redo a imperfect surgery

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  • Dr. Corenman
    Moderator
    Post count: 5378

    For any redo cervical fusion, I always use autograft as the success rate for re-fusion is not as high as the original surgery and you would want the best chance of redoing this only once.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    ThikAche
    Participant
    Post count: 11

    I am fused but I have foraminal stenosis. My pain and stenosis is bilateral (pain and stenosis maps to each other).
    Now that I am fused. Should I get an anterior surgery to open up both foramens? Is it still possible to do allograft (almost 4 months)? Is it better do it early? Or late (like in six months)?

    Dr. Corenman
    Moderator
    Post count: 5378

    If you have symptomatic foraminal stenosis as a residual after an ACDF (solid fusion), then you have two choices for a surgical repair. One is to have a posterior foraminotomy performed. This will open up the volume of the nerve channel (foramen) by taking off the posterior wall of this pathway. This does make more room for the nerve root but does not take away the bony mass in the front of the channel that was originally the cause of the compression in the first place. This procedure can be successful but with less success rate than this other technique.

    The other surgery would be an osteotomy and repeat decompression and fusion of this level. In this procedure, the fusion would be taken down and the nerve decompressed on the front side where this bone spur originates. It is more surgery than the foraminotomy but has a higher success rate for decompression.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    george99
    Participant
    Post count: 2

    I was in the same situation as Thikache, but unilateral foraminal stenosis. I decided to go with minimal invasive posterior foraminotomy to give some space to the root and it turned out to be a bad decision, cause it may gave me some more power (50%) to my left arm, but the neck now feels harder and more difficult to turn on the spot and the dizziness remained the same. I would do a ACDF revision if i were in your shoes… with the right surgeon of course.

    Dr. Corenman
    Moderator
    Post count: 5378

    Thank you for sharing your experience. Generally, this is what I have found also but I occasionally still do posterior foraminotomies. Patients do complain of more neck pain and stiffness after posterior neck surgeries than anterior surgeries.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    ThikAche
    Participant
    Post count: 11

    Dear Doctor Corenman

    I have an update. One of my levels C45 had loose screws and now it seems that the C4 and C45 collapsed and it created a kyphosis. Is it possible to fix this kyphosis aneterior way? As it is less than six months old,is it possible to do osteotomey with allograft (it looks like it needs a large bone). I have not been able to do an SNRB. I have foraminal stenosis at another level which makes it even more complicated.
    These are the difficulties I have hard
    1) Anterior osteotomy & fusion may not work because screws will have little purchase. So a posterior fusion would be needed.
    2) Anterior surgery has to be done with autograft. I am a bit worried about permanent pain/issues on autograft.

    Both posterior approach and autograft are known have higher degree of permanent pain and issues than ACDF with allograft.

    I guess osteotomy with allograft is not option? Spacers (zero-profile or not) or ADRs are not possible as well I would guess.

Viewing 6 posts - 13 through 18 (of 22 total)

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