Realistic Time Line 2 level cervical fusion

[Toebin]

WoW is about all I can say at finding this place by chance through a Google search. Like minded folks that have gone through many of the same things I have experienced. How WONDERFUL !!

As you can tell I am new here. I have spent most of the afternoon reading up on the ADR and other issues and can so relate to much of what is posted.

I've had ddd in my cervical and lumbar area for as long as I can remember, multi levels in both areas. I am also part of the LDR Mobi-C ADR clinical trial out of The Spine Institute in Santa Monica California. It's a random study and unfortunately I was randomized for a fusion, which I had on May 9th of this year... but, things work out. My surgeon said I had so much "junk" (osteophytes and such) to clear out at C5-C6 that by the time they were done the intervertebral space was just too big for an artificial disk to work well , and that a fusion was probably the best solution. They did a 2 level fusion C5-C6 and C6-C7. So now I am a "control" in the clinical trial.

The surgery went well and I was home in 2 days. All of the tingly, zappy, zingy pains down my arms stopped immediately and appear to be totally gone now. I still have pain down my right shoulder blade unchanged from before surgery but am hopeful that once I am able some PT may help with that. They also say that the nerves affected will take time to heal after having the pressure released from them. I sure hope so, as it was this pain that sent me to the surgeon to begin with.

My question really is.. what is a realistic time frame for the fusion to be done? At least enough to be stable and safe. Currently I am still in a hard cervical brace and wearing my bone stimulator 24/7 . I have my next set of xrays this coming Monday, which will be about 12 wks post repair. The last xrays showed no fusion but it I was only 6 wks post op at that time, and was told that everything looked good with the repair, nothing had moved, and that things must be "sticky" at least.

I have learned that my idea of a long time is not the same as my doctors idea of a long time already...lol. And they just keep telling me that fusions take a "long time", especially with the gap I have at C5-C6.

As you can imagine I am going a bit nuts with the collar .... it's summertime in California , hot and muggy.. not a time for wearing a hot, hard plastic turtleneck!! I'm also trying to be realistic about when I can consider looking for gainful employment again .... something I lost this past March between my neck problem and herniating yet another disk in the lumbar spine (which after 2 sets of CT guided epidurals seems to be behaving).

Any thoughts would be appreciated.. and tips on making this collar more comfortable would be as well... lol

[Harrison]

Hey Toebin, welcome to our global community of spine patients! Thx for sharing...and congrats on getting through a HUGE milestone. Quick question -- pls tell us more about the details of the fusion procedure; e.g, type of hardware, fusing compounds, etc.

Thx

[Toebin]

Hi Harrison,

Thanks for the warm welcome!!

I will actually have to ask about the hardware in my neck.. I know I have a plate with 3 screws and they used cadaver bone grafts, they made it seem like they didn't use any fusion compounds as well... but that's about all I do know.. other than I did not get the ADR as I had hoped...

I see the doc on Monday again so I'll ask a lot more questions and get back to you all..

Just went to the LDR trials page and pulled this info.. Maybe this is what you were asking about?

The control treatment consists of conventional anterior cervical discectomy and fusion (ACDF) in accordance with the Smith- Robinson procedure. The anterior approach to the cervical spine may be performed by an exposure surgeon. ACDF is defined as a complete disc removal and nerve decompression with grafting of allograft corticocancellous bone between the vertebrae adjacent to the degenerated disc to eliminate articulation at the damaged segment. Autograph bone cannot be used as part of the control treatment.

A block of corticocancellous commercially available allograft is inserted and a constrained anterior cervical plate is fixed into place. Frozen or freeze-dried corticocancellous allograft may be used. For allologous corticocancellous bone grafts, no osteoinductive bone growth factors, bone graft extenders, and bone graft substitutes are permitted as part of the control treatment.

Following discectomy and grafting, a semi-constrained rotational anterior cervical plate will be placed.

[Toebin]

Just a short update.. My appointment this past Monday was canceled. The xray tech was sick and there is no sense going in without having any pics taken.. everything depends on IF I have any fusion going on..

So, I have a new appointment next Monday the 6th of August. I'll ask about the hardware used then.

Still feeling really uncomfortable in this rigid collar though..

[Toebin]

Well,

My follow up appointment wasn't all that great. The xrays of my neck show I am not fusing after 3 months.. We're going to wait another 6 weeks and continue as is with the hard collar and bone stimulator... but if that doesn't work the doc is talking about another surgery ?

Said something about putting a plate on the posterior side of my neck?

I did ask about the hardware used with the fusion and the only response I got was a titanium plate and bone graphs... there evidently was not any fusion compound used..

I'm a bit down at the moment.. wondering where all of this is going to lead..

I was warned prior to the surgery that some folks never fuse.. I didn't think it would be me however.. oyi..

[tmont]

Toebin,

Sorry to hear you're having this problem. I don't have the stats on time lapse for fusion (my C6-C7 looked 'solidly fused' by 6 months) but I'd be glad to try and help you out with info and even image readings once my NS gets back from his vacation. He's great about giving his help and opinion to folks and is well-known here as a top-notch surgeon.

Let out a holler if you want another opinion...

Hang in there,

Trace

[kanutta]

Hello Toebin, I had a ADCF with PEEK (polyethylen or plastic as I call it to keep it simple )cage at c5-6 well over a year ago.
They also put some bone growth stimulating material in the cage.

But no bone graft or metal screws, the cage has an auto click system that fastens to the vertebra above and below.
I think that all of Scandinavia use this method now, the surgeons wanted a material that didn't create artefacts on the MRI, and plastic doesn't.

But what's all this fuss about fusion, nobody ever bothered to know if I ever fused; they operate you, send you home after one day; and thats that. They probably don't think it's important whether you fuse or not; but it might be because I have a cage there to assure stability from day one. No neck collar at all.

It took me almost a year to feel any better than before surgery; so hang in there, it's early days yet. Some get better really fast, but not everyone. You could have a lot of distraction pain which can give all sorts of funny symptoms; but that will subside little by little.

After all you had a big gap in C5-6, and when the disc height is increased that much your nerves and other structures will be stretched quite a bit.
That you're not fused at 3 months is not unusual after what I've read.

I'm in many ways better thn before surgery, but still have bad flare ups that can last a couple of months. My C4-5 was not good before surgery, and probably has not gotten any better, MRI says narrowing of the nerveroot canal and disc degeneration of course, with osteophytes here and there. I am not so good as I hoped to be after the surgery, and now I've given it over a year.

Which brings me over to Tmont; I would really appreciate if your neurosurgeon could have a look at my MRI's, with the queues to get an appointment in this country we are almost forced to go abroad. I received a letter in june promising me an appointment within 6 months to one year. That's how the social democracy works in Norway.

[tmont]

Originally posted by kanutta:

Which brings me over to Tmont; I would really appreciate if your neurosurgeon could have a look at my MRI's, with the queues to get an appointment in this country we are almost forced to go abroad. I received a letter in june promising me an appointment within 6 months to one year. That's how the social democracy works in Norway.

No problem Kanutta; PM me your contact info and we'll get the ball rolling. Gotta sleeeeeeeep for now

[kanutta]

Thanks Trace; I'll PM you tomorrow.
Sleep tight; glad to hear you're doing so well, must it last.

[Toebin]

tmont and kanutta,

Thanks for the moral support, it's much appreciated..

Kanutta, the fuss about fusion for me is that they won't let me out of this hard collar until they are sure my graphs are solid enough.. I'm thinking you are correct that they had the cage in your case so things should stay in place.

They've made such a big deal I half expect my head to fall off my neck at some point if I don't have the collar on...

Not to mention I can't start any PT while still in this thing.. I can't help but think some PT would help with the remaining pain in my shoulder and upper back.

tmont, so far what I was told by both a NS and my spine surgeon was that fusion can take 3, 6, 9 months and that some folks never fuse.. I guess I'm just following a slow course..

Frustrating.. but it helps when your surrounded by folks that understand here on the boards..