Dr. CorenmanModeratorSeptember 12, 2017 at 7:21 amPost count: 5383
If the C4-5 level collapsed and has loose screws, it is unlikely that this level fused. I do agree it needs to be addressed surgically by a repeat ACDF with autograft. Autograft is necessary to allow the best chance for fusion and this graft will not collapse. I would strongly disagree with you regarding the graft site discomfort. I use autograft about 90% of the time and patients generally have no complaints with their graft site. If they do (1-2%), the discomfort is a 1-2 on a 1-10 visual analog scale and no one is unhappy with the graft site. The screws that need to be placed are not a problem as there is always purchase that can be gained in a revision.
Dr. CorenmanPLEASE 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!ThikAcheParticipantSeptember 13, 2017 at 7:17 amPost count: 11
Dear Doctor Corenmen,
The artifact of C45 is more to the reason C4 is shaved off 1 cm in the surgery ( not sure why). is it possible to do an osteotomy and put a 1 cm high graft in the C45 (the current C45 is 2mm. Its creating an abnormal structure. I have a couple of questions
1) Now that the surgery is done for a few months, Does it mean height increase would not fix the dispositions of the lamina?
2) There is probably no device like zero profile device or ADR that can fix a 1 cm height issue.
3) For autograft, taking a 1 cm from the iliac crest, would it be more painful because it is so big?
4) I saw a write up that says allograft has 92-95% fusion rate as opposed to 95-98% in autograft. Do you think it would be different for this case?
5) Will waiting for a month or two make it even worse? Should it be fixed ASAP because the structures will become more permanent?ThikAcheParticipantSeptember 14, 2017 at 3:32 pmPost count: 11
Sorry I spoke too soon. It does look like a graft collapseDr. CorenmanModeratorSeptember 16, 2017 at 7:12 amPost count: 5383
The fusion rate you quote compares a one level fusion on a previously non-operated disc level. This dos not apply to failed fusion levels.
A 1cm graft from the pelvis is generally inconsequential.
The longer you wait, the more difficult surgery can be but this is no a hard and fast rule. I have seen many patients with pseudoarthrosis years later that underwent revision surgery with very good results. There is no need for immediate surgery.
You would not be a candidate for a PEEK cage or an ADR with failure of fusion in my book. You need resolution of this and the ACDF with autograft is the correct procedure in my opinion. You want the absolute best chance for “one and done”.
Dr. CorenmanPLEASE 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!
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