[Jellyhall]

#31118

I have problems throughout my spine. I had an ACDF of C3/4/5 done 7 years ago. I also had a lumbar laminectomy and fusion of L4/5 done 9 and a half years ago. I now have adjacent disc syndrome either side of both my cervical and lumbar fusions.

I am awaiting radiofrequency ablation of nerves in my lumbar spine in the hope that I will get longer lasting pain relief after facet joint injections helped me.

My cervical and thoracic spine are still concerning and I am being sent for 3-Tesla MRI scans of them both, ‘counting up from L5/S1’.

At my last appointment, and the first with the consultant himself, he shocked me by saying that I might need more surgery on my neck. Three of his Fellows hadn’t noticed this. He has sent me for a cervical CT scan to see if I am fused or not. Surely I would have known before now if I had not fused. Is it possible for an already fused level to suffer a broken fusion?

I have looked at some flexion / extension cervical x-rays that were done a year ago, and I think I can see why the surgeon is concerned. There appears to be a dark line / gap between the edge of the Titanium CeSpace implant used and the edge of the vertebra on the lower implant. If it is discovered that this is not fused, will another surgery be the only solution? Would this likely be anterior or posterior?
My follow up appointment isn’t until February next year, which seems a very long time to wait for an answer! (I am in the UK where long waits are very common)

I would be very grateful to hear what you think Dr Corenman.

[Donald Corenman, MD, DC]

#31123

You certainly could have a pseudoarthrosis of your C4-5 level as you note “appears to be a dark line / gap between the edge of the Titanium CeSpace implant used and the edge of the vertebra on the lower implant”.

Is another surgery the only option? Well, this lack of fusion will not heal by itself after so may years of distance between surgery and now. This condition is generally not dangerous however so you could live with it as long as you can tolerate the pain. The options to fix it are to go anterior again, remove the old cage and perform a new fusion (normally with iliac crest bone graft which should be used for all pseudoarthroses in my opinion) or go posteriorly and perform a fusion from the back. The fusion in back takes longer to heal but is still a reasonable option. If you have a need for other levels to be included, I would advise an anterior approach.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Jellyhall]

#31142

Thank you Dr Corenman for your reply.

The 2 levels of C5/6 and C6/7 are also very degenerated with the disc practically completely gone and there is foraminal stenosis, which is why I am assuming that I have pain in both hands and arms.

I asked the neurosurgeon who did my ACDF 7 years ago, about not using any bone graft, plate and screws or collar. He explained that he and other neurosurgeons at the same hospital had been using the ‘stand alone titanium CeSpace implants’ for over a decade and they were successful. He described one of his colleagues who needed to remove one just 2 weeks after the ACDF surgery due to incorrect placement, and it was in so tightly that it was necessary to drill it out.
This now worries me as although the upper level of the implant appears to not be attached, the lower level does look like it is fused to the vertebra.
He also explained that he was doing an anterior surgery because he may need to do another surgery on the two levels below in the future, and it was difficult to do a repeat fusion surgery using anterior access after a posterior surgery had been done. I do have more pain now than before my first neck surgery, both in the neck and in my arms and hands.

[Donald Corenman, MD, DC]

#31146

It very well may be true that you need to address the C5-7 levels as well as the failed C4-5 level. I am not sure why this surgeon is reluctant to remove this titanium cage but maybe he has little experience with removals or has had a bad experience in the past. I am unclear why “it was difficult to do a repeat fusion surgery using anterior access after a posterior surgery had been done”. It generally is not a problem to repeat an anterior approach and a posterior fusion does not generally affect a repeat anterior approach.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Jellyhall]

#31224

I have now had a CT scan to see if my lower level of ACDF is fused or not. I am awaiting flexion/extension x-rays on my neck and a new MRI scan in 3 Tesla scanner of my neck and thoracic spine. I hope that I will hear if I am fused or not before my February appointment. It is a long time to wait with that uncertainty.

My last flexion/extension cervical x-ray stated that there is a grade 1 spondylolisthesis that moves slightly on the flexion x-ray compared with the extension one. Would you think that this also needs to be dealt with if another surgery is done?

I am also looking into postmenaupausal women having a higher chance of pseudoarthrosis due to lack of estrogen. I am now 64. If I do need another surgery to deal with this, do you think that it would be worth me taking HRT to attempt to improve my chances of fusing? I am also wondering if having a plate would help.

The surgeon who did my ACDF wasn’t reluctant to remove a titanium cage. Our discussion was before my surgery when I had asked about not having any bonegraft, plate and screws or collar. He was giving me evidence that a stand alone titanium cage would fuse.

I am under another surgeon in London for ongoing spine issues. These are also in my lumbar and thoracic spine. I had thought that my cervical spine was fine and wasn’t going to need another surgery because I had been told that there was spinal fluid flowing around the cord, so no more surgery was needed. This latest surgeon has told me that I do have foraminal stenosis.

I am very interested to hear your opinion about taking HRT and if you think C2/3 would need attention.
Thank you for your help Dr Corenman.

[Jellyhall]

#31233

I have just read my post above and realised that I didn’t tell you which level the grade 1 spondylolisthesis that moves slightly was at. It is at C2/3, the level above my top fused level.

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