Anyone had an Anterior Cervical Corpectomy and Discectomy with Fusion?

Posted by Hank @jesfactsmon, Feb 17, 2020

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.

@jenniferhunter

@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.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
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.

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Thank-You so much for responding. Your post helps me a lot….and You asked ALOT of good questions that I need to pursue. I will check back here regularly and let you know what I find out.
Thank-You again!!!

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@constancebabe

Thank-You so much for responding. Your post helps me a lot….and You asked ALOT of good questions that I need to pursue. I will check back here regularly and let you know what I find out.
Thank-You again!!!

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@constancebabe I'm glad I could help. Please do check back in and let me know how you are doing. When you ask the right questions, you get your doctors to consider things they may not have thought about. I was able to find the answers to my spine issues when 5 surgeons missed it and had refused to help me because they didn't understand my symptoms. I would look for the next surgeon just in case things didn't work out with a current one and I read their research literature. In doing that, and looking up terminology, I found literature with case studies similar to mine, and I sent that in when I requested to be seen at Mayo. I also watched a lot of surgeons presenting their cases for other surgeons online at conferences, so I understood a lot about spine surgery and that helped me know when I was in front of a good surgeon who understood the issues. It was my Mayo surgeon's paper that had the term I looked up "funicular pain" and his paper referenced leg pain with cervical stenosis, so I knew he would understand. Before I came to Mayo, surgeons were telling me my leg pain and difficulty walking was not related to my spine issue with cord compression at C5/C6 which of course it was. I sent that literature to the last surgeon who refused to help me after I had spine surgery that resolved the issues. I was kind with my letter to him, and never heard from him after that. Still, it was the right thing to do even if he would never admit the error.

I just read a few of your other posts. I hadn't seen those before I answered you, but I did see you had had a brain aneurism and related surgery and an issue with the femoral artery and that past history could be part of the issues you are having with walking and swelling in your legs. It is worth asking about how much that past history could play into your current symptoms and if something has changed. By the same token, you can't assume that is the total picture and need to ask if there are other issues or problems yet undiscovered at the root of the issues that can either be found or ruled out. You might want to consider a second opinion at Mayo and when Mayo analyses a patient with a history of multiple issues, they will retest and reconfirm the findings and collaborate between departments to try to figure out all the issues and which is most important. Mayo has also been doing a lot of research with spinal cord injury patients and walking and they have a lot of specialists.

You can send a private message to another member if you click the envelope icon at the top and type in their name (yours is @constancebabe). You can share information there. With a public forum, it is for everyone's safety not to share personal information in public or imaging that shows personal information on it.

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@constancebabe

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!
~ Connie

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Hello @constancebabe and welcome to Mayo Clinic Connect. You have had quite the healthcare journey. I am glad you have found this community and joined this conversation. It looks like you have successfully connected with several members already who are very supportive, which is great!

You will notice that I have removed your Facebook name and replaced it with a note to have people private message you for your contact information. We do this to protect your privacy from spammers and in general. You are allowed to privately share that information as you see fit.

All that said, it sounds like you have a lot of information you plan to use in seeking answers for what is next. Will you come back and provide updates so other members can learn from your experience as well?

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@amandajro

Hello @constancebabe and welcome to Mayo Clinic Connect. You have had quite the healthcare journey. I am glad you have found this community and joined this conversation. It looks like you have successfully connected with several members already who are very supportive, which is great!

You will notice that I have removed your Facebook name and replaced it with a note to have people private message you for your contact information. We do this to protect your privacy from spammers and in general. You are allowed to privately share that information as you see fit.

All that said, it sounds like you have a lot of information you plan to use in seeking answers for what is next. Will you come back and provide updates so other members can learn from your experience as well?

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Oh….Thank-You so much for messaging me about the practices on this site. I have never participated in a chat room or a forum before and I’m kind of dense I guess, not realizing people could misuse my FB name or email address. Yes… I will definitely check back here…update my condition…and try to find answers to my many questions for sure!!!
This forum has been a godsend to me… I have researched corpectomy‘s a lot before, but I never thought about looking for a forum/chat room to find out some information from people that have gone through the same thing. My sister-in-law asked me last night if I had done that? I never even thought of it. I am so so glad I did it because yours was the first site I went to and it’s been a tremendous help in trying to understand what’s going on with me…..in thinking about what questions I should have answered …and also giving me some bit of ‘peace’ in realizing that I’m not the only one out there going through this.
Again, Thank-You for letting me in on this site. I truly appreciate all of the kind and caring people that have written back to me in hopes of helping me figure this all out. I know this will help me next week when I go back for my 12 week check up, while I still have some concerns about my walking ability and my legs.
As my son continues to tell me… ‘Take it one day at a time, Mom’ …and that’s what I’m trying to do. ☺️❤️

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@amywood20

I had ACDF C4-C6 on December 19th. I would say recovery is going pretty good, so much so that during my six week follow-up the surgeon's PA said I did not need to come back for another appointment unless I had an issue come up or physical therapy didn't help. Most of my symptoms involved the left arm/hand/shoulder. That's what I am going to PT for. I will say this surgery is not cookie-cutter in terms of the healing process. Everyone is different in how they heal, which is based on what needs to be done, how long the issue was there before surgery, age, health, physical activity level, smoker vs non-smoker, etc. Also, it seems that the surgeons have their own preference in terms of having to wear a collar/neck brace after surgery, bending restrictions, lifting restrictions, etc. Post op I only had to wear a soft collar when riding in a vehicle and that was just to protect the neck in the case of an accident. Some have to wear them nearly 24/7 for various amounts of time, which could be three months. My surgeon doesn't like patients wearing a collar/brace because the neck muscles weaken, but other surgeons require it. Like I said, it really varies. I had mine done by a spine specialist. Some go to an orthopedic doctor. It takes a long time for the nerves to heal after surgery, as they regenerate at a very slow rate. I'm not talking weeks, but months…even up to a year. Pain that isn't nerve-related goes away much faster though. I know your friend is scared but she really needs to get this taken care of. The longer she goes the higher the risk of the nerves not healing. I don't know if it's allowed to mention a Facebook group in these forums, but there is one for ACDF. I am in it and there is a lot to be learned there from others. Having said that, if she were to join that group it needs to be taken for what it is. Those with good outcomes don't stick around that much after healing, as they move on with their lives. Those that are struggling tend to post more, as they are seeking support from others. But like I said, I have found it helpful. It sounds like your friend's cervical spine is in worse shape than mine. I don't want her going into surgery and then being disappointed if she doesn't recover at the rate I am going at. I had very high expectations for how I thought I would feel immediately after surgery. Some wake up and the nerve pain is gone. I know a few like that. But, those tend to be the exceptions…which I didn't realize. When I woke up and had the same pain in the upper left shoulder blade and other areas, I was pretty frustrated. I had new pain that I did not have before surgery. So, she really needs to go into it without expectations since again, it is going to vary. One thing I did not know about before surgery was how the surgeon pins the arms down to help access the cervical spine. The arms get pulled and pinned tightly. That can cause quite a bit of post op pain. Also, when the cervical spine has discs replaced it causes the height to go back to where it should be. This stretches a lot of muscles connected to the neck. Again, this can cause pain, spasms, etc. I hope what I have mentioned is helpful. If she wants to join that Facebook group let me know and I will post the title of it.

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I’m almost at 12 weeks now….And I am starting to get a little concerned because I still haven’t gotten my normal ability to walk back… Did you ever have any problems walking ….and if you did, did they resolve themselves or are you still having any residual problems? I go to the doctor on Tuesday for an X-ray, etc…. but I’m just concerned that something must still be wrong since I can’t walk very well…..and I still have some swelling (bilaterally) in my legs and feet. Do you EVER feel like you’re back to ‘normal’???

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Anyone 70+ with arthritis and osteoporosis had this done and if so how is it going?

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@lfortin

Anyone 70+ with arthritis and osteoporosis had this done and if so how is it going?

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Hello @lfortin and welcome to Mayo Clinic Connect. You will notice that I have moved your post into an existing discussion on this same topic so you may connect with members such as @constancebabe @jenniferhunter and @amywood20.

As well, feel free to go back through the previous comments to see what you can learn while we wait for others to join.

Is this a procedure that you have been presented with as a recommendation for you personally or someone you care for?

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@amandajro

Hello @lfortin and welcome to Mayo Clinic Connect. You will notice that I have moved your post into an existing discussion on this same topic so you may connect with members such as @constancebabe @jenniferhunter and @amywood20.

As well, feel free to go back through the previous comments to see what you can learn while we wait for others to join.

Is this a procedure that you have been presented with as a recommendation for you personally or someone you care for?

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Personally

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@lfortin

Anyone 70+ with arthritis and osteoporosis had this done and if so how is it going?

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@lfortin I had a cervical fusion in my 50's, but I don't have osteoporosis. Bone quality is a factor if any hardware will be screwed into the bone because screws can become dislodged or loosen. I didn't want hardware because my body reacts to metals such as pierced earrings and I had to give that up. I had a single level fusion at C5/C6 with only a bone graft (no hardware) and stayed in a hard collar until it fused which was 3 months. I knew that going in and made that choice and that time went by faster than I thought since I focused on resting and healing. You might want to ask if you can have a procedure without hardware. A surgeon takes a risk when they allow a patient to make that choice because you have to be careful and compliant and just stay home instead of riding in a car that could be involved in an accident when you are not fused yet. Other factors that affect bone healing adversely are smoking which I mention for information, but I have never been a smoker. I do take bio-identical hormone replacement which does help to preserve bone density and I healed well and spinal fusion had begun at 3 months post op. With spinal discs that collapse, it puts pressure on the facet joints when they get closer together and causes arthritic changes. A bone spacer in a fusion restores normal height and takes pressure off the facet joint which will no longer move because that level is fused.

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@jenniferhunter

@lfortin I had a cervical fusion in my 50's, but I don't have osteoporosis. Bone quality is a factor if any hardware will be screwed into the bone because screws can become dislodged or loosen. I didn't want hardware because my body reacts to metals such as pierced earrings and I had to give that up. I had a single level fusion at C5/C6 with only a bone graft (no hardware) and stayed in a hard collar until it fused which was 3 months. I knew that going in and made that choice and that time went by faster than I thought since I focused on resting and healing. You might want to ask if you can have a procedure without hardware. A surgeon takes a risk when they allow a patient to make that choice because you have to be careful and compliant and just stay home instead of riding in a car that could be involved in an accident when you are not fused yet. Other factors that affect bone healing adversely are smoking which I mention for information, but I have never been a smoker. I do take bio-identical hormone replacement which does help to preserve bone density and I healed well and spinal fusion had begun at 3 months post op. With spinal discs that collapse, it puts pressure on the facet joints when they get closer together and causes arthritic changes. A bone spacer in a fusion restores normal height and takes pressure off the facet joint which will no longer move because that level is fused.

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Thank you. You are the second one who has mentioned not doing the metal hardware. I have the same problem.

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