post failed ACDF

Posted by birdman518 @birdman518, Jan 11 7:20am

Almost 1 year ago, I had a 3 level ACDF for pain and numbness all down my right shoulder, arm and especially hand. The surgery was not successful. My pain is as bad as ever, and is also somewhat present in my left side, although not as bad.

Because I have a pacemaker, I was always told I could not have an MRI, but I have recently had a replacement (after 7 years) and now my cardiologist says I can get one. I am trying to schedule it now.

I do not blame my spine surgeon. My issues were severe and I had evidence that I had pressure on my spinal cord which I hope this did alleviate. My surgeon expressed great shock that my surgery did not alleviate my symptoms at all. He would like to see the MRI to evaluate what could still be causing my pain.

My question is this. I still think I would be well served by getting a new "second opinion" (I had one before and both Drs agreed on the diagnosis and treatment/surgery). I live in greater Tampa (but not Tampa) and I was wondering if I should try to get another spine/neuro-surgeon there (Tampa General is supposed to be very good), or if I should try to find someone at Mayo in Jacksonville. It is only a 4 hour drive. For either scenario, I would like to hear people's suggestions about how to choose another surgeon. I can use the Internet, of course, but I would prefer real first-person suggestions if possible.

Thanks,
Mitch

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@birdman518 Hello Mitch. I had hopes that your recovery would be better. I think a new MRI is a good idea. Can you say why you think your surgery failed? Is it because you still have significant pain? I can surely empathize with that. Typically a failed fusion is where the bone does not grow and fuse, so there is still some movement between the parts at those levels. Imaging can confirm that, and a flexion/extension X-ray may be advised.

I don't have specific knowledge of surgeons at Mayo Jacksonville, but I know that Mayo is very good. My Mayo surgeon is at Rochester. MN. If you would be willing to travel, he would be an excellent 2nd opinion. What you can do is apply to be seen at Mayo, and request that your imaging be sent to him for review. It won't cost you anything to do that much. If there is something the doctor can do to help, they may offer an appointment. When you become a patient, then costs will apply. One thing I recommend is to call the billing department of any facility where you wish to be seen and ask if your insurance or Medicare is accepted and in network.

My neurosurgeon surgeon was Jeremy Fogelson at Rochester. Here is his profile.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
If you wish to apply to be seen at Mayo, you may use this link:
http://mayocl.in/1mtmR63
My process for choosing a spine surgeon happened over a few years because I kept seeing local surgeons who didn't want to help me. I was always researching the next one as a Plan B in case it didn't work out with the current doctor. I started looking for videos and published research papers of any surgeon I considered, so I could see what their area of interest was because that should match what a patient needs. With my background in biology, I could understand the papers I was reading, and if I came upon terminology I didn't know, I looked it up. I was also dealing with a lot of anxiety, so I wanted to see how a doctor presented themselves and if their mannerisms seemed to be interested in helping on a human personal level. Beyond that, I looked at where they trained, and if they were recognized and respected in their field. I looked for a surgeon who had extra training like a spine fellowship. One of the surgeons I saw locally was a neurosurgeon who also had orthopedic spine surgery training. I used to think of looking for an older more experienced surgeon, but younger surgeons are trained in newer techniques. Surgeons also attend conferences at several spine societies and when you find a surgeon who teaches at those, they might be a leader in their field. I watched a lot of those online presentations that I could find that were accessible with out a subscription. I looked at Becker's Spine Review website to see the news about spine surgeons and spine centers. It gave me information about what research was going on. I looked at information on clinical trials for spine devices and which surgeons were doing that, so I looked up those doctors too. I looked at the facility where the doctor practices to see if they were well ranked by US news and World Report. I looked for any media stories about the surgeon. I looked to see if the doctor was board certified and looked at the state records to see that there had not been disciplinary action against them. There is also a listing of medicare surgical successful outcomes for some doctors, but few are listed because the criteria is limited for that data.

What I saw with Doctor Fogelson was that he had excelled in many areas of his life receiving a full undergrad scholarship to Bemidgi State, and receiving an outstanding alumni award from them for his success at Mayo. He trained in neurosurgery at Mayo, and now teaches in that program. In addition to the 7 year neurosurgery education at Mayo, he had fellowship training in orthopedic spine deformity at Washington University Medical School, and he was the course co-director for spine surgery lab workshops at St Louis University for the Spine Research Society. There were numerous awards for his presentations at spine societies. Recently he received a teacher of the year award from Mayo. There was a story about doing back surgeries on a Minnesota governor. At the time I hired him, he wasn't yet listed as a surgeon to know in Becker's Spine Review and that came a couple years later. I had seen so many surgeons who didn't understand what was wrong with me, and when I saw a paper co-authored by Dr. Fogelson that described leg pain from cervical stenosis, there was a term I looked up, and that led me to other medical literature with cases similar to mine. Finally, I knew I had found a doctor who would understand my symptoms and equate them with my spine condition. From there, I contacted Mayo and asked for an appointment with Dr. Fogelson. At that time, I couldn't find any videos of him speaking, but I had a good feeling about him, and he put me at ease when I met him. I knew he was giving good answers to my questions because by that time, I had learned enough to know what was current in spine surgery procedures and some of the risks.

I had an excellent outcome to my surgery, and when I got the follow up questionnaire from Mayo's CEO about my surgery, I felt multiple choice answers were not enough to describe how well my surgery went and how impressed I was with the quality of my care. I wrote a personal letter and sent it back with the survey, and I got a personal letter back from the CEO thanking me and it also said that Dr. Fogelson was one of their best. My hunch had been correct. I do talk about him a lot on here, and I'm sure there is a long wait to see him. A couple of the neurological spine surgeons listed at Mayo Jacksonville were trained at Mayo.

Jennifer

REPLY
@jenniferhunter

@birdman518 Hello Mitch. I had hopes that your recovery would be better. I think a new MRI is a good idea. Can you say why you think your surgery failed? Is it because you still have significant pain? I can surely empathize with that. Typically a failed fusion is where the bone does not grow and fuse, so there is still some movement between the parts at those levels. Imaging can confirm that, and a flexion/extension X-ray may be advised.

I don't have specific knowledge of surgeons at Mayo Jacksonville, but I know that Mayo is very good. My Mayo surgeon is at Rochester. MN. If you would be willing to travel, he would be an excellent 2nd opinion. What you can do is apply to be seen at Mayo, and request that your imaging be sent to him for review. It won't cost you anything to do that much. If there is something the doctor can do to help, they may offer an appointment. When you become a patient, then costs will apply. One thing I recommend is to call the billing department of any facility where you wish to be seen and ask if your insurance or Medicare is accepted and in network.

My neurosurgeon surgeon was Jeremy Fogelson at Rochester. Here is his profile.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
If you wish to apply to be seen at Mayo, you may use this link:
http://mayocl.in/1mtmR63
My process for choosing a spine surgeon happened over a few years because I kept seeing local surgeons who didn't want to help me. I was always researching the next one as a Plan B in case it didn't work out with the current doctor. I started looking for videos and published research papers of any surgeon I considered, so I could see what their area of interest was because that should match what a patient needs. With my background in biology, I could understand the papers I was reading, and if I came upon terminology I didn't know, I looked it up. I was also dealing with a lot of anxiety, so I wanted to see how a doctor presented themselves and if their mannerisms seemed to be interested in helping on a human personal level. Beyond that, I looked at where they trained, and if they were recognized and respected in their field. I looked for a surgeon who had extra training like a spine fellowship. One of the surgeons I saw locally was a neurosurgeon who also had orthopedic spine surgery training. I used to think of looking for an older more experienced surgeon, but younger surgeons are trained in newer techniques. Surgeons also attend conferences at several spine societies and when you find a surgeon who teaches at those, they might be a leader in their field. I watched a lot of those online presentations that I could find that were accessible with out a subscription. I looked at Becker's Spine Review website to see the news about spine surgeons and spine centers. It gave me information about what research was going on. I looked at information on clinical trials for spine devices and which surgeons were doing that, so I looked up those doctors too. I looked at the facility where the doctor practices to see if they were well ranked by US news and World Report. I looked for any media stories about the surgeon. I looked to see if the doctor was board certified and looked at the state records to see that there had not been disciplinary action against them. There is also a listing of medicare surgical successful outcomes for some doctors, but few are listed because the criteria is limited for that data.

What I saw with Doctor Fogelson was that he had excelled in many areas of his life receiving a full undergrad scholarship to Bemidgi State, and receiving an outstanding alumni award from them for his success at Mayo. He trained in neurosurgery at Mayo, and now teaches in that program. In addition to the 7 year neurosurgery education at Mayo, he had fellowship training in orthopedic spine deformity at Washington University Medical School, and he was the course co-director for spine surgery lab workshops at St Louis University for the Spine Research Society. There were numerous awards for his presentations at spine societies. Recently he received a teacher of the year award from Mayo. There was a story about doing back surgeries on a Minnesota governor. At the time I hired him, he wasn't yet listed as a surgeon to know in Becker's Spine Review and that came a couple years later. I had seen so many surgeons who didn't understand what was wrong with me, and when I saw a paper co-authored by Dr. Fogelson that described leg pain from cervical stenosis, there was a term I looked up, and that led me to other medical literature with cases similar to mine. Finally, I knew I had found a doctor who would understand my symptoms and equate them with my spine condition. From there, I contacted Mayo and asked for an appointment with Dr. Fogelson. At that time, I couldn't find any videos of him speaking, but I had a good feeling about him, and he put me at ease when I met him. I knew he was giving good answers to my questions because by that time, I had learned enough to know what was current in spine surgery procedures and some of the risks.

I had an excellent outcome to my surgery, and when I got the follow up questionnaire from Mayo's CEO about my surgery, I felt multiple choice answers were not enough to describe how well my surgery went and how impressed I was with the quality of my care. I wrote a personal letter and sent it back with the survey, and I got a personal letter back from the CEO thanking me and it also said that Dr. Fogelson was one of their best. My hunch had been correct. I do talk about him a lot on here, and I'm sure there is a long wait to see him. A couple of the neurological spine surgeons listed at Mayo Jacksonville were trained at Mayo.

Jennifer

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Jennifer, thanks as always for taking the time to provide such a thoughtful reply. When I say "failed" I simply mean that the problems I went in with are still the same (pain, numbness, loss of function) or slightly worse.
Clearly getting the MRI should identify what is still causing these problems. If I could have had one before, I would have.
I am very happy that my new pacemaker will allow this to happen, and I am not in a hurry. I will at the very least have one other surgeon around here also look at the images once I get them, then I will have to decide what to do and where.

Mitch

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I had C-4-C-7 fused by Dr Selby Chen.He was amazing

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I would definitely get at least one more opinion and don't be afraid to get several. (I got 4 recently). After I saw the surgeons, I went back to my PCP, sifted through all the information and with her help, selected who we thought was the best of them. My PCP changed my mind by looking at it from a different point of view. In a nutshell, she said this is serious stuff, look for a doctor who has a history of these surgeries and go to a hospital where they take on hard cases. Skill level of the doctor is extremely important. Ask lots of questions of the surgeons, general answers or perplexed looks may mean the doctor isn't overly familiar with your situation. Best wishes!

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