Anyone had an Anterior Cervical Corpectomy and Discectomy with Fusion?
My friend is going to be undergoing an Anterior Cervical Corpectomy and Discectomy with Fusion. She is very nervous about this and has been holding off for while as she has sought opinions from several doctors. Here is a recent message she sent me a few days ago when she first told me about it:
"I supposed to have this last year but kept pending it because I was scared oh well I am still sacred:)
Anyway, I did not get better with conservative/traditional treatment. I was diagnosed with Severe Cervical Spinal stenosis on 2018.
I went to 4 different specialist and surgeons (nerve and orthopedic surgeons) from different hospital and all urge me to have the surgery sooner than later to avoid serious conditions later (becoming a paraplegic) so here we are." Just wanted to start a discussion to see if anyone else has had this so I can tell her to join Mayo Connect and maybe get some answers. Specifically what was it like to have the surgery, how long to recover, kinds of complications, anything info that might be useful to someone facing this surgery. Thanks, Hank
Interested in more discussions like this? Go to the Spine Health Support Group.
Thanks Amy, I will tell her about your post. I do hope she joins this group and the Facebook group. I think it will be instrumental for helping her clear her thoughts before going into the procedure to get her questions and fears addressed by people who have actually been through it. Thanks and hopefully she will pop up in this forum soon. So far I haven't gotten a reply back from her since telling her about it.
@jesfactsmon Hi Hank. I am a Mayo cervical spine surgery patient with a single level ACDF at C5/C6. I had spinal cord compression and a great outcome from my Mayo surgery. That being said, I am also a member of the facebook ACDF group, but I prefer to participate here instead because I can provide more information here and personally it means a lot to me to share what I have learned through my experience to help someone else on that difficult journey. On the facebook group, they will delete posts that have any identifying information for the surgeon or the facility. That makes it hard to share medical literature that could be beneficial, and to be honest about my surgical outcome or even to share Mayo's or other general medical information because it can be construed as promoting Mayo or other facilities. The facebook group tends to be more about patients venting or expressing their fears and frustrations rather than detailed information and patients who have success tend to leave the group. I like to share detailed information that explains things because it helps reduce fears of procedures, and I can't share freely when the group moderators are overly concerned. Here on Connect I can share my Mayo story and also pass along information about spine surgery that are not related to Mayo. Not everyone can come to Mayo, and it helps that we can encourage others to seek the best treatment they can find. When someone is considering a major surgery, the skill of the surgeon, their team, and the facility are very important. Finding the best surgeons in the field and doing everything you can as a patient to increase your success will go a long way toward a great recovery. I came to Mayo after 2 years of consulting several surgeons and none would offer surgery and they missed understanding and connecting my symptoms to my spine injury. I was just getting worse, loosing muscle mass and coordination and loosing the ability to control my arms. During that time, I was also watching online presentations at spine surgery conferences for surgeons by surgeons, and reading medical research literature. When I got to Mayo, I knew that I was getting the right answers, and I had already found medical literature that explained why my case was different. If a surgeon isn't confident, you don't want them operating. I knew I was getting a confident surgeon with the right answers by the way he answered my questions, and I already understood my MRI images before I met him.
It sounds like your friend is getting consistent opinions. I believe a corpectomy removes the vetebral body (bone). A discectomy removes the disc (cartilage), and then the fusion is when the bones grow and heal together because a bone spacer is placed between them. When discs collapse, it can cause the jelly like inner nucleus to be squished out, and that causes inflammation. The body tries to stabilize it by remodeling the bone and growing bone spurs. For me, the disc and bone spurs went right into my spinal cord and compressed it which caused random pains all over my body. The uneven pressure on the end plates of the vertebrae also causes the bone remodeling, and given enough time, the spine can start to fuse itself with bone overgrowth, and that causes problems that affect spine alignment and compression on nerves that exit the spine between the vertebrae. It might be possible that excessive bone growth could make the problem inoperable if it goes on long enough. I have read posts by patients who are wheelchair bound and paralyzed by spine injuries who refused surgery. I know the fear of surgery is real and can be very disabling itself, but you have to weight that against the prognosis of what happens if there is no surgical intervention. Always ask the surgeons questions about what they think about when would permanent and irreversible nerve damage begin to happen, and when is the best time to think about surgery. There may be several different procedures that could address the problem, or different approaches, so always ask why they recommend as they do.
Yes, there are great outcomes out there and I am one of them. Here are some links with my story and some other patient stories about my surgeon, Jeremy Fogelson. I am 3 years post op and doing great. If I need spine surgery in the future, I will return to my surgeon at Mayo. Let me know if I can be of further assistance or answer any questions. For anxiety, counseling can help a lot. One of my greatest lessons in life was to overcome my surgical fears and deprogram them, so fear doesn't control me any more. I worked out my own ways to cope with the fear and learn from it. I've been tested by some other medical issues and fear can still creep in, but I will recocgnize it sooner and be able to get it under control. Those disabling fears usually come from a past experience that creates an automatic reaction because the original fear was not processed and understood. I was still thinking like a 6 year old, and I found a new way to think about my medical dilemma that wasn't so threatening. It is possible to overcome the fear, and in doing that to choose your best choice for your future instead of letting your fears make that choice for you.
Here are a few other links about Dr. Fogelson.
Jennifer, I like the information in your post. My friend said she has begun reading this thread but she obviously has not posted anything herself yet. I like what you said about overcoming the fear. I also agree with you about the importance of finding the right doctor/team. it made me think of that TV commercial where the patient and his wife meet the surgeon who has just been "reinstated" and tells them that he is nervous about the operation too but says "we'll figure it out" just as the guy is about to be wheeled into the OR. Definitely hilarious, but not so much when it's real. I saw you posting over at the neuropathy websites, so one of your outcomes was PN apparently? Now that is frustrating! I see my wife every day suffering with that and can hardly believe how helpless I feel. She just suffers and suffers!
@jesfactsmon Yes, I know that commercial about the "re-instated surgeon". We all should keep that in the back of our minds and expect the best from our doctors. I did search the state medical boards that license physicians to make sure that any doctor that I wanted to see was licenced and has not had disciplinary action against them and I recommend that patients do that. Doctors need to earn your trust with their expertise. Having blind faith as a patient doesn't help you, so ask questions. There are also online success & complication rates for medicare patients for specific procedures for surgeons and the institutions where they practice, so you can compare them. That doesn't really tell you how it relates to your case, and Medicare patients might have a lot of other health issues that can add to the complication rates. Insurance companies also keep track of success rates, and you can ask them for the information. I have physical issues that cause nerve compression with tight tissue and work on that in physical therapy. I have thoracic outlet syndrome which is nerve and vessel compression in my neck and shoulder. I also have been a caregiver to my elderly parents and have learned a lot advocating for them and the moderators like to call on me for input about a lot of topics. Sometimes, I find medical literature and post that. In my PT, I do a lot of myofascial release and I started the discussion on that. It can help neuropathy if there is a physical cause, and it helps break up surgical scar tissue. I'm sure this has helped me in my recovery from spine surgery. You might like to look up TED talks about fear. I hope that I will be a presenter there one day and tell my story about how I overcame the biggest fear in my life. Thanks for your comments.
I’m interested in finding out from you any complications you might have had. I had a Corpectomy on C5/C4,C5 disc removal,with a titanium cage put in for the fusion. I’m doing pretty well except my legs are still bothering me (that’s what happened that brought me to the clinic to begin with.) I never had much as far as arms or shoulders but it was my legs. I’m three months out and I’m almost done wearing my neck brace which I had to wear for 12 weeks. I get x-rayed next week but it bothers me…Every day is different… And today I could barely walk. I noticed I was having problems for 3 to 4 months before they did the cervical MRI. When you said the nerves take time to heal you’re talking months not weeks… How long did yours take to heal? Right now I can’t do much during the day I’m a fairly ‘young 63 year old’….Who never has had much wrong with them in the past. Then two years ago I had a ruptured brain aneurysm, (Which I healed completely from… )Then I had a femoral bleed after an angiogram (which I also healed completely from) and then about three weeks after being cleared that my clip in my brain was OK, I started not being able to walk… And then they finally found my spinal cord was like a ‘Z’. Anything you can tell me about healing or positive things that have happened to You. Some days I get so tired and frustrated by the time I go to bed I am very depressed. I live along with a bunch of dogs (thank God for them). …And I have a lot of friends that stopped and I’m grateful for that. I would just like to know when I will be able to go back to a normal life or a ‘new life’ and what that will be like. Thank you for anything you can help me with. ~ Connie
I found your story very interesting. I went to a wonderful surgeon in Madison Wisconsin (I live just south of there). I also had an Anterior corpectomy with fusion of C5.(C4, C5 discs removed) Fusion is with a titanium cage. Right now I’m 12 weeks out from surgery and I’m doing OK but the reason I had surgery to begin with was because I was having trouble walking all of a sudden. I never had much for arm problems or shoulder problems but it was always my legs. Did you have any trouble with your legs and walking? And if you did did it take a long time to get that back….your ability to walk? I am very frustrated because every day is different some days I have fairly good days where I’m only minimally numb and my legs aren’t swollen ….other days It seems very difficult for me to even walk. I also have bulging disc in my lumbar but from the EMG I had that says that that’s not causing any problems. I will find out next week with an x-ray of my neck to see if that’s doing well… I had one done at six weeks and it looked like it was doing well. Again my problem is my legs and my walking ability. Am I being too impatient to think that some of that should’ve come back already after 12 weeks ??How long did it take you to feel like your spinal cord/nerves healed? I would be interested in any information you could give me at this point. Thank you in advance in case you do write me. Sincerely, Connie
@constancebabe my goodness, you have been through a lot! I wish I could tell you when you will be able to get back to a normal life, but I don't know. It's been one year and five months since my ACDF C4-C6 and I still have issues with my left shoulder and left side of my neck. Imaging shows the fusion is fine and healed. There is a small disc bulge at the C6-C7 that the surgeon said didn't show up on imaging before surgery. According to the physical therapist I have been going to for about a month now (I put myself back into physical therapy), disc bulges can resolve without surgery but can take a long time…like a year. I also have a bulge in my L4-L5 and a few other issues. I do have lower lumbar issues but I've had those on and off for many, many years. Seems I do something to flare it up, get it to calm down and am then good for a while before I flare it back up again. My left foot is tingly at times and doesn't feel the same as the other foot. I have had all sorts of tests on it and nothing jumped out at the specialist. This was before neck surgery so I let it go. Recently, I saw a different specialist for it and he thought it was coming from my lower lumbar and not the foot/ankle. MRI did show a few things, but they are the same things that have come up before, before I had these symptoms.
I will say that imaging like MRIs do not tell the entire story. I'm almost 45 and if you were to scan people my age and older you would most likely find a variety of bulges and small tears here and there. That does not mean they are causing any pain the person might be having. These images are just one tool a specialist should be using in their toolbox. Example: I have a labrum tear in my left hip. It does not cause any issues. I had one in my right hip as well and after five years of chasing pain in my lower back and front of the right hip, I had it repaired. Prior to I went to several physical therapists and specialists and got a variety of opinions. Was it the tear in the right hip causing the pain, something in the spine, something else? So I had that tear fixed, went through four months of post op physical therapy and then went back to a normal life of being active, lifting weights again, etc. Well, the pain came back! It was NOT caused by that tear. Surgeon said I still needed it fixed, as it was shredded. I learned from that experience and continue to read and research whenever I have an issue. Another example I'd like to share…I have a full thickness tear in one of my rotator cuffs of the right shoulder. This type of tear cannot heal itself and will need surgery. First specialist I saw said I needed to have it fixed within six months or the tendons would turn to "mush." He must have thought I was an idiot that didn't do my research. I walked away from him and went to a different specialist. He agreed there was a tear that needed fixed but also said I needed to have the cervical spine surgery first. He said what the other doctor told me about my shoulder was a scare tactic and that I have plenty of time to have it fixed. It's almost two years since that shoulder tear was discovered and I have yet to get it fixed and I am doing OK. I do have issues with it, but the arms works, etc. I won't bore you with what the current physical therapist said about it since this response is already getting to be too long. 🙂 I will say everyone is different and if this tear was causing my arm to not work, I would need it fixed ASAP. I guess the point of all of that is continue to do your research, get multiple opinions from different specialists, etc., and it's not always what it seems. That first specialist I saw for my left foot never suggested it could be an issue with my lower lumbar. I knew that was a possibility and that's why I sought out a different expert for another opinion.
As far as your leg issues, they are thinking that's from the cervical spine? I would think it's from lower down the spine or something in your brain and not the nerves from the cervical spine region. Are you getting treatment at the Mayo Clinic (the specialists I've mentioned were not from Mayo and were those where I live)? I don't know if my response has been all that helpful. I've tossed in a lot of things that had nothing to do with my cervical spine surgery but hopefully you've taken something good away from it.
Thank-You SOooo MUCH for your reply. It helped me greatly to understand what all is involved….And how very different every patient can be. (And btw, It’s never ‘too long’ for me. I found it very very interesting and I learned something from all of it….So again, thank you!)
And no, I’m didn’t have this done at Mayo… Although the Mayo clinic is fairly close to us. I had it at a hospital in Madison Wisconsin ….and actually the same Neurosurgeon that operated on my aneurysm did my Corpectomy. I do have a lot of faith in him. As I said, I am 11 weeks out and I go back to my doctor next week. I know I’m just terrible at being patient and waiting for something to change here. I did ask my doctor if this could’ve been from my aneurysm that my legs were acting the way they are) and he said no. But from what I’m reading, sometimes the basic tests that are done don’t always give an accurate answer. (If you would like to connect on email or Facebook, private message me for my information.) You sound like you’re quite an athlete and work out a lot. I haven’t gone to any physical therapy yet but I think they have that planned for me. Before this all happened I was working out quite a bit and I have been biking a lot last summer it was an unusual for me to go 20-30 miles a day. When this started happening where I couldn’t move my legs very well and I was getting very numb feet, my workouts pretty much all stopped. When my low back MRI showed bulging discs I backed off exercising hoping they would heal by themselves but they didn’t. I would love it if I could get back to doing some sort of exercise routine every day!!
Thank you for all your words of wisdom. I’m sure I will re-read your letter quite a few times…..And I will be on here fairly regularly to see what more I can pick up!!! (You are right when you say ‘DO YOUR RESEARCH’. I have done a lot of research but I had never looked at any forums before a friend of mine suggested trying to find a ‘Corpectomy forum’.
Ok……..Hope to talk to You again soon!, Take good care of yourself!
@constancebabe never be afraid to get a second opinion if you have even a hint of doubt in your treatment. With the disc bulges, often times people think they need to stop being active. That is the opposite of what you want to do. You just need to avoid certain movements and add those that will help the weak areas. Obviously, something caused the discs to bulge. A weak link is there, which is probably muscular in nature (i.e. a weak core). I think physical therapy would help a great deal. One piece of advice I will give you with that is go to the website of the place you will be doing therapy at. See if the therapists and their credentials are listed. If so, pick the one with the most experience and that has a specialty in the area of concern (if it's listed). Don't just let the scheduler assign you someone. I have had great physical therapists and awful ones. If you have complicated issues the last thing you need is someone straight out of school. For my current physical therapy I did exactly what I just mentioned. I picked the lead PT, as he also has additional training in manipulation that I felt would be beneficial. The physical therapy place connected to the neuroscience center where my cervical spine surgeon is at was awful. I thought the therapist would be exceptional since he sees a lot of the surgeon's patients. Nope. After two sessions I quit and went elsewhere (that was around February 2020). Be your own advocate and take control! 🙂
@constancebabe Thank you for your question, Connie. I presume that you are able to walk, but with a lot of difficulty from your question. Yes, I did have trouble walking when I had cervical spinal cord compression. I walked like I had a limp with an uneven gait. Before my spine surgery, muscle spasms were moving my vertebrae around and would twist or tilt them which effectively made the spinal canal smaller. My physical therapist would work on the spasms and get my neck realigned, and I walked normally again. It was an intermittent problem that happened when more pressure was put on the spinal cord from misalignment. It was never a permanent situation. I had tracked the progress of my spine related symptoms and pains for several months, so I knew which symptoms were caused by cord compression, and unfortunately several surgeons discredited that information. I knew that when I had a pain could be turned on or off simply by changing the position or bend in my neck, it absolutely was caused by that specific position. The spinal cord floats in the spinal fluid like a rope inside a bendable tube. It has to move to allow your body to move, and the problems happen when something pins the spinal cord in place. Later on, as the bone spurs progressed putting more pressure on my cord, I got to where I could not turn off pain by changing position, but it did sometimes change where the pain was. It also got to where I could bend my neck forward and send an electrical shock down my entire body. I did loose muscle on the back of my upper arms and shoulders (about half the muscle mass) and since surgery 4 years ago, about half of what I lost has come back. Immediately after surgery when I woke up, all of the pain I had previously was gone. The pain I had was from the surgery itself, but there was no more leg pain and I walked normally. It got more painful from inflammation for about 2 weeks and there were some neck muscle spasms during healing, but by 6 weeks, I felt pretty good, but still tired from healing. I was in a neck brace for 3 months which creates muscle weakness, so when that came off, I had to do physical therapy. I agreed to 3 months in a brace to avoid having hardware placed on my spine and only had a bone spacer. My neck complained a lot about having to hold up the weight of my head, but by 6 months, I was doing well. My MRI images never showed any damage to the spinal cord itself and a patient can have mild myelopathy that does not show on imaging. That is why it is important to have decompression surgery before permanent damage happens. If you have your MRI imaging, look for a whitish diffuse area in the spinal cord. That is what damage looks like, and of course, you need a medical opinion to diagnose your case. Your surgeon should explain what your imaging shows. Another possible diagnosis could be an issue with the brain related to difficulty walking. I am not saying that to scare you, but if this hasn't been ruled out with brain imaging, your doctor doesn't know. I worked with a lady who developed brain cancer, and this was her first symptom with difficulty walking. A neurologist should be questioning this if a patient presents with a sudden difficulty in walking. A spine surgeon naturally thinks about it being a possible spine problem. They have to rule out issues in the entire spine too. I had an MRI of my complete spine before my spine surgery.
I would suggest getting a second opinion about the lumbar bulging disc in relation to issues with walking. I also have a lumbar bulging disc. Mine will crack and is sometimes slightly rotated and I have had sciatic pain that I could stop by rotating my spine. Other things that can affect the lumbar spine can be overly tight hip flexor muscles. That happens when we sit too much and since you have difficulty walking, you must be sitting a lot. ( I spent the last year healing a broken ankle and sitting too much, and I'm working on this now.) I get tight and have to stretch my legs and hips to relieve aching in my low back. There are places that create nerve compression points between overly tight hip muscles and can create symptoms similar to a lumbar spine problem. My surgeon told me the best way to prevent spine problems is to maintain good core strength. This link explains issues that can be confused as spine related, but are caused by pelvis misalignment and tight hip and leg muscles. It is technical and covers a lot of different issues and was written for physical therapists.
Has your doctor given you an opinion about why you have leg swelling? Do you have circulation issues? One possible cause of leg swelling is blood clots and that is a risk after any surgery for maybe about a month. From your post, it sounds like you had leg swelling prior to spine surgery. I think you should question that until you get some answers. If there is a circulatory problem in your legs, that could be a reason for difficulty walking and pain. There can be multiple things going on causing similar symptoms at the same time and it may be or may not be related to the spine issues. An EMG test shows a doctor if your nerves are working correctly and delivering impulses to activate the specific muscle it serves. Those tests find damage, but also are done to rule out inflammatory nerve issues like MS. They also have to consider the physical aspect of a damaged disc and if the bulge from it begins to press on something like a nerve root exiting the spine. If that progresses to a herniation and the disc begins to collapse, the vertebrae will get closer together closing down the space between them ( called the foramen) where those nerves exit the spine. That inflammation also causes bones spurs and arthritic changes that also close down that space. The uneven pressure on the end plates of the vertebrae causes the bone to remodel that can create spurs. I did not have nerve root compression, only spinal cord compression in my case, so when that was resolved, all the pain was gone when I woke up from surgery and it was done before permanent damage happened. Perhaps the slight muscle loss in my shoulder and arms is a bit of permanent damage. I was getting sharp pains in my arms and shoulders for a year before surgery, and they continued for abut a year after to a lesser degree which I presume were then healing pains which can happen as peripheral nerves heal. I would have done this surgery sooner, but I couldn't find a surgeon willing to help for 2 years. Then I came to Mayo and got help right away.
You also mentioned numbness. Is that in your legs? I would definitely tell your surgeon about that. Did your doctor say if the fusion process has begun yet? Some patients fail to fuse, so that would be something to ask about. I was fusing at 3 months time, but we are all different. The inflammation from the healing process also increases inflammation in the rest of the body and can affect other issues you may have. For me that was thoracic outlet syndrome which got worse for awhile and I couldn't move or stretch my neck to work on it. I just had to endure the discomfort an pain for a few months before my surgeon would let me do therapy. A physical therapy evaluation may be helpful, but only if your surgeon clears it for you as it is still pretty early in the healing process and you had more than one cervical level involved. I hope this helps. I certainly understand. Healing takes a lot of patience and giving yourself permission to just rest.