Failed ACDF with 3 different opinions from 3 top surgeons.

I am very sorry for such a long and detailed email, but I am hoping that you might have some advice for me, and also that my history might help others. Essentially in a nutshell I had ACDF surgery in NYC performed by a top surgeon at a very prominent hospital. I am in need of revision surgery and have received three completely different opinions from my surgeon and two other very prominent surgeons at very prominent NYC hospitals. I have done alot of research and am unable to find the right solution. I have been advised that if I do not perform further surgery soon, my pain and numbness may become permanent. I am a 52 year-old male and had ACDF surgery on 5/12/14, utilizing allograft struts and an Atlantis plate. I do not smoke, wore a hard collar for six weeks post surgery, have normal vitamin D levels and did not take any NSAID’s. Prior to surgery I had very bad pain in the shoulderblade area. When I awoke, my shoulderblade area was burning really bad and I had really bad numbness as well in the scapular region. One month after surgery my right arm became very numb for a two week period. Eight weeks after surgery my right arm became very numb again and has continued through this point. My right arm also feels cold and feels like it is twitching at times. Initially the shoulderblade pain was better post surgery then pre-surgery, but at times has been worse post surgery than pre-surgery. The pain post-surgery has been constant, except for one day two weeks ago and two days last week, when it surprisingly got much better, before flaring up again. The pain and numbness in the right arm are made worse by turning my head to the left or bending my neck. An EMG was done on 9/3/14 with the following finding: “This is an abnormal study, with electrophysiological evidence of a right suprascapular neuropathy with acute and chronic denervation. There is electrophysiological evidence of a chronic right C7 radiculopathy.” An MRI was done on 9/17/14 with the following finding in connection with C5-7 (C3-4 shows severe right foraminal narrowing caused by uncovertebral degenerative joint changes and T2-3 shows a broad-based central disc herniation with paracentral components and bilateral foraminal narrowing): ” At C5-6 there is apparent moderate to severe right and mild to moderate left foraminal narrowing. Right foraminal disc/osteophyte complex and foraminal narrowing appears improved when compared to preoperative study. At C6-7 there is moderate to severe right and moderate left foraminal narrowing. This appears to be relatively similar in appearance to the preoperative exam. Right shoulder radiographs were done on 9/29/14 and show as essentially normal. Cervical radiographs from the same date with AP, lateral neutral, flexion, and extension views show as follows: “Hardware is in appropriate position. No significant listhesis or dynamic instability. Vetebral body heights are maintained. There is mild multilevel arthosis and moderate multilevel uncovertbral hypertrophy is present. Prevertebral soft tissues are unremarkable.” CT scan of 10/6/14 shows: “C3-4 moderate to severe right neural foraminal stenosis. C5-6 mild central canal stenosis. Severe right and moderate left neural foraminal stenosis. C6-7 mild central canal stenosis. Severe right and moderate to severe left neural foraminal stenosis. C7-T1 no stenosis. Moderate right and mild left facet atrophy. There are large anterior osteophytes at both the C5-6, and C6-7 levels, worse at the right on C5-6. There is incorporation of the intervertebral cage at the superior endplate of C6, but only partial incorporation of the inferior endplate of C5. Very small amount of bony bridging is seen at this motion segment. At C6-7, there is incorporation of the intervetebral cage to the inferior endplate of C6, but only partial incorporation to the superior endplate of C7. There is productive bone at the disc space, but no intervertebral body bony bridging. The positioning of the hardware is anatomic.” A second radiologist read the CT scan as showing motion at both the C5-6 and C6-7 levels. The surgeon that performed my operation would like to do a posterior laminotomy and forinatomy on the right side. The second surgeon said that he needs to do a new ACDF and remove the plate and bone grafts and use autografts. He told me that he needs to do it prior to fusion occuring. He is not sure if I will fuse and advised me that fusion typically occurs within three months. He said revision ACDF is much harder to do if fusion occurs. He said that an anterior approach is the only way to remove the large anterior osteophytes. This surgeon is the only one that did a CT scan. He felt that the osteophytes were not visible on the MRI as clearly, and said that the operating surgeon may not have known they were there. He said that a posterior laminotomy and forinatomy would only have a 50% chance of working. Everything I have read suggests that anterior osteophytes need to be removed with an anterior approach. But I have also read that revision anterior surgery is dangerous, has a lesser chance of fusion, and has significant risks of dysphagia and other possible complications. The third surgeon (also very prominent, but with a different hospital) wants to do a posterior laminectomy and forinatomy, with instrumentation and autografts. He would utilize two rods and screws to fuse the back sides. His view is that this is the best approach, since if the front didn’t fuse, in his view it won’t matter, since the back should fuse. While he wouldn’t be able to get the anterior osteophytes, he said that opening up the space in the back is 95% certain to solve the problem. I know that such a posterior approach is very painful and has a long recovery. This leaves me in my present predicament, which is bad pain and numbness in the right sholder blade and arm (shoulder blade improving and arm getting worse, except for the few days when the pain spontaneously greatly improved before returning). I have also seen a physiatrist who tried nerve hydrodissections as well as barbotage treatments, both with only minor improvements. I also did an 8-week course of physical therapy. Thanks very much for any advice.