made the choice of bone graft from my Ileac region, however when I awoke from surgery they did not perform a bone graft!! I was so happy but I was also surprised as they were confident that they would not be able to harvest enough bone from the surgery site. Have you heard of this before?
honestly precious, and to anyone else who's surgeons actually allow you to even wear one of those "soft collars", esp during that very highly critical 6 week post op period, burn em. the one thing that IS very simply NEEDED during that immediate and up at least thru the six week phase after any ACDF is the bone ends to ALWAYS be touching each other in the exact same way as with what you just "have" with that hard collar, with NO movement even ALLOWED(esp any side to side or rotation in the neck) that would definitely compromise what could have been starting as a real fusion of bone. everytime you simply turn your head even just a little bit to far like a quarter turn(like a total sideways or beyond that turn?), you ARE impacting that fusion site since THAT IS what normally allows us basic head movement, ya know what i mean? a hard collar PREVENTS that type of bad movment,while the soft collars simply DO NOT 'stop" any real turning of the head and neck or even going downward at the side(slight forward IS much safer than side/downward) like you would if you tucked a phone under your ear to talk type movement? there just IS a real good reason as to why the hard collars are uncomfortable compared to the nice softer collars. it is simply ment to stabilize and prevent movement to keep bone ends always touching each other, period. like any other splint would simply 'do' when bones need to reattach themselves to one another.

if you just look at the overall make up of the hard collars compared to the stupid wayyy too cushy soft collars, just even TRY and find anything there that gives you what IS giving you the ability to even STOP you from simply turning your head and neck? nothing. its just wayy too soft to even GIVE what is supposed to be like a solid 'splint' as you would simply splint ANY bones like even with a broken arm? there IS a very good reason that they will either heavily splint one or actually do the best thing by placing a nice solid cast on it. this allows NO movement of the bone ends away from each other that can easily break apart ANY 'knitting together/fusion' of bone ends at all if it just was not there helping to do that part. this is what your hard collar simply is, a good solid "splint' that keeps everything where it just needs/has to be in order to end up with a good all around thru every segment of bone end fusion.

i have no clue as to how or why ANY surgeon would even possibly think that a patient post ACDF should EVEN have access to any type of 'soft collar" at all. seriously, this actually is scarey to me just in the very basic way of REALLY needing those bone ends to touch in the "right ways",always at all? it does the patient NO favors by allowing them to even wear something that takes away the potential success of a good solid fusion by taking away that good solid stability. if you simply look at what IS supposed to be the end result here and what the hard colars really do to help that BE successful, vs simply allowing too much movement and no real full neck stability really with the soft collar since it just allows "too much' movement among other things in just a very logical and common sense way, it just realistically makes no sense at all, ya know? like i mentioned above, that hard collar just IS your splint here that assures everything just is in and stays in the proper alignment along with the critical touching of those bones ends/endplates to the bone graft itself.

the ONE critical test that i would ask your surgeons to do here when you see them for the like six week check? do NOT obtain any MRIs or CTS to check for fusion. all this really takes(esp when you did not have any hardware placed) and is BY FAR the very BEST way to SEE fusion is by having one very simple and inexpensive type of x ray called a flexion and extention x ray. when i did not fuse(thats a whole nother story) i had an MRI stating inconclusive for fusion that recommended a CT which actually stated i WAS when i KNEW based upon my ongoing radicu and pain and grinding in my neck symptoms that i DID NOT actually fuse? it took one simple flippin very inexpensive flex and ext x ray which shows HOW the boney prominences fan out in the back of your neck that DO show SOOO very clearly by just HOW they fan out whether or not your fusion occured, they should ALWAYS just DO this one x ray FIRST and not last, like in MY particular case? its just THAT good in showing fusion.

i would honestly wear that hard collar as much as possible and really DO try and stay away from the really useless for what simply needs to be done for you here and what just IS the ultimate outcome you are trying to achieve. sometimes we have to put aside some level of comfort for the better of our health. and this definitel;y IS one of those times. i have been down the collar road twice already and am looking at another stupid round again based on findings from my CT done last week. and you can bet i will be weaing a fitted hard collar(the very BEST way to go) only thru out this round. i have learned way too much from past surgeries. and ALOT from the many people here who have used that soft collar actually with some within the first critical weeks too. that type is simply NOT ment to stabilize bone/c spines.

i DO sincerely hope that everyones surgeries come out with good solid fusions, really. just make certain that you DO TELL your surgeons you WANT that best possible way of seeing full fusion with the flex and ext type x ray. you will know almost immediately as to whether or not it did or did not fuse. fused sections will always have those bone ends kind of move as one unit(and close together) vs total fanning out without fusion or a 'normal neck' would be. but please DO stay away from the soft collars, esp if you are in the earlier stages. you yourself can seriously even tell the overall diffrence in how well supported your own neck realistically even is simply by first wearing the 'soft collar" then switching to that hard collar. big differences there which you CAN really 'feel'. good luck, Marcia
Yes, I have heard of that. They can also use cadaver bone if they need to. If you had a fusion, what did they use to hold the vertebra together ? I also have a plate and screws there. I found out I'm a bleeder when they took bone from the ileac, as they couldn't stop the bleeding and I ended up in icu for a few days.
[QUOTE=Precious55;4746817]Yes, I have heard of that. They can also use cadaver bone if they need to. If you had a fusion, what did they use to hold the vertebra together ? I also have a plate and screws there. I found out I'm a bleeder when they took bone from the ileac, as they couldn't stop the bleeding and I ended up in icu for a few days.[/QUOTE]

2 Titanium plates and screws were used at c5-6 and c6-7. At first, I was told that they felt confident that they would be able to acquire enough bone from the site, however the second NS didn't feel the same comfort level and explained to me the alternatives. He did highly recommend my own bone from ileac region, as this provides the best chance for fusion, however it was ultimately my decision. I agreed, but at the end no bone graft was needed! I was very thankful when I awoke from surgery. Although I've seen my GP I am not scheduled to see my NS until next month when x-rays will be taken. My biggest concern as the days and weeks march along is am i progressing normally? I still have pain in the back of my neck (hard to describe) and generally don't feel great. By the end of the afternoon I can be quite uncomfortable. If necessary I'll take 1/2 tab of oxcycodine with 1 extra strength tylenol as directed by my Dr. This works well.

I absolutely agree with Marcia around the soft collar issue. I've even heard people on this site and via youtube that their NS told them to wear a "Soft Collar" for a week and then NOTHING!!! This amazes me! I wear a hard collar 7x24 with 1 exception; my NS told me I could take it off when showering. The first couple of weeks wearing this was hell, however I'm use to it now. As a matter of fact, it has become a love / hate relationship!!LOL When it comes time to remove it, I know it's going to be hard!!

Wishing everyone on this site good luck and good health ;)

Dave
precious, what holds the bone in place without any hardware IS supposed to be the "splint/hard collar" along with muscle, tendon,ligament and the rest of the 'stack' of vertebrae too. that bone plug IS also fit into that disc space pretty tightly since it does tend to get a bit smaller over time too. while some surgeons do not normally use hardware during an ACDF, some also do, just to make darn certain that those bone ends ARE solidly in line and in place during healing. it gives that fusion a much better chance of healing esp when using cadaver bone, much moreso than when using your own? cadaver bone is great only because you do not have to go thru what can be seriously agonizing post op pain at that iliac graft site where they pull out basically a 'plug' of your own bone then shave it down to 'fit' into that discspace. historically tho, using your own bone, you just also tend to run a much better chance of full fusion than using someone elses bone(cadaver can in some cases kind of "reject" itself with your particular body physiology, or not fuse completely depending alot on how it was also harvested and kept while IN that bone bank too, vs taking it fresh right out of a body would be). but in your particular case precious, you also have the added help of the titainum plate and screws as well. i DO think you will more than likely have no issues really with the fusion aspect based on those two particular factors alone. you just HAVE the very 'best set up' in place there. but there could very easily be a few different reasons there for your pain complaint? i will get to those.

but your graft pull site really sounds like at least 'something' is up? are you running any even low grade fevers or is that area 'exceptionally painful' compared to only having 'some' pain there? it should also NOT be swelling at this point either(is this like a 'pocket" of swelling over that site or a larger area of swelling?).where 'exactly' is your pain and how does it 'produce" or when(is it ONLY in the hip or down the leg too)? is this AT ALL black and blue? have you spoken to your surgeon about THAT particular issue? if not, DO. you just seriously DO need to have that area first, palpated/seen by him and to also find out exactly where IS the swelling coming from,and if this is indeed "pocketed" as well. considering that you do appear to have some level of bleeding issues too(along with certain post op issues WITH that particular area), this really NEEDS to be done sooner vs later since this could just 'possibly' be blood or a mixture of blood and fluid too that if it is way too much, really would need to be aspirated out of there to allow for basic healing. but DO see him about this,esp if there is anything that does not 'look right' or you ARE running any levels of fever with this too.

i used a bone bank/donor bone(cadaver) while when my hubby had his c 5-6 done, they used his own bone? i watched this man who NEVER ever takes pain meds for anything use them like there was no tomorrow, not for the neck pain but that graft site pain. he actually also had to use a cane for at LEAST a month and a half to keep the weight off that side of the illiac and the leg too. soo of course when i blew out my c 6-7 like five years after hubbys nightmare, when my surgeon stated he liked to use donor bone, i WAS elated that i would not have to go thru the hell i watched hubby go thru.

there are some possibles here for your c spine pain that could be directly related to going from hard collar to soft collar with the muscles moreso than given the plate, the fusion site? what levels got fused in you and where exactly are you getting pain? what does that pain feel like? does it stay in one spot or radiate out? when anyone has a hard collar on at all, the muscles really DO get pulled to more their fuller extent, and there just IS full support OF them. but when you remove the hard support that is holding them and also very much also weakening them til you can safely get PT, they DO go more 'limp' only because atrophy tends to set in VERY quickly when any given muscle is not moving all the time and in most cases just no longer strong enough alone to keep that neck up and well supported either. this just places a really heavier than it should be load ON the muscles,tendons and ligaments that YOU now have to try hard to keep upright and supported vs what that hard collar was doing for you too? so this just 'could' be some level of muscle pain/reaction or depending upon your answers to my questions, something else there too.

but those soft collars just based upon the mere fact that they do NOT really even have the overall ability to simply do whats needed for a post op ACDF patient, give solid immobile support overall, they really do NOT do for you what any hard collar simply does. the reason they are so flippin hot is it is pretty much made out of only very thick soft cushion that merely wraps around ones neck(and not from top to bottom of neck either for most), and NO ventialation spaces like you have with what is mentioned above like with a good fitted aspen collar or what i used the second time around as the miami J collar which is pretty much the same. there are spaces in the make up of the hard collars that DO simply allow some air exchange that is not there with only thick cushioned material. while they do make you 'feel' better only becasue they are cushioned, not having good solid always aligned suppport(esp in the early weeks) will in many cases, not allow for a good solid fusion to occur. or could allow for a very 'off' type of fusion that is NOT well aligned too. but with that plate there in your case precious, that IS a godsend considering.

all it seriously takes to 'break up" what was starting as a good fuse is one unexpected turn, quick turns are worse, for your head and neck. in a hard collar, your whole upper body would move/turn, with a soft one, you WOULD turn only your head,AT the neck. thats the problrem i personally see with ONLY using a soft collar vs hard. i just personally, even if given the option, would NEVER go with the soft one after what i already ahve been thru with non fusion and two surgeries having to simply just wear a collar that IS somewhat uncomfortable but i KNOW is keeping everything 'stable' in there, but in the longrun and to avoid future issues i would, and will stick with ONLY the hard til at LEAST post op 6 weeks. this IS simply my own personal opinion here. and not all surgeons simply even know what IS actually 'best" either. thats another thing i have found out after six surgeries. you simply 'assume' they do? not in all cases, trust me. you simply HAVE TO also inject basic common sense and logic into anything you are told TO do or NOT to do by any doc or surgeons esp, or their sometimes really stupid PAs or NPs as well. just go with what your 'gut its telling you' along with what your surgeons are. and hopefully everything will simply go the best ways possible for you. marcia





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