Still having issues 4 months post op ACDF C4-C6

Posted by amywood20 @amywood20, May 1, 2020

Hello! December 19th I had an ACDF C4-C6. Pre-op most symptoms were in the left arm/shoulder/hand. I am still having issues. I'm in physical therapy and even the stretches the therapist is having me do causes arm pain. It's incredibly weird, as so many movements hurt. I had a MRI with contrast on the left shoulder in January to see if it might show something noteworthy and different than the one I had in August. The radiology report was very similar. Some of the key findings were:
-Tendinosis at the insertion of the left subscapularis and supraspinatus tendons. No discrete cuff tear. Rotator cuff muscle volume is maintained.
-No discrete labral tear. There is some imbibition of the intra-articular contrast into the superior labrum suggesting degeneration. No large paralabral cyst is seen.
-T2 bright signal is present in the subacromial subdeltoid bursa; however, this does not fill with intra-articular contrast. (i.e. subacromial subdeltoid bursitis).
-Left long head of the biceps tendon is intact.
-Mild degenerative changes of the left AC joint. No acute fracture or acromioclavicular separation.
The therapist I am working with has done ASTYM on the shoulder and arm. It hasn't helped. She did note I do still have weakness and that because of that, I could be having the pain that I am (i.e. the movement of the shoulder is being affected because of the weakness). I am back on the hamster wheel of not knowing if my issues are from a shoulder dysfunction or the cervical spine. Because of that, I requested a MRI on the cervical spine via my doc's patient portal. Surgeon said no but agreed to a CT scan, which I had done on Tuesday. I see him on Monday to go over the images. I've already looked at them, as I have a copy of the disk. I am not an expert in reading CTs, not by any means. One image did stand out. I took a photo of it and have attached it here. To me, it looks like one of the screws is pushing into an area that maybe it shouldn't. I think it's the spinal canal. I don't know if this is a big deal or not and if it could be the source of my continued arm/shoulder issues. Of course I will be discussing this with the surgeon on Monday but wondered if anyone had thoughts on this image. I will say that the arm/shoulder issues I have been having over the past month and a half or so are different than the ones I had pre-op. So many things hurt now when I move the arm that didn't before. It's as if it's gotten worse. I also have left side neck pain in the morning that I didn't have much of until now. If the surgeon doesn't think the cervical spine is causing my ongoing issues I guess I will go back to the shoulder doc to get his thoughts. I hope that's not the case though, as I'd imagine he is tired of this much like I am. Prior to surgery I saw him, two physical therapists and the neurosurgeon. All said my issues were from the cervical spine, which is why I proceeded with the ACDF surgery. So very frustrated that I still have issues...and they are worse. Any insight regarding the CT scan image I attached and/or the summary of the shoulder MRI is greatly appreciated!

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@upstatephil

Good morning to rbcookson! I read your post and was motivated to re-read my post-surgical dairy (I suggest you maintain one yourself) to gain perspective on the swallowing struggles you're experiencing post-ACDF. I didn't see how many levels you had? At any rate - it was at the 5-6 week point (per my diary) that I noted a marked improvement in swallowing ability. I'm now 7+ months post ACDF (4-level) and swallowing isn't of any concern. Point is - you will turn a corner soon and be able to focus on something else. Wishing you the best!

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@upstatephil Yes, I remember wondering and waiting for improvement in swallowing and for when all the pain would subside, and like you said, it seems to just disappear right on schedule. My surgery was 7 years ago, and I swallow fine, but I can swallow wrong if I am not paying attention and cough on some water. I do still have some tightness on one side of my throat, and stretching that out does help.

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@jenniferhunter

@upstatephil Yes, I remember wondering and waiting for improvement in swallowing and for when all the pain would subside, and like you said, it seems to just disappear right on schedule. My surgery was 7 years ago, and I swallow fine, but I can swallow wrong if I am not paying attention and cough on some water. I do still have some tightness on one side of my throat, and stretching that out does help.

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Wow - still some affects seven years later...But better off I'd suspect...

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@upstatephil

Wow - still some affects seven years later...But better off I'd suspect...

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@upstatephil I remember swallowing right after surgery, it was like the left side of my throat wasn't sure what to do. It still feels slightly different after all these years although it operates correctly. It may be decreased awareness on the left side of the throat which can let water in too fast before the swallow reflex happens. It's only slightly an issue and I do fine if I don't rush. If I was drinking a lot of water, I would pause every few swallows for a slight rest and then drink more.

All surgery creates scar tissue. I still get some muscle spasms that can shift my neck vertebrae because of thoracic outlet syndrome which causes tightness in the neck and chest and these issues of C5/C6 fusion and TOS are physically very close to each other and were present before spine surgery. Yes, I am a lot better since spine surgery. I think any time you have surgery, there are lasting effects because of scar tissue. That is why I do myofascial release to loosen up the scar tissue and muscle tightness.

With anterior cervical spine surgery, when they retract your esophagus and trachea to get behind them to access the spine, it probably also stretches some nerves that are not so happy about that. Vocal cord paralysis and swallowing issues are risks of course. I do have some facet arthritis too which happens when discs collapse and those joints get more pressure on them that happened before any spine surgery. Of course, the fused level won't be moving the facets, but the other levels do, and occasionally there is a twinge of pain from that, and I do have a bit of laxity in other discs, but not bad enough to require intervention.

I have collected these greater issues on my left side and have body wide tightness from my jaw through my neck, chest and pelvis and into the left leg. I also have my surgical incision on the left side of the neck kind of connecting into the other problems. No matter what body part is fixed, it's never as good as the original equipment. I would be far worse off if I had not had spine surgery because of the spinal cord compression and disability it was causing. I do best when I am getting exercise for my core strength like walking and riding my horse because that supports my spine from the bottom up making it all stronger and able to hold better body posture.

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@jenniferhunter

@upstatephil I remember swallowing right after surgery, it was like the left side of my throat wasn't sure what to do. It still feels slightly different after all these years although it operates correctly. It may be decreased awareness on the left side of the throat which can let water in too fast before the swallow reflex happens. It's only slightly an issue and I do fine if I don't rush. If I was drinking a lot of water, I would pause every few swallows for a slight rest and then drink more.

All surgery creates scar tissue. I still get some muscle spasms that can shift my neck vertebrae because of thoracic outlet syndrome which causes tightness in the neck and chest and these issues of C5/C6 fusion and TOS are physically very close to each other and were present before spine surgery. Yes, I am a lot better since spine surgery. I think any time you have surgery, there are lasting effects because of scar tissue. That is why I do myofascial release to loosen up the scar tissue and muscle tightness.

With anterior cervical spine surgery, when they retract your esophagus and trachea to get behind them to access the spine, it probably also stretches some nerves that are not so happy about that. Vocal cord paralysis and swallowing issues are risks of course. I do have some facet arthritis too which happens when discs collapse and those joints get more pressure on them that happened before any spine surgery. Of course, the fused level won't be moving the facets, but the other levels do, and occasionally there is a twinge of pain from that, and I do have a bit of laxity in other discs, but not bad enough to require intervention.

I have collected these greater issues on my left side and have body wide tightness from my jaw through my neck, chest and pelvis and into the left leg. I also have my surgical incision on the left side of the neck kind of connecting into the other problems. No matter what body part is fixed, it's never as good as the original equipment. I would be far worse off if I had not had spine surgery because of the spinal cord compression and disability it was causing. I do best when I am getting exercise for my core strength like walking and riding my horse because that supports my spine from the bottom up making it all stronger and able to hold better body posture.

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So well put...everything relating to ACDF, swallowing, recovery. You are a very valuable contributor/leader of this forum. My ACDF rarely enters my conscious thinking. Makes me think it's 95% resolved with some long term (minor) lingering effects. The lumbar work is still very much a work in progress. I'd say 80-85% resolved? As you astutely pointed out in another post - the lumbar spine is the central support for your upper body and recovery is, therefore, more challenging. At the end of Oct I will see the neurosurgeon and gain (hopefully) his "release" back to normal life with some lingering (and hopefully continuing to resolve) issues. I do think it is of value to those who post on this board to read your perspectives. Yours is a very worthwhile service!

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@upstatephil

So well put...everything relating to ACDF, swallowing, recovery. You are a very valuable contributor/leader of this forum. My ACDF rarely enters my conscious thinking. Makes me think it's 95% resolved with some long term (minor) lingering effects. The lumbar work is still very much a work in progress. I'd say 80-85% resolved? As you astutely pointed out in another post - the lumbar spine is the central support for your upper body and recovery is, therefore, more challenging. At the end of Oct I will see the neurosurgeon and gain (hopefully) his "release" back to normal life with some lingering (and hopefully continuing to resolve) issues. I do think it is of value to those who post on this board to read your perspectives. Yours is a very worthwhile service!

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@upstatephil Thank you, Phil. Your words mean a lot to me. I really do enjoy helping patients and explaining what I can about physical conditions. I think it really helps when you can understand visually and in 3 dimensions how the body works. I also thank you for your help for others in the spine group. While I don't have your experience of lumbar spine surgery, I have learned a lot about it and it is good to hear the details from your experience. Your positive attitude is wonderful and helpful to other members. I am a firm believer that getting onboard with a surgeon and having a positive outlook before your surgery goes a long way to help in healing and recovery after the surgery (with a good surgeon of course). I look forward to your next update after your followup. I was just at Mayo for a conference, and for the first time, saw a falcon flying near the campus. I watch the falcon nest webcam in the spring which is at the top of the Mayo building.

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@rbcookson

Jennifer, I am at the end of week 7 post-op. My biggest concern was being unable to swallow satisfactorily after surgery. At 6 weeks post-op I saw a speech therapist for dysphagia, and she noticed how tight the right side (same side as my incision) of my throat was compared to the left side, and ordered a barium swallow test. She thought my swallowing problem may be due to either swelling of my throat or to scar tissue from incision. Anyway, the swallow test had to be postponed this week because she was out of town and wanted to be with me during the testing. In the meantime, I began to very gently massage the really tight muscles that began up closer to my chin (not the ones farther down below where my new disks had been implanted), and then two days ago I noticed that the right side of my neck had become much softer and for the first time I was able to take my pills without any major problems, and I even got down a larger nutritional supplement, which I hadn't taken since my surgery. I have concluded that my swallowing problem was the result of swelling after surgery, which brings me to another issue. The night after my surgery, I had a nurse who was wonderful about making my pills into a smaller or in some cases even a powdery form, which she mixed up with chocolate pudding. Then the next morning, she was replaced by another nurse who while I was too groggy to really know what was going on, put all of my pills into one cup of chocolate pudding and fed it to me. I, not understanding what was happening, bit down on one medication that not to be broken apart, and just the liquid from it got down my throat and caused me to violently throw up. Needless to say, when I finished throwing up, I asked the nurse why in the world she gave me the pills like that and she told me that was how she always her patients their pills, even ones right after ACDF surgery. Then she told me that, albeit unconscious at the time, I shouldn't be having any problem taking the pills because I was able to take all of them with just water when I first arrived in my room, which implied my problem was just an emotional one, not anatomical one. Now that I have figured out that my problem swallowing, that I have had until recently, was related to swelling in my throat, causing my muscles to be too tight. Therefore, I am guessing that the reason I was able to take them when I was first out of surgery was because my throat had not swollen yet. Anyway, that was the only bad experience I had while at Mayo. Everything else was wonderful!

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@rbcookson Robin, how are you doing with your recovery since your spine surgery? I'm just checking in and I hope you are doing well.
Jennifer

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