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combined anterior and posterior cervical spine surgery

Spine Health | Last Active: Feb 26 11:19am | Replies (20)

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Thank you for the information, it is very kind and very much much appreciated. I will read up on the MFR discussion.

My surgeon informed me that yes, they will cut the vertebrae and stabilize with hardware of the OPLL condition. I have had 4 other surgeries for other unrelated purposes and different broken bones on 3 occasions early in life. I have had a section of colon removed for diverticulitis, a knee, a hernia, and lastly a gall bladder removal\hernia repair combo surgery. But none have involved hardware. I have heard from friends and relatives that the fusion around metal can cause quite a bit of pain.

I plan to ask my surgeon if he has other previous combined anterior\posterior surgery patients would be willing to share experiences. That is a great suggestion. The last appt to discuss the surgery was a bit overwhelming and that was one question I just didn’t think to ask. I think I assumed I could find more patient experience stories for info on forums such as this or on youtube. But that has not proved to be so true. At least for the combined approach for a condition such as this.

One concern I have is around the anterior approach you had performed. I read that you can have trouble swallowing and that there is swelling in your throat and surrounding areas. Did you find that distressful? If so, how long did it last? And is it worse from a swelling perspective if hardware is involved.

In a previous surgery, I was under for approx 4 hours, my only lengthy time under anesthesia. When I came out of anesthesia I was extremely nauseous. My only experience like this. They were concerned I would get sick and with abdominal surgery that could be very bad. They quickly wheeled me in a room, turned out the lights, put wet rags over my head and shot anti-nausea medication into my IV. It passed a few minutes later. I guess I have this fear of this reoccurring or being worse with a 7 hour surgery. In addition, the concept of having difficulty swallowing or breathing coming out...in tandem with nausea is distressing.

The success of the surgery is obviously paramount with no issues that result in any kind of paralysis, serious infection or side effects, hardware issue, or lasting chronic pain. And of course, pain of recovery is obviously a concern. But of the things that seems to be the most top of mind...for me to understand...is those first minutes\hours after wake up.

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Replies to "Thank you for the information, it is very kind and very much much appreciated. I will..."

@sksdl I also get nauseated from anesthesia, but there is a patch that the anesthesiologist can put behind your ear to stop the nausea before the surgery and it worked great for me, absolutely no nausea after surgery and it can be left in place a few days. You have to not touch it and then rub your eyes because it can damage your eyes. Perhaps that will ease your fears about waking up after surgery.

As for the sore throat with ACDF, yes that happens and I had throat pain kind of bad for 2 weeks, and then better but still painful for another. It also feels like something is stuck in your throat, and one side is worse. That is because they have to retract the trachea to get behind it to the spine. Your neck muscles can also be tight, but you can stretch that prior to surgery. My surgeon told me where his incision would be (left side) and he showed me how to put my hand on my neck and pull down. That is how myofascial release works; you make a shearing force (gentle not painful) and hold it waiting for the tissue to move and release (could be 5 to 15 minutes) and you can feel that happen. Doing this will make it easier for the surgeon during surgery and you can see a physical therapist to stretch the back of your neck and shoulders prior to surgery. There is also a risk of vocal cord paralysis from the anterior surgery. If that happens and does not come back, there is a procedure to place an implant to get the vocal cords to meet again and restore the voice. Mayo does this. I was a bit hoarse for about 2 days. If you have a vocal cord issue you would talk in a whisper.

Some patients always feel like there is something in their throat. The left side of my throat feels a bit different to me even 5 years later, and I am careful swallowing since this makes it easier to swallow wrong. I really don't notice it much. Right after surgery, you have to think about how to swallow correctly, don't let yourself be distracted or you can make a mistake. As for metal hardware, for me titanium plates and screws on my ankle caused pain, a low dull throbbing pain and feeling like I was getting kicked in the shins all the time and I got chronic hives, and excess phlegm in my lungs all the time. I have allergic asthma, so that was an issue for me and could cause a lung infection very easily. I had my hardware removed a month ago and that pain is now gone, I'm breathing a lot better and I don't have the throbbing pain. I still have healing pain, but it is not bad. My ankle surgeon told me about 20% of patients ask for hardware removal.

ACDF can be done without hardware (uses only a bone spacer) if your surgeon allows it and you would need to stay in a neck brace until fused. I did that and it was worth it. I would ask if hardware can be removed at a later date if it causes a problem. With spine surgery, that isn't an easy solution, but you should understand what you are getting into. Patients do have revision spine surgeries and spine hardware can be removed then such as the plates on the front of the spine. I would ask if you will be able to bend your spine after this surgery and how much motion you will loose. Fusing C5/C6 and C6/C7 does not affect head turning much at all. Most of that is done by C1 & C2 with some help from C3 and C4. My head turning is normal with a C5/C6 fusion, but I cannot touch my chin to my chest. It is close however.

When you wake up from surgery, they will be giving you ice water and the nurses need to know if you can swallow, and then that you are able to empty your bladder. Since they are talking about several days in the hospital, it sounds like you will need a lot of help in the first days. I don't remember a lot of swelling in my throat, but I can imagine you may have swelling on the back of your neck with an incision that large, and I would expect that to cause headaches from muscle tightness to the back of the head. You may want a neck wrap that chills for that, but that is a question for your surgical team as to what you can do post op. My incision was dry and did not need a drain tube; many patients do have a drain tube. They used dissolving sutures and steri-strips. I had a hard foam collar to use while showering. I was not allowed to bend or twist, so it's kind of like walking around like Humpty Dumpty. I put elastic laces in my shoes so I could just slip them on since I could not bend over to tie my shoes.

I would also ask what the hardware is for the longitudinal ligament part and the ACDF part. There are metal or PEEK (plastic) cages for the fusion that usually have a place inside where they can seed bone growth with bone spurs that they remove. My surgeon told me it heals best with natural bone instead of foreign materials. You can look the hardware up on the manufacturer's website. Will your hardware be individual pieces for each vertebrae and not rods connecting everything and preventing movement and bending?

As a precaution, my surgeon prescribed Muipiroicin which is an antibiotic ointment to put in my nose for several days before surgery. That was to prevent a staph infection, since staff can live in the sinuses. You might also be asked to shower with Hibicleans to kill germs before surgery.

There is a lot to think about. What other questions would you ask your surgeon? Are you having symptoms now from spinal cord compression?

I had cervical discotomy and fusion on c4/c5 and c5/c6 in 2019. I have not had any pain due to the hardware at all. My neck does still bother me at times but I was told by my surgeon we can hope for 70% success rate as I had these problems for years. I am above 70%.