ACDF scheduled for Wed: How did you manage sleeping post-op?

It has been about 10 days since my 3-level C3-C6 ACDF procedure. It has been rough, as you can see from my prior posts. But I know that it is still very early, and I think there is a small amount of light ahead.
Yesterday I had my first PT and I feel hopeful that it will help restore my right arm movement, which has already improved since the day after surgery.
I have really only taken about 3 Percocets (325mg) per day (at 8 hours or so), and want to cut that back to zero soon. Unfortunately, Extra Strength Tylenol does nothing for me. I wish I could try Ibuprofen but that is not allowed.
I have my 2 week followup with my surgeon next Thursday. It will be interesting to see how he views my situation.

I have been using a CBD lotion on my neck and I don’t understand it , but it works . It is sold at Whole Foods . I was astonished at the results .
It’s easy to get discouraged after surgery when we want to just return to normal and go about life. I really think you do have some light at the end of the tunnel that hopefully will become brighter every day .
Please ask me anything if I can be of help . Hopefully I would be able to . Keep up the good work .

Yes it will get better… Hang in there! The worst part for me was the surgery recuperation. Like you, I did not take any ibuprofen and Tylenol didn’t help and I weaned myself off the OxyCodone with an appropriate amount of time because I did not want to have to deal with withdrawal. Everybody kept telling me though be sure to take your pain medication as it helps you to heal. So I did. The sore throat and difficulty swallowing was and still is a challenge but less of a challenge each day. I still take one 5 mg of baclofen and two Tylenol in the evening as it seems worse in the evening although it’s not bad. I plan to be off the baclofen this week. My surgery was December 2 so you see it does take time. I had many symptoms but I woke with the two major ones being relieved ( left thumb that was totally numb and I couldn’t walk a straight line as I was so off balance. ) But little by little the other symptoms are easing up. So thankful as I have had nine and a half years of shortness of breath upon minimal exertion and that seems to be getting better too!!! Hang in there. So happy for you that the arm seems to be better already !

Thank you for replying and sharing your story. I know I am still only at 11 days after my surgery.

@birdman518 Mitch, that is very good news... so you just keep on believing this is the beginning of your arm having a total recovery. My physical therapist just posted an article that says that patients who believe they will get better, do get better, and patients who believe they won't get better, don't. Your mind and beliefs are very powerful. This I know to be true from my own surgical experiences. I will be rooting for you all the way! It is a long recovery and that takes patience. You will get there. Thanks for the update!
Jennifer

Mitch, hope you’re doing well. I worried about sleeping correctly, too, and they said just don’t on your stomach.

I have 2nd PT on Wed. and 14-day checkup with surgeon on Thurs.

Suggestions solicited for tomorrow's 1st post-op visit with surgeon:

Here is the bottom line. Nothing I undertook this for is better. In some ways I have more arm pain than before. My C5 nerve palsey is slightly better than the day after, but I still have lost 50% of my right (dominant) arm usability. That is a new problem.

How should I approach this with the Dr.? I don't want to be or even sound angry, but I am a little bit. What should I expect him to say?

Even if I get back the new problem with my right arm, I say I am worse off than before.

Here is the hardest part to say. I went in thinking I would have an ACDF for C6-C7, which is the exact symptom I have had for several years. Pain and numbness down my right arm, with particular numbness in my thumb and index finger.
Neither this Dr nor the neurosurgeon I consulted beforehand recommended doing this. With the same images and neuro reports, they both independently recommended this surgery that I had. Now to be fair, I believe that my problems were extensive, and included myelopathy probably around C3-C4.
They only explanation I can think of is that my C3-C6 was addressed to what they saw as my most pressing issues, and/or to avoid longer-term damage to my spinal cord.
Still, if that were the case, shouldn't either of them indicated that "BTW this surgery, despite being 3 levels, essentially does not address at all your primary arm and hand problems".

Thanks for letting me vent a bit, but comments are always greatly appreciated.
Mitch

@birdman518 Mitch, it is perfectly OK to vent here, and that is preferable. I have had an experience where I had carpal tunnel surgery and my symptoms were still there because the doctor had missed that I had thoracic outlet syndrome. When I brought the symptoms to his attention and told him my hand was turning blue, he got a bit nasty, took my pulse, told me I was fine, and he accused me of malingering. TOS does alter blood supply to the arms and hands, so he missed something crucial. You need to stay on the good side of your surgeon, so be careful in how you address him. They never want to make mistakes or have something like that on their record. I do know how hard this is to be a patient and trying to get better, but still in pain. With your very recent surgery, there will be pain from the surgical path too which is traumatic to the body, and your body is exhausted just trying to heal. I hope I can shed some light on your situation.

Myelopathy is a huge concern, and if you had significant spinal cord compression, you probably would have had the same recommendation from most spine surgeons because preventing further damage is the reason they do surgery. They can't always promise to take away pain. I had myelopthy too, but early enough that it did not show up on an MRI. If you had whitish diffuse areas within the spinal cord on your MRI, that could indicate permanent damage because the nerve axons die and dissolve, and the missing cells show as a whitish area.

When you have very specific nerve pain such as in your thumb and index finger, that pain can be caused by compression or inflammation causing pressure anywhere along the path of that nerve from where it leaves the spinal cord and the path all the way to your hand. The nerves exit between the vertebrae and each level is named on the dermatome maps for the vertebrae under where it exits. If you are have C5 nerve palsey, that is the nerve that exits at the C5/C6 level (being below C5). If you were having an issue at C6/C7, nerves that exit there would be the C6 dermatome. You are correct that the C6 dermatome involves the thumb and index finger. A neurologist needs to figure out exactly where pain from the C6 dermatome would be coming from. It could be the spinal nerves in the foramen, or it could be from elsewhere in the body. You can always ask for an explanation on your MRI about potential issues in the foramen next to the C6/C7 disc. The disc may have been intact or not bad enough to require surgery, and they should be conservative unless there is a real need to intervene. My C6/C7 looked like it was bulging to my untrained eye, but the surgeon said it was OK and just removed C5/C6, and now 5 years later, he says everything still looks good.

Here are some links that show the dermatomes and related nerves.
https://www.ebmconsult.com/articles/anatomy-dermatomes-hand
https://www.neurologycentersofchicago.org/numb-hand-map

I also found some research about C5 Palsey after cervical spine surgery and possible causes for this. One explanation is that the spinal cord moves into a new position which stretches the nerve roots, and because the C5 nerve root is the shortest, it gets stretched and compressed against the bone of the foramen where it exists. When you have cervical problems, often a patient looses the correct curvature in their cervical spine, and that curve could change after spine surgery. My neck was very straight like a pole before surgery, and my physical therapist was helping to maintain it as best she could. I did not have a surgical "Curve correction" that would involve hardware as some surgeons want to do. Changing the curve does change how the spinal cord will be positioned as it floats in the fluid within the spinal canal. The study mentions also doing a foramintomy (to expand the foramen) during the cervical surgery to prevent C5 palsey. It also mentions physical therapy specifics to help address this. I would recommend that you call your physical therapist with the study and ask their opinion. While they cannot make a judgement about spine surgery, they may be able to guide you in how to understand this literature and how to approach it. My physical therapist has taught me a lot and how to understand my own symptoms.

I hope this information helps. If you feel that you are not getting a good explanation from your surgeon, you can always get another opinion, and perhaps a neurologist opinion would be good, as they are not a surgeon who could be blamed for a condition that could be a risk to the surgery that you had. Since your surgery is very recent, another spine surgeon may not want to give you a consult.

You could also phrase the question to your surgeon and ask what happens when the spinal cord is freed from its tethered position and could this start pulling on the nerves? He may answer that. You can ask him to explain how the steroid injections were expect to help the situation. Ask him what therapies or possible additional treatments may help? If he doesn't explain, you may want to ask a neurologist.

What was the diagnosis that you had for your arm and hand problems before your spine surgery? Has anyone ever suggested something like carpal tunnel or thoracic outlet syndrome as a possible contributing factor to your symptoms?

@birdman518 Mitch, I found a few more studies about C5 palsey after cervical spine surgery. So here are the links.

Jennifer