What to expect from an ACDF (anterior cervical discectomy and fusion)?
August 27, 2022 7:20 PM Subscribe
Really, I’m after anecdotes from anyone who has had this surgical procedure, or anyone who has avoided having this procedure.
I have a herniated disc at C7. I’ve already had a nerve root injection, with limited success. I still have pain, weakness/tingling in my right arm. I’ve had one surgical consult where he recommended ACDF. I’m having another in 10 days with the same orthopaedic surgeon to decide whether to go ahead.
The surgeon says I need to have the procedure soon if I’m to have it at all, or the damage can become permanent.
- has anyone had this surgery recommended and managed to avoid needing it? Or declined having it and then got better?
- people who’ve had it, how did it go?
Anything appreciated. Thank you so much.
I have a herniated disc at C7. I’ve already had a nerve root injection, with limited success. I still have pain, weakness/tingling in my right arm. I’ve had one surgical consult where he recommended ACDF. I’m having another in 10 days with the same orthopaedic surgeon to decide whether to go ahead.
The surgeon says I need to have the procedure soon if I’m to have it at all, or the damage can become permanent.
- has anyone had this surgery recommended and managed to avoid needing it? Or declined having it and then got better?
- people who’ve had it, how did it go?
Anything appreciated. Thank you so much.
Based on what I know of her personality, if the routine is rigorous, I would expect her to have been doing it fully and consistently.
posted by aniola at 7:28 PM on August 27, 2022 [1 favorite]
posted by aniola at 7:28 PM on August 27, 2022 [1 favorite]
Here's a previous question that covers the stretching thing a little more (via the herniateddisc tag)
posted by aniola at 7:36 PM on August 27, 2022 [1 favorite]
posted by aniola at 7:36 PM on August 27, 2022 [1 favorite]
Best answer: I avoided ACDF surgery by having disc replacement surgery instead. now I have two titanium-polymer-blend thingums in my neck that move more or less like healthy unexploded discs would have, if I'd ever had any. This may be impossible in your particular case for whatever reasons, but if you have to have surgery anyway, and if a surgeon experienced in disc replacements says you're a candidate, it is preferable.
Of the two neurosurgeons I consulted, one suggested ACDF in spite of having no answer to my questions about What will I do when the 3rd one down, which was (is) already bulging/herniated, gets even worse due to the stress that an ACDF puts on adjacent discs? this was because he was old, set in his ways, and habitually did his favorite surgery in cooperation with a younger & more athletic orthopedic surgeon partner, only stepping in to tie off the nerves in fancy windsor knots or whatever it may be. which is fine. but the other neurosurgeon, whom I ultimately selected as the favored one permitted go right through my neck to my spine, had a much more convincing brand of arrogance and told me he'd replace my discs & I'd walk out the same day no problem.
he massively massively massively undersold the pain. there was an extraordinary amount of pain. much more than with the famously painful rotator cuff surgery I had had previously. I say this not to scare you but because I had read a lot of positive patient testimonials and was expecting it to be not that bad, which made it worse because I thought something had gone terribly wrong (it hadn't, it just really hurts after). I do not know how disc replacement surgery pain compares to ACDF pain, and having two discs done vs. just one hurts more, I'm sure. I did get to go home the same day, screaming all the way. in a couple of weeks I was back at work and my surgeon was very forceful about how I could go back after just one week if I really wanted to (read: if I was tough and cool, like him. but I am not. I am a frail flower.)
anyway:
-- if you really don't want the surgery it might get better on its own with just time. time plus physical therapy is not necessarily superior to just time (I enjoy PT but a lot of its benefits are making you feel like you're doing something while time passes.) the problem is the time it takes to improve on its own is on the order of years, not weeks. and when these things don't get better, they get worse. if it is unbearable and getting worse, you probably don't want to just wait and see.
-- nerve root injections are bullshit. in the neck, that is. in the lower back, they helped me, but the neck is different. and also scarier to let people stick things in. worth trying, but it doesn't mean anything much if they don't help. but if you haven't already tried a short course of oral steroids, definitely do. I don't know why they should work when a steroid injection doesn't, but often they do.
-- tons and tons of people have had ACDF surgery and been just fine, which is why lots of older surgeons apparently still don't talk about disc replacement - they like to do what they're used to. and it is probably always safer to let a surgeon do what they are comfortable with and experienced with than whatever is the updated top recommendation, if they aren't comfortable and experienced with it. so you should be ok if you have the fusion. but if you are given the choice, take a new disc. and if you can't, make sure they explain why.
posted by queenofbithynia at 9:05 PM on August 27, 2022 [1 favorite]
Of the two neurosurgeons I consulted, one suggested ACDF in spite of having no answer to my questions about What will I do when the 3rd one down, which was (is) already bulging/herniated, gets even worse due to the stress that an ACDF puts on adjacent discs? this was because he was old, set in his ways, and habitually did his favorite surgery in cooperation with a younger & more athletic orthopedic surgeon partner, only stepping in to tie off the nerves in fancy windsor knots or whatever it may be. which is fine. but the other neurosurgeon, whom I ultimately selected as the favored one permitted go right through my neck to my spine, had a much more convincing brand of arrogance and told me he'd replace my discs & I'd walk out the same day no problem.
he massively massively massively undersold the pain. there was an extraordinary amount of pain. much more than with the famously painful rotator cuff surgery I had had previously. I say this not to scare you but because I had read a lot of positive patient testimonials and was expecting it to be not that bad, which made it worse because I thought something had gone terribly wrong (it hadn't, it just really hurts after). I do not know how disc replacement surgery pain compares to ACDF pain, and having two discs done vs. just one hurts more, I'm sure. I did get to go home the same day, screaming all the way. in a couple of weeks I was back at work and my surgeon was very forceful about how I could go back after just one week if I really wanted to (read: if I was tough and cool, like him. but I am not. I am a frail flower.)
anyway:
-- if you really don't want the surgery it might get better on its own with just time. time plus physical therapy is not necessarily superior to just time (I enjoy PT but a lot of its benefits are making you feel like you're doing something while time passes.) the problem is the time it takes to improve on its own is on the order of years, not weeks. and when these things don't get better, they get worse. if it is unbearable and getting worse, you probably don't want to just wait and see.
-- nerve root injections are bullshit. in the neck, that is. in the lower back, they helped me, but the neck is different. and also scarier to let people stick things in. worth trying, but it doesn't mean anything much if they don't help. but if you haven't already tried a short course of oral steroids, definitely do. I don't know why they should work when a steroid injection doesn't, but often they do.
-- tons and tons of people have had ACDF surgery and been just fine, which is why lots of older surgeons apparently still don't talk about disc replacement - they like to do what they're used to. and it is probably always safer to let a surgeon do what they are comfortable with and experienced with than whatever is the updated top recommendation, if they aren't comfortable and experienced with it. so you should be ok if you have the fusion. but if you are given the choice, take a new disc. and if you can't, make sure they explain why.
posted by queenofbithynia at 9:05 PM on August 27, 2022 [1 favorite]
Best answer: I have had a cervical fusion. Actually fused (iirc) 4 disks. I was concerned with the increasing loss of strength in my dominant hand and the tingling in the fingers.
First, would I do it again? In short, yes, without hesitation. Having said that, I probably would have cursed the doctor out to his face the first 4 weeks post surgery. The arm got better within days. The soreness and pain in the neck was worse than I expected AND I had had a lumbar fusion years before so sort of knew what to expect.
Could I have avoided it? I guess maybe. I will never know. I will say that I tried rehab and working with a physical therapist for 6 months before the operation.. I think that helped me with the operation in that it strengthened my neck muscles, but it also hurt those 6 months and in my amateur way, I think because the muscles were stronger and tighter that they were sorer than they might have been if I was weaker. I don't know.
Mine was also done through the front of the neck. I think the doctor said it could be done front or back, but he recommended front and my best friend from childhood who is a neurosurgeon in another state said he would go with the surgeon suggestion so I did.
I had to wear a hard brace for a few weeks (?) post surgery and a soft brace for 2 weeks after that. At first I was really scared of getting in a car accident and snapping my neck just below the fusion. I even had a bad dream where my head snapped off. I never even thought about it after 6-8 months. Also, it is not really a risk. Now, my strength is full, tingling mostly gone and really I never think about it. The only time I think it is an issue is when I am drinking from a can of sodabeer and try and tilt my head all the way back to get that last swig. No pain, just less range of motion.
This is sort of stream of consciousness, so if you have any specific questions, feel free to memail me. Also, I watched so many videos of my operation before I went under, I think I could do the procedure in an emergency. Not really, but....
posted by JohnnyGunn at 11:13 PM on August 27, 2022 [1 favorite]
First, would I do it again? In short, yes, without hesitation. Having said that, I probably would have cursed the doctor out to his face the first 4 weeks post surgery. The arm got better within days. The soreness and pain in the neck was worse than I expected AND I had had a lumbar fusion years before so sort of knew what to expect.
Could I have avoided it? I guess maybe. I will never know. I will say that I tried rehab and working with a physical therapist for 6 months before the operation.. I think that helped me with the operation in that it strengthened my neck muscles, but it also hurt those 6 months and in my amateur way, I think because the muscles were stronger and tighter that they were sorer than they might have been if I was weaker. I don't know.
Mine was also done through the front of the neck. I think the doctor said it could be done front or back, but he recommended front and my best friend from childhood who is a neurosurgeon in another state said he would go with the surgeon suggestion so I did.
I had to wear a hard brace for a few weeks (?) post surgery and a soft brace for 2 weeks after that. At first I was really scared of getting in a car accident and snapping my neck just below the fusion. I even had a bad dream where my head snapped off. I never even thought about it after 6-8 months. Also, it is not really a risk. Now, my strength is full, tingling mostly gone and really I never think about it. The only time I think it is an issue is when I am drinking from a can of sodabeer and try and tilt my head all the way back to get that last swig. No pain, just less range of motion.
This is sort of stream of consciousness, so if you have any specific questions, feel free to memail me. Also, I watched so many videos of my operation before I went under, I think I could do the procedure in an emergency. Not really, but....
posted by JohnnyGunn at 11:13 PM on August 27, 2022 [1 favorite]
I had this back in July of 2011, in response to losing sensation first in my left arm and hand, and then later on in my right (dominant) arm. Two of the discs in my neck had completely ruptured. The surgeon told me that I could put off surgery for a while if I wanted to, but the longer I did so the longer it would take to heal and the more he would have to do to correct it.
The operation itself took about 5 hours, during which the ruptured discs were replaced with titanium spacers and a metal plate with screws installed in front to hold everything together. I was prescribed Vicodin for the pain, which I only needed for 2 or 3 days before it became manageable enough for OTC meds like ibuprofen.
After the operation, I wore a hard brace for 4 months (with a soft brace I could use while taking a shower). I had to wear it continuously, even while sleeping - which meant I had to sleep on my back the entire time, when I'm used to being more of a side sleeper.
Since that time I've had no further issues, thankfully. I have lost a slight bit of range of motion when turning my head from side to side, but aside from that there have been no lingering problems.
posted by Roger Pittman at 5:00 AM on August 28, 2022 [1 favorite]
The operation itself took about 5 hours, during which the ruptured discs were replaced with titanium spacers and a metal plate with screws installed in front to hold everything together. I was prescribed Vicodin for the pain, which I only needed for 2 or 3 days before it became manageable enough for OTC meds like ibuprofen.
After the operation, I wore a hard brace for 4 months (with a soft brace I could use while taking a shower). I had to wear it continuously, even while sleeping - which meant I had to sleep on my back the entire time, when I'm used to being more of a side sleeper.
Since that time I've had no further issues, thankfully. I have lost a slight bit of range of motion when turning my head from side to side, but aside from that there have been no lingering problems.
posted by Roger Pittman at 5:00 AM on August 28, 2022 [1 favorite]
i successfully had this - with some relief. turns out a lot of my pain had a different source.
the side effect that bothers me is - being intubated and having my windpipe manipulated permanently affected my larynx. my voice is weaker and scratchier.
posted by j_curiouser at 7:05 AM on August 28, 2022 [1 favorite]
the side effect that bothers me is - being intubated and having my windpipe manipulated permanently affected my larynx. my voice is weaker and scratchier.
posted by j_curiouser at 7:05 AM on August 28, 2022 [1 favorite]
Best answer: I had this around... 2003, I think. Mine was an ACDF at C5-C7, recommended to me because I was having extreme pain in my upper arm and presented with significant muscle weakness on that side. I was told the same as you - that it needed to happen fast, or the damage could become permanent. I wasn't offered the fancy disc replacement option at that time and I didn't press for other options because honestly - I was in so much pain I didn't care, I just wanted it fixed, right now. I was in crying-at-work pain, which for me is like, 15 out of 10. (FWIW, I would have absolutely taken the fancy disc replacement option if it had been available and offered).
I will fast forward to the happy ending, then double back. I'm 100% fine. I would say I reached 100% fine about 2 years after surgery, and have been great ever since. The worst part was the first 6 months after surgery, which were pretty bad, but improvement was very rapid and steady after that. I have full range of motion, and I've had no spinal deterioration as a result of the surgery. There's nothing I could do before surgery that I can't do now (other than you know, stuff that you normally can't do when you're 51.) I don't need any movement modifications or whatever - I just live my life.
Now the bad part - the surgery was about 6 hours, and the pain after was really bad. I don't want to terrify you, but it was much worse than I expected. The pain in my arm was gone when I woke up, which was great, but now I had pain in my entire upper back and neck. This is partly because the first pain medication they tried on me - which I think may have been dilaudid - was like injecting pure water into my veins. It had zero effect. I came out of anaesthesia in pain and I stayed in so much pain for the next 24 hours that I refused to let my mother (who had come down to help me after surgery) in to see me. They eventually figured out I wasn't just whining, I was actually in bad pain, and they tried something else that worked. That helped a LOT, but not all the way. I was in the hospital 3 days, and on the last day they taught me a lot about how to move without screwing up my neck while I was healing - stuff like how to get out of bed. How to stand up and sit down. How to twist my entire upper body to look to the side instead of turning my neck.
I was in a neck brace for... I forget how long, maybe 6 weeks? I learned a great deal about how not to jar my neck area - like sitting in the side seats on the bus or train instead of facing front or back, because the stop and start motion jerks your head back and forth. There was a LOT of pain, and the only thing that helped me with pain was oxycontin, so I would strongly suggest to you that if you have any tendency toward physical addiction to substances, you be very, very careful with that.
Possibly because of the pain, I also had a very strong, unpleasant bout of post-surgical depression. I had never had any kind of clinical depression before, and haven't since, and didn't recognize it for what it was. For about 6 months, I felt like my life was over. I felt like this injury had made me an invalid. I wished I'd never had the surgery. I felt isolated (I lived alone at the time, in a city with only a couple of acquaintances and no real friends) and everything was dark and miserable. At the time, I thought this was all true and would be forever. I didn't know I did NOT have to suffer like that! A short-term course of antidepressants or anti-anxiety medication could have helped me immensely, but I didn't recognize the depression as a THING, I thought it was just how life was now after surgery. I tell you this so you don't have to go through it like I did - if you feel like this after surgery, tell your doctors! At the end of those 6 months it was like a dark cloud suddenly lifted off my life and I could see color and sunlight again. It was almost overnight.
At some point in the very early part of those 6 months, the pain was so bad I started researching, and I learned that many people who go through this surgery are prescribed physical therapy afterwards. I was not, and didn't know to ask about it until very late in the process. Physical therapy ALSO helped my pain immensely, and almost immediately. It was lifechanging. Make sure you push hard for PT as soon as it's safe for you to do it, which I understand is generally right after the neck brace comes off.
Now that I've told you all the bad stuff I want to re-emphasize that I am fine now, and that many of the things that were bad for me could have been MUCH better with proper post-surgical monitoring and treatment, which I did NOT receive... and yet I still survived and I'm fine. The most important thing I can tell you is to not underestimate your pain when talking to your doctors - if anything, over-emphasize it. I'm also quite sure there are new things that can be done that will help now, that we didn't know about 20 years ago. Having surgery was definitely the right thing for me to do in my situation and it saved me from permanent chronic pain, weakness, and deterioration. It just wasn't a cakewalk, and I encourage you to strongly advocate for yourself in the areas of pain relief and mental health in the post-surgical period.
Best of luck to you! Please feel free to DM me if you want to talk more about it, now or after surgery when you're dealing with stuff. I'm happy to be a cheerleader or sounding board!
posted by invincible summer at 7:10 AM on August 28, 2022 [1 favorite]
I will fast forward to the happy ending, then double back. I'm 100% fine. I would say I reached 100% fine about 2 years after surgery, and have been great ever since. The worst part was the first 6 months after surgery, which were pretty bad, but improvement was very rapid and steady after that. I have full range of motion, and I've had no spinal deterioration as a result of the surgery. There's nothing I could do before surgery that I can't do now (other than you know, stuff that you normally can't do when you're 51.) I don't need any movement modifications or whatever - I just live my life.
Now the bad part - the surgery was about 6 hours, and the pain after was really bad. I don't want to terrify you, but it was much worse than I expected. The pain in my arm was gone when I woke up, which was great, but now I had pain in my entire upper back and neck. This is partly because the first pain medication they tried on me - which I think may have been dilaudid - was like injecting pure water into my veins. It had zero effect. I came out of anaesthesia in pain and I stayed in so much pain for the next 24 hours that I refused to let my mother (who had come down to help me after surgery) in to see me. They eventually figured out I wasn't just whining, I was actually in bad pain, and they tried something else that worked. That helped a LOT, but not all the way. I was in the hospital 3 days, and on the last day they taught me a lot about how to move without screwing up my neck while I was healing - stuff like how to get out of bed. How to stand up and sit down. How to twist my entire upper body to look to the side instead of turning my neck.
I was in a neck brace for... I forget how long, maybe 6 weeks? I learned a great deal about how not to jar my neck area - like sitting in the side seats on the bus or train instead of facing front or back, because the stop and start motion jerks your head back and forth. There was a LOT of pain, and the only thing that helped me with pain was oxycontin, so I would strongly suggest to you that if you have any tendency toward physical addiction to substances, you be very, very careful with that.
Possibly because of the pain, I also had a very strong, unpleasant bout of post-surgical depression. I had never had any kind of clinical depression before, and haven't since, and didn't recognize it for what it was. For about 6 months, I felt like my life was over. I felt like this injury had made me an invalid. I wished I'd never had the surgery. I felt isolated (I lived alone at the time, in a city with only a couple of acquaintances and no real friends) and everything was dark and miserable. At the time, I thought this was all true and would be forever. I didn't know I did NOT have to suffer like that! A short-term course of antidepressants or anti-anxiety medication could have helped me immensely, but I didn't recognize the depression as a THING, I thought it was just how life was now after surgery. I tell you this so you don't have to go through it like I did - if you feel like this after surgery, tell your doctors! At the end of those 6 months it was like a dark cloud suddenly lifted off my life and I could see color and sunlight again. It was almost overnight.
At some point in the very early part of those 6 months, the pain was so bad I started researching, and I learned that many people who go through this surgery are prescribed physical therapy afterwards. I was not, and didn't know to ask about it until very late in the process. Physical therapy ALSO helped my pain immensely, and almost immediately. It was lifechanging. Make sure you push hard for PT as soon as it's safe for you to do it, which I understand is generally right after the neck brace comes off.
Now that I've told you all the bad stuff I want to re-emphasize that I am fine now, and that many of the things that were bad for me could have been MUCH better with proper post-surgical monitoring and treatment, which I did NOT receive... and yet I still survived and I'm fine. The most important thing I can tell you is to not underestimate your pain when talking to your doctors - if anything, over-emphasize it. I'm also quite sure there are new things that can be done that will help now, that we didn't know about 20 years ago. Having surgery was definitely the right thing for me to do in my situation and it saved me from permanent chronic pain, weakness, and deterioration. It just wasn't a cakewalk, and I encourage you to strongly advocate for yourself in the areas of pain relief and mental health in the post-surgical period.
Best of luck to you! Please feel free to DM me if you want to talk more about it, now or after surgery when you're dealing with stuff. I'm happy to be a cheerleader or sounding board!
posted by invincible summer at 7:10 AM on August 28, 2022 [1 favorite]
Response by poster: Thank you for each and every answer; I’m so grateful. I have had a second opinion, which is that I need the surgery, so I’ll probably be back with more questions soon! Thank you again.
posted by Salamander at 1:26 AM on August 31, 2022
posted by Salamander at 1:26 AM on August 31, 2022
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Hopefully someone else will come along and know exactly what she was talking about, but in the meanwhile, I thought you might like to know that at least one person has managed to avoid having some sort of spinal fusion surgery.
posted by aniola at 7:25 PM on August 27, 2022 [1 favorite]