combined anterior and posterior cervical spine surgery

Posted by sksdl @sksdl, Oct 20, 2021

I am new member, please excuse any rookie mistakes. I have 2 conditions. 51 yr old male. One is causing me current pain in my neck, right shoulder blade, right triceps area...with tingling in my right forearm and some numbness in my right hand. It is believed from CT scan, MRI, Xrays, and examination from neurologist that I have bone spurs and a bulging disc causing issues with C5-C7.

Secondarily I have OPLL - ossification (calcification) posterior longitudinal ligament - with some stenosis pressing on my spinal cord. My surgeon and his team are recommending a combined anterior and posterior approach. Anterior to fix the bone spurs\bulging disc (my most serious current pain) and Posterior to correct the OPLL\Stenosis issue. This is a mouthful but my upcoming surgery is called "c5-c7 anterior cervical discectomy and fusion and C2-T2 posterior spinal decompression and fusion". With the combined approach and many levels its an estimated 6-7 hour surgery 4 or 5 days in the hospital.

My question is if anyone on this forum has had a combined anterior\posterior cervical spine surgery? and if so what was their experience? anything regarding expectations post surgery...both short and long term would be appreciated. I know it won't likely be positive, but I have experienced difficulty finding information regarding patient outcomes of a similar procedure. Good or bad, I can't find it. It just appears to be rare, though my neurosurgeon tells me he does many of them each year.

Any advice on how to find folks with a similar experience to learn from?

Interested in more discussions like this? Go to the Spine Health Support Group.

@marycdickens01

I think we may be related ! I do not meet many people who have had almost the same amount of surgery that I did . My surgery was done about a year later than the surgeon wanted , bc I had an infection that was thought to be dessiminated . I was so sick up until surgery ; we hoped the infection was gone or I could be in bigger trouble than I already was .
I had become very weakened prior to surgery / the infection plus several other conditions made me feel so awful that by the time I had my surgeries I really couldn’t cognitively handle even what the details of the surgery entailed . I knew my chances of making it were slim due to all my issues . I had been inactive for so long and had endured so much to get to this point , I was just ready to do it . My biggest concerns post op were that I would be able to walk
better ,that my head and neck would be straightened back to normal placement and my newly developed urinary incontinence would be cured .
I had C3-C5 ACDF done first ; when I became aware of just being awake after surgery , I immediately knew the incontinence problem was over . I also was aware that the positioning of my head and neck was better . I recovered pretty quickly from that it seemed . I was pleased at the progress that had been made . I wore a collar /brace they went to my waist . I was still in a precarious situation until I had the rest of my cervical surgery done a month later. This part was more serious and took around 10 hours I think . I am a nurse practitioner and I was acutely aware of all the things that could go wrong , plus my surgeon had been very blunt that my surgery and /or recovery might kill me. I would say I was just more uncomfortable after the posterior surgery . (C2-T2) Because of my previous problems and still being on IV antibx ; I stayed in the hospital 2 weeks then I went to a rehab facility for two weeks. It was hard to be away from home but I needed the extra security so that I didn’t fall and I received intensive PT /OT . I had pretty extreme weakness of my upper body . Just lifting my toothbrush up and brushing for a decent amount of time was really hard for me . I prob developed some gingivitis during this time . The area around the incision was pretty numb but weakness just plagued me . I guess you could call it tightness too . My upper body would tremor like I was just exhausted when I tried to do anything. And everything involves your upper back and neck . However it just seemed like one day a few months later , I realized the strength was coming back slowly but surely . The tightness and just absolute weirdness that I felt in that area improved . Unfortunate Covid and a hip surgery complicated things and I lost some of the strength i had gained. I felt like I literally had been living under a dark cloud for years by then . Even though my therapy was delayed some , it seemed to be helpful that I went back even though it wasn’t a new problem / I just needed to get stronger and work on my wimpy upper body and just generalized weakness . I really noticed a change then and felt I had become a much stronger person . I remember thinking it had taken me 18 months to recover from they surgery . However I had very complicating factors that made my situation a disaster. But considering eveything going against me ; the surgery was a success . I would have liked to have returned to normal and been the old me , but that will never happen . My surgery was to save my life and prevent paralysis .
I don’t know about you or anyone else reading this , but I was misdiagnosed and looked over for years while I endured terrible pain , brain fog , and proximal weakness of my body . It was like no one would listen to me . My surgeon said it was something like RA had eaten up my spine. My family and I had moved during the start of this nightmare and that also created more confusion and no communication from my caregivers . I remember when I started to realize that I was being tagged as a nutcase - and yes , that description was correct bc by this time I had caused a huge disruption in our family life , lost my career , caused great financial distress with all the medical bills and the lack of my salary . I was also on steroids which was the only thing that touched my pain but it made me less then nice , you might say . I think the hardest thing about this has been the lack of time specialists spent with me and the time that was lost while I was trying to get someone to listen to me . Then I am referred to this orthopedic spine surgeon by accident / I was supposed to see an orthopod who specialized in feet - anyway he became my doctor and was I surprised when he told me how serious my situation was . How I got to that point I do not know how , and I ask myself every day how this happened and here I was a NP and I could not get help .
Could I ask you or anyone reading this ….what kind of shape are you in now ? What activities do you do ? Just fill me in on your story whoever is reading this . I literally have not known a soul who has gone through what I have !

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Hi @marycdickens01 hope you’re doing well. I am 55 and scheduled for anterior and posterior fusion C2-T2 soon. Front and back at same time. I’m 55 with severe RA for many years. This will be my 19th orthopedic surgery (but first on my spine) so I’m pretty familiar with most aspects of the surgery and pain management etc. My surgeon has said I’ll be 5 nights in the hospital and I was wondering what exactly they do for you all that time? The doctor says they have you up and walking the same day so is the long stay just for pain control?
Also are there any things I should pack that would be helpful during my stay? When you got home what position were you able to sleep in? I’m fairly active now - driving, cooking, traveling, keeping house. About how long until you were able to get back these activities? How long until you were able to do your hair and makeup? Will I be able to dress myself right after the surgery? My husband works from home and my son will be back from college so I won’t be home alone but I like to be very independent.
Is there anything that surprised you about either the surgery or the hospital or the recovery or anything else I should know?
Thank you!

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@lorihgk

Hi @marycdickens01 hope you’re doing well. I am 55 and scheduled for anterior and posterior fusion C2-T2 soon. Front and back at same time. I’m 55 with severe RA for many years. This will be my 19th orthopedic surgery (but first on my spine) so I’m pretty familiar with most aspects of the surgery and pain management etc. My surgeon has said I’ll be 5 nights in the hospital and I was wondering what exactly they do for you all that time? The doctor says they have you up and walking the same day so is the long stay just for pain control?
Also are there any things I should pack that would be helpful during my stay? When you got home what position were you able to sleep in? I’m fairly active now - driving, cooking, traveling, keeping house. About how long until you were able to get back these activities? How long until you were able to do your hair and makeup? Will I be able to dress myself right after the surgery? My husband works from home and my son will be back from college so I won’t be home alone but I like to be very independent.
Is there anything that surprised you about either the surgery or the hospital or the recovery or anything else I should know?
Thank you!

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@lorihgk Welcome to Connect. C2 to T2 is a big surgery. You'll need to be walking so they know that you can walk, and to also exercise your lungs, and to know that you have control of bladder and bowel functions. They will consider you a fall risk until you demonstrate that you are not. Anesthesia causes phlegm build up in lungs that you need to clear so it doesn't turn into pneumonia. You will need help at home, and this is your excuse to be a couch potato and nap because you will need that. You will have lifting restrictions that start about 5 or 10 pounds max. I think the hospital stay is so they can be sure you will be able to function and walk safely after you get home. This surgery will probably be more painful because of cutting though the back and front. A lot of cervical fusions are done only through the front as mine was for C5/C6. I was able to handle that without pain medication, and I was really nauseated by pain meds. I may be the unusual patient that could manage like that. If you can control your anxiety and fear, it will help control pain and help in healing. If you take them, it may cause serious constipation, so you'll need to work on relieving that.

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@jenniferhunter

@lorihgk Welcome to Connect. C2 to T2 is a big surgery. You'll need to be walking so they know that you can walk, and to also exercise your lungs, and to know that you have control of bladder and bowel functions. They will consider you a fall risk until you demonstrate that you are not. Anesthesia causes phlegm build up in lungs that you need to clear so it doesn't turn into pneumonia. You will need help at home, and this is your excuse to be a couch potato and nap because you will need that. You will have lifting restrictions that start about 5 or 10 pounds max. I think the hospital stay is so they can be sure you will be able to function and walk safely after you get home. This surgery will probably be more painful because of cutting though the back and front. A lot of cervical fusions are done only through the front as mine was for C5/C6. I was able to handle that without pain medication, and I was really nauseated by pain meds. I may be the unusual patient that could manage like that. If you can control your anxiety and fear, it will help control pain and help in healing. If you take them, it may cause serious constipation, so you'll need to work on relieving that.

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I understand I will be up and walking right away - on day 1 they tell me, so I’m wondering why the long stay after that. Also, I want to know how long after surgery until I can brush teeth, style hair, do makeup, dress myself head to toe independently. This is my 18th orthopedic surgery so I’m very familiar w pain and pain meds. Not worried about that. Also not anxious - more just curious.

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@lorihgk

I understand I will be up and walking right away - on day 1 they tell me, so I’m wondering why the long stay after that. Also, I want to know how long after surgery until I can brush teeth, style hair, do makeup, dress myself head to toe independently. This is my 18th orthopedic surgery so I’m very familiar w pain and pain meds. Not worried about that. Also not anxious - more just curious.

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@lorihgk I think you'll be able to brush your teeth. I was given a separate foam neck brace to use while showering. You kind of feel like Humpty Dumpty when you can't bend or twist. It wasn't hard to wash my hair, just different because I had to not move my neck. I was able to dress myself, and I had a bin with folded t shirts and shorts to wear that was on a bench next to the bed, so I didn't need to bend down or look up for it. You might want to pretend and see what you have to modify if you can't bend or twist your neck. Elastic shoe laces helped a lot so I could just slip my feet into my gym shoes.

You nurse may be able to answer further, but there may be a lot of inflammation and pain with the extent of the incisions that you'll have.

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@lorihgk

I understand I will be up and walking right away - on day 1 they tell me, so I’m wondering why the long stay after that. Also, I want to know how long after surgery until I can brush teeth, style hair, do makeup, dress myself head to toe independently. This is my 18th orthopedic surgery so I’m very familiar w pain and pain meds. Not worried about that. Also not anxious - more just curious.

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@lorihgk
I am also 55 and had ACDF surgery on C5-C6 in 2022 and decompression/fusion of L3-L5 in 2024. I may also need ACDF surgery on C6-C7 in 2025 due to a herniated disc impacting my spinal cord.

Do you have disc bulges/herniations C2-T2? What is the reason for such extensive surgery/fusion/hardware? Doing the surgery from the front is much less painful than the back due to cutting through muscle in the back. My lumbar surgery was done from the back and it was a pain level of 11/12 out of 10. It was extremely painful. I could not really drive for 4 weeks and in so much pain when I got home I could not really function for quite a while. Getting in and out of bed was very difficult and managing pain/discomfort took time. They said it takes about 3 months to fuse and it could take 6 months to a full year to determine the impact of the surgery. I am 6 months post surgery and doing much better now but really relief on getting help doing housekeeping, shopping/errands, walking dogs, taking care of teen son, caring for cats, etc.

Since you are having your neck/upper back mostly impacted, you may have issues using arms/hands as usual due to muscles being cut into. Sleeping and lifting/picking up things may be a challenge for a while. I had a cervical pillow to sleep on when having my ACDF surgery. Keep in mind that bending over may be hard with incisions on front and back of neck (squatting may be necessary to support neck).

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@jenniferhunter

@lorihgk Welcome to Connect. C2 to T2 is a big surgery. You'll need to be walking so they know that you can walk, and to also exercise your lungs, and to know that you have control of bladder and bowel functions. They will consider you a fall risk until you demonstrate that you are not. Anesthesia causes phlegm build up in lungs that you need to clear so it doesn't turn into pneumonia. You will need help at home, and this is your excuse to be a couch potato and nap because you will need that. You will have lifting restrictions that start about 5 or 10 pounds max. I think the hospital stay is so they can be sure you will be able to function and walk safely after you get home. This surgery will probably be more painful because of cutting though the back and front. A lot of cervical fusions are done only through the front as mine was for C5/C6. I was able to handle that without pain medication, and I was really nauseated by pain meds. I may be the unusual patient that could manage like that. If you can control your anxiety and fear, it will help control pain and help in healing. If you take them, it may cause serious constipation, so you'll need to work on relieving that.

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Hello,
Wonder if anyone has had their entire Cspine fused c4-t1 or similar. My scenario, at pretty young age I had very successful ACDF c5-c7 (due to many problems including chord compression, a reverse curve to my neck (common if have long straight neck, that my NeuroSpine surgeon straightening w the fusion by carving out the cadaver bone in a metaculios way). Over the years other areas of my Cspine has become worse. Radio Frequency Ablation by a very skilled Pain Mgmt doctor, worked great to rid of any pain years after the fusion. I never needed Pain meds etc. Over
last 9 months bad pain started creeping up and RFA or other non invasive procedures did not help at all. Recently (15 years after original c5-c7 fusion), imaging shows I have bad stenosis, the worse at c4-c5 with anterior/ posterior chord compression, among many other issues thoughout my Cspine, including Anterolisthesis with flexion at c4-c5 and c7-t1. Total mess. I am on my own w no help. I wonder how you function on your own, after having your entire neck fused? I did great after my first fusion, but this is far more drastic. I would appreciate any candor from others who may have had a similar fusion/ experience. Ty

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@dlydailyhope

@lorihgk
I am also 55 and had ACDF surgery on C5-C6 in 2022 and decompression/fusion of L3-L5 in 2024. I may also need ACDF surgery on C6-C7 in 2025 due to a herniated disc impacting my spinal cord.

Do you have disc bulges/herniations C2-T2? What is the reason for such extensive surgery/fusion/hardware? Doing the surgery from the front is much less painful than the back due to cutting through muscle in the back. My lumbar surgery was done from the back and it was a pain level of 11/12 out of 10. It was extremely painful. I could not really drive for 4 weeks and in so much pain when I got home I could not really function for quite a while. Getting in and out of bed was very difficult and managing pain/discomfort took time. They said it takes about 3 months to fuse and it could take 6 months to a full year to determine the impact of the surgery. I am 6 months post surgery and doing much better now but really relief on getting help doing housekeeping, shopping/errands, walking dogs, taking care of teen son, caring for cats, etc.

Since you are having your neck/upper back mostly impacted, you may have issues using arms/hands as usual due to muscles being cut into. Sleeping and lifting/picking up things may be a challenge for a while. I had a cervical pillow to sleep on when having my ACDF surgery. Keep in mind that bending over may be hard with incisions on front and back of neck (squatting may be necessary to support neck).

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The reason for the extensive surgery is because of the RA damage. My discs are destroyed and the vertebrae are bone on bone and sliding forward and back. The vertebrae are also compressing my spinal cord so I already have arm and hand pain, numbness and lack of strength and coordination (on top of the arm and hand pain from the RA).
I already have to sleep on a cervical pillow so sleep is a challenge and I can’t lift much. I don’t trust myself cooking because I can’t carry hot pans or pots of boiling water. Believe me I wish I could just have the ACDF surgery.
I’m aware of how much pain there will be after. I’m used to that. I just want to know that I’ll be able to take care of my hygiene needs and fix myself up. I don’t want to look like an invalid on top of being one 😘

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@lorihgk

The reason for the extensive surgery is because of the RA damage. My discs are destroyed and the vertebrae are bone on bone and sliding forward and back. The vertebrae are also compressing my spinal cord so I already have arm and hand pain, numbness and lack of strength and coordination (on top of the arm and hand pain from the RA).
I already have to sleep on a cervical pillow so sleep is a challenge and I can’t lift much. I don’t trust myself cooking because I can’t carry hot pans or pots of boiling water. Believe me I wish I could just have the ACDF surgery.
I’m aware of how much pain there will be after. I’m used to that. I just want to know that I’ll be able to take care of my hygiene needs and fix myself up. I don’t want to look like an invalid on top of being one 😘

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@lorihgk It is Ok to ask for help. I needed help after my single level fusion. It’s a bit strange when your pride doesn’t want to ask for help and you need it. If it was someone else, you’d offer to help with even simple things. No one will expect you to shine when you are recovering from surgery. It’s ok to relax and you’re going to be very tired when healing. Maybe it won’t be your norm for awhile. Toward the end of my recovery, I was at the grocery store in my neck brace and lots of people were offering to get items from the shelves for me and it was kind of nice that they cared.

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@jenniferhunter

@lorihgk It is Ok to ask for help. I needed help after my single level fusion. It’s a bit strange when your pride doesn’t want to ask for help and you need it. If it was someone else, you’d offer to help with even simple things. No one will expect you to shine when you are recovering from surgery. It’s ok to relax and you’re going to be very tired when healing. Maybe it won’t be your norm for awhile. Toward the end of my recovery, I was at the grocery store in my neck brace and lots of people were offering to get items from the shelves for me and it was kind of nice that they cared.

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Thank you for listening.
I can ask for help and have lots of people who would be happy to, but because have I have surgery every year (and know I need at least 4 more after the neck thing) I’d wear ‘em all out😜. Plus I don’t always want to be seen as the “sick” friend. There is not much I can control about my illness but I can control the image I present to people. So it’s important to me that once I’m home from the hospital I can put myself together everyday head to toe. That’s my goal.

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