Very well explained… unfortunately my ACDF levels 4-5-5-6 after 4 years, I’m still struggling. It was a failure. I’m basically just taking it day by day with the meds. My. Neurosurgeon said that my spinal cord was damage and there was nothing left he could do, I hope for everyone to be as successful on their surgery.
Thank you for posting these videos!!! When it was clear I needed to get surgery they really helped me understand the myelopathy, the types of surgery available, and the risks so I was able to have better conversations with my surgeon. Showing your videos to my parents also helped them understand and be less fearful of what would happen. I had one level ACDF last week and am doing very well. Thank you again! :)
Thank you for more clarity on what to expect. This was so helpful to reduce my anxiety. I m having c4-5, c-5-6, c6-7. I have been and guess still scared a little. Wish you were doing my surgery, But think I have one of the best Doctors in the Atl. area.
I worked in the OR in the UK for 30+ yrs. My father collapsed, paralysed, could only breath. Thankfully, I got him transferred to a surgeon I 1st assisted for. But, it took 7 days. After surgery( cage 2 levels) he started limb movement. In 3 mnth, fully walking independently. I use to love assisting this op. But, when you see the results 1st hand - it's beyond amazing !
This is so good. I had 3,4,5,6 fusion it has been 10 years. Now I am having pain and lack of function of pointer and middle finger in both hands. It wakes me at night. I drop things and I am 72. This helps with explaining surgery it was the easiest surgery I ever went through, and helped my pain intensity. I feel I have the post surgery arthritic changes. I did have replacement screw c7. 6 weeks after first surgery to put in larger screw. The first surgery took 6 hours. Thank you.
Awesome. It's been 8 years since my three level fusion in the cervical spine. I am just now learning from this video what it was! I have had pain and turns out my c6c7 did not fuse and the screws are loose. I would love to see a video entailing how that would be repaired. Great video.
My screws broke in my neck fusion fond at my 6 month.exray. I've had ongoig issues over the 15plus years. I'm now experiencing multiple problems in my Vigus nerve I believe.
My husband just had this surgery yesterday with Dr Hsu from Rothman in Pa. Everything you explained is how things have been going thus far. It was refreshing to hear your explanation.
this was such a great video. i am having the procedure done within the next 10 days. makes me feel tons better. thank you for addressing every question. 😎
Excellent video! You’ve put my mind at ease, as I am scheduled for this procedure next month. I got 17 years use out of my first surgery of C5-7 and now need to have C3-4 done. I was looking for answers regarding neck movement post op which you explained. Thank you.
Very thorough explanation. I am having my surgery 9.18.24. Been watching numerous success stories on YT and surgery explanations like this. Thank you for making it very plain.
Hi Dr Su finally had my C5/6/7 ACDF six weeks ago we have had many messages back and forth and my two discs were completely collapsed.. it’s been one hell of a journey but as soon as I was out of surgery there was immediate relief not only has height been restored disc space but also 24mm to 28mm at base skull.. curve corrected I can finally rest my head on car headrest when I drive!
I had my surgery February 17 and I'm doing awesome compared to before I had to have it or I was going to go paralyzed happy i did it because it started to affect my walking and. My feet would feel ice cold even if the heat was on 90 tingling burning in my legs omg I was going through it for months happy I had the surgery
@@Livinglyfestylecollcetion Sometimes the spinal cord is compressed, not only the nerves coming out the sides, and that can produce myelopathy such as the difficulty walking that the commenter mentioned. If there's trauma (such as a fall or a car crash) when the cervical spine is damaged by bone deterioration, bone spurs, and/or stenosis abd nerve comoresssion, the area is at higher risk of spinal cord injury than it would be otherwise. Spinal cord injury produces paralysis.
I have a C4 to C6 neck bulge with mild stenosis & Radiculopathy in the left arm . i’m also having neurological issues because of nerve impingement . this exactly what I have to have !
Thank you Dr. Brian for this very thorough explanation of ACDF. I met with a surgeon yesterday and frankly, I left thinking Hell No! While I am still not convinced that this procedure is worth it, your explanation makes a lot of sense. Right now I'm weighing my current discomfort level with the risks of surgery and that at best, there may only be a 50% improvement from what I understand. Thank you for making the procedure clear
PS: using Peyton Manning as an example is not helpful 😂. I am a 66 year old grandmother. It's not an apples to apples thing at all, but I get your point...sort of.
I really like your teaching technique. No frills, hand held word definition charts x MRI analysis with physical pointer and models that you draw on! Fantastic
Thank you for sharing the way you explained everything puts me at ease even though I trust my neurosurgeon he did my back in 2015 with great success. I’ll be having ACDF 03-11-24
You have allayed a lot my fears and anxiety about my cervical disc disease. I have multilevel foraminal stenosis c2-t1 , most likely arthritic . I’m dealing with the pain just fine PT, combining 200 mg Motrin and 500 acetaminophen 2 x per day . I take .5 of Xanax and I’ve been good with arm and shoulder pain . What has been a bigger concern is balance and gait disorder. I’m a long distance runner of more than 50 years and it’s been a struggle to find my 7:40 pace . I’m 70.5 years old and love to lift and run . On one had offered anything but PT which i attend 3 x per week , it has helped . I have an old non mri friendly pacemaker and it’s been a year of waiting to have imaging to better define anatomy. Should I see you in consult? Thank you sir !
I had this procedure done in 2002 after a fall on a concrete floor at work. I had C5-6 C6-7 level done with cadaver bone put in. I had to fight with workman comp each and every step of the way. It took 14 and a half months to have an MRI and 22 and a half months to have the surgery. After surgery, I developed a crack in the C7-T-1 level. My surgeon got tired of waiting for workmans comp to approve the revision, so he went ahead and did the second surgery. In doing do, he found the crack had healed. He removed the plate and I have it on my Keychain. I have arthritis above and below my fusion. Heat helps. I highly recommend this surgery if your surgeon says you need it. I am thankful I had it. It took the pain and numbness from my arms and hands. This is an easy recovery. I say this after having both knees and my right hip replaced many years after my neck fusion.
Thank you for reassuring me after I had this surgery. I was/am upset that I still have pain, 5 weeks post surgery. (I’ve recovered within 2 weeks after two knee replacements) but from what you say, I am overly optimistic.
Thank you. I watched all the videos. Just found out I have sever deterioration from c4-c7. Multiple pinched nerves on the right side. I’ll be seeing a spine surgeon next week. Pretty nervous. Out of all the surgeries I think I’d prefer the posterior one. If I qualify
Dear doctor been diagnosised with stenosis watch all your videos have problem with c7 since I was in a job recently my pain is so severe my mum can't understand, had pain in my neck 😢 numbess in both my arms and legs pain in my lower back also had trouble walking, my Doctor has been amazing, can't get into the specialist till December , I have also been bleeding and problems with bowels and urine, however I tried going to a physiotherapist while waiting ,made me worse extreme pain from physiotherapy, and then I get on to utube with another Doctor saying what not to do when you have stenosis , he did it all, 😢 nobody understands how painful this condition is how to I help them understand I'm in extreme pain , appreciate your videos
❤ 2023 I had 3 level fusion neck 1st March 😢 yes still early pain but no more tingling just recieved bone stimulator now makes healing quicker. put this surgery off never do that !! you will feel better my doctor great I'm 71 2017 had fusion in back I still hurt exercise good thank you for your video . why did my Doctor not have me to wear neck brace ? things might have changed
Does ACDF process remove the osteophytes which have been compressing the nerve roots at the nerve exits so it combines foraminotomy and well as diskectomy? I have stenosis in four places, two of which I think are giving the symptoms of pain and weakness down my right arm which are being described as severe stenosis which could compromise nerve roots, which they are. The surgeon wants to do an injection at c5/6 to see if it improves things by shrinking the nerve so as to diagnose the level, and then inject at one of the other levels if there is no improvement - I don't know if this will continue for the four levels, not if there is a difference from the first injection, I guess. The indications to suggest c5/6 injection first are because my thumb is affected. This video on ACDF does make it clear that posterior foraminotomy is now out of the picture and I can see why the surgeon has suggested the former because there is now further change in the disc (I had posterior decompression in 2004 or microdiscectomy as it was called which didn't involve removal of the disc though it was thinned out so as not to have a bulge again.) With the formation of osteophytes and discs together which I now see are being called discophytes I do have osteophytes across the nerve roots and what's been called tethering, so here's hoping fusion will take away this horrible nerve pain which is like a spider with electric feet running across my thumb pad and the deep cramp in the arm and hand will be lifted when with fusion the space is created and the pressure is lifted off. I am sorry to go on, but it is so hard to have this sharing of symptoms with people who are not experiencing this kind of spine manifestation and pain and I am so pleased to hear of people who are doing so well after surgery. My other question to Dr Su is given you say the bone fuses and grows together over the cage in six months to a year, can osteophytes form again over that period? Thank you and wishing all well in these comments with thanks to Dr Su for his sharing information in such a clear and dedicated way.
That s extremely well explained. What about pain after surgery? How long is pain med taken post OP ? Do patients “feel” something different in their neck ? Thanks for that video 👊🏻
Hi Dr Su, thank you for this video. Just walked in, returning from a neurosurgery appointment where ACDF was discussed as an elective. What city do you practice out of?
Dr. Su you are really awesome… i feel that I’m sitting at a class in Med school…! Can you kindly share your thoughts on chiropractic care for spine health or even things like herniated or bulged disc… is it beneficial or damaging?
I think it's no problem to use chiropractic care. The one danger is when there is severe Central cord compression. I've seen two cases of paralysis from acute manipulation. Otherwise it can be helpful particularly for cervical facet disease
very interesting video. I had this surgery done on C3-C4 , after i broke my neck in an accident 5 years ago. I was completely paralysed but learned to walk again and gained some of my motor functions back. After 5 years, no more progress is noticable. I can't help but wonder if maybe my spinal cord can be fixed, if maybe something went wrong in the surgery... Do you have any suggestions or help for me? I really want things to be the same as before again, i'm 20 now and had my accident when i was 15
Hi Dr Su, I would like to know what the stats are on revision for someone with hypermobile Ehlers Danlos needing ACDF single level C4/5? I'm 39, multi DDD, osteph. complex with foraminal stenosis and compression on c5.. not certain if fusion is best approach ...alsteuggling to find information of hEDS stats for cervical fusion. Any reference material suggestions will be appreciated. Regards from Namibia
In my experience a single level fuses quite well even in somebody that has connective tissue disorders. However, I think the concern is break down above and below because of hypermobility. As a disclaimer please consult your surgeon
Thank you Dr Su for explaining ACDF to us. You've made it so easy for me to understand and the "potential risk" associated with the procedure. I had a meeting with my Neurosurgeon/Spine Surgeon this week and the ACDF procedure came up as an option for me after years of suffering chronic neck. I'm not "mentally" ready for this procedure because of the risk or the success rate but are running out of options to manage my neck pain. I had RF denervation with disaster outcome (feeling of ant crawl/tingling sensation after the procedure) as well as facet joint injection done on separate occasions but both options done nothing to alleviate the pain. Is other options or breakthrough procedure in helping neck pain other than the 3 mentioned here? I heard about a new ultrasonic procedure but not sure if this is suitable for neck pain. Can you please provide your comment (if you can)? Thanks!
A few weeks after a 2-level ACDF (c5-c7). Still dealing with residual parasthesia, but more dispersed and lesser in magnitude than it used to be, and the localized pain and tender spot central to the spine is gone. Unsurprisingly there was plenty of osteophyte complex and foraminal stenosis to go around. What was unusual was that there was an osteophyte rubbing on my esophagus which explains years of something I thought was normal: Pain while swallowing liquid while lying on my side? Had I known the significance, I’d have mentioned it to my specialists. I thought it was just something necks were not built to do. I’m still dealing with dysphagia and dysphonia both (they’ve had a ride), and waking up in the morning feels almost as bad as it used to, but thankfully goes away with a short time in a soft collar. Looks like I’m going to be a slower in healing compared to my surgeon’s typical patients. I don’t regret my surgery, though I wish it had been offered earlier - the MRIs showed a clear problem noted years ago, and yet I had to deal with a decade of repeated failures going the PT and epidural route, and a few springs on narcotics when the nerves got really bad.
Thank you for the information. I had an ACDF approximately six weeks ago of my C5-C6 and have been experiencing pain from the base of my neck down to my left shoulder, extending to my left hand’s pinky, ring, and middle fingers. According to my surgeon, I have permanent nerve damage, but the pain should subside over time.
Are these 'older' than 2yrs video's? or information? My surgeon (2023) said they no longer use cadaver bone grafts, and now will use other materials to recreate removed bone/disks. In my surgery, the 'bones' were too deteriorated to 'graft/replace", and a cage was used to fuse 3 disks--ouch!.. Was held 2 days overnight in hospital for observation, and at home on 3rd-7th day I noticed the 'swelling gradually' reduce, and with Opiod pain meds the resulting 'pain' and swelling was moderate to sort of about okay. I do still have some concern about my 22-day recovery state right now, with a feeling of a 'clump' in my throat when swallowing. Contacting my surgeon for earlier appointment with him (x-rays next week) -but surgeon not till April 19) to question what is going on with this odd swallowing throat feeling and motion issues. I had 3 disks fused, so did notice some ample-slight motion loss, but with turning, up/down motions I do have some mild-moderate pain I'm also concerned about. Did not receive a neck 'brace' at all, am concerned now about that, too. Unfortunately, I had to wait 4 full-months to get the surgery due to my insurance co's. pre-surgery requirements, even 6 PT sessions, which I found way more harmful and painful as I knew it would. I'm 62 yr old active male, well I was until last year due to this disk health issue! Just to add too: this is my 2nd surgery on different disks, this was c5-c6-c7, prior 17 years ago was c4 or 5 I think, and it went much better with that outdated? 'disk shaving"' technique. That was 1-disk arm/should pain from Right shoulder/arm to mild finger tingling-more arm pain, this was Left arm to severe finger tingling/lava-like pain up to neck and bad shoulder pain, and some upper back discomfort. PT seems to be the big industry2023 'push' these days, and honestly, I'm near 100% against it, unless forced, or because you haven't/don't "properly" exercise enough on your own to avoid the 'waste' I feel that PT is lauded about these days. I may be 100% wrong about PT, but it's not the save all cure all of 'most' issues it's presented like it is, imo. Also, epidural works imo, for about 50% of people, with wide varying results of how long they work/last on 'pinched nerve/disk' issues. But, Thank you for this informative video, and best of luck to anyone with similar cervical disk issues/problems. Avoid surgery? Probably best to "have it" to get more relief sooner, with less insurance $ waste/expense of: do this/that/and the other things to "see if it works," imo.
Problem: Numbness in arms, hands, and feet. Mild pain in neck, and more pain in lower back. Feet are dragging and I have balance issues. Pain level at moment is at a 2 in neck and a 6 in back. My original visit was about my back. I do have a nerve block scheduled for my back. The surgeon said that he would not even talk about my back until my neck was taken care of. He even said that I may get some relief in my back from the issue in my neck. Does this make sense? Diagnosis: Cervical myelopathy Solution: Anterior cervical decompression and Fusion at 4-5 and 5-6. Is the purposed surgery the same thing as Anterior cervical discectomy and fusion? Are discectomy and decompression the same? Also, is that 2 levels or 3? I assume 2. Is it 4 and 5 or 5 and 6? is there anyway for this to get better without surgery? The doctor said this would be a simple outpatient surgery with very little pain. He said I would have minor throat irritation. He said I’m lucky I’m not having more symptoms, meaning more pain. He wasn’t pushy and answered all my questions that I had at the time. He said he could do the procedure at his clinic or at a hospital, Which ever I prefer. Do you see any red flags? Is there any reason I could put this off? Like I said the pain is manageable
You should watch the cervical stenosis video do I have to have surgery. Not everybody with severe spinal cord compression needs surgery. Is a disclaimer please consult with your physician or make a virtual appointment with me
I have been dealing with severe neck pain for a couple of years. I have beefed my dr’s for help. I have pain up into my jaw and back of my had. My left arm is heavily and weaker. They finally did an mri and said stenosis with facets. I’m afraid if itt isn’t fixed I will not be able to drive. I am so disappointed that the surgery won’t take away this pain😢
Hello Doctor ..... yes you have really explained it very well. Have have got this surgery done for C5-6-7. The surgery went off well but i still have pain in my shoulders and lower back. It's been 3 months since my surgery. Will this pain go or increase. Also they said that there is calcification on my other vertebra. Does that mean more operations to come.
I just had 3 level ACDF C4-C7 I have Moderate bilateral neural foraminal stenosis on the CT scan after! I’m 6 weeks post op. I have 3 Interbody spacers. Should I still have the bilateral stenosis even if there’s no definitive cord compression??? This is what the CT scan says the day after. They wanted to make sure there wasn’t any subsidence. Because I was complaining of dysphagia! So they CT scanned me the day after ACDF.
@ he’s not a compassionate surgeon with the best bed manner. He hasn’t expressed to me how much to lift, or if I can lift a little more. Looked at my incision from his chair while we were both seated! I don’t think the NS cares. I think they just want numbers I’d think a surgeon should feel the incision area for soft or hard tissue near area.
How I wish I could just walk in your facility and this service. I have compression on 2 discs 😭but no resources for surgery and my hands are almost nonfunctional
Thanks for the detailed video, and thorough explanation of most of the issues. Is the reason that you go in through the front of the neck, because most of the musculature is in the back, or that once you move the trachea aside you have much easier access to the widest part of the disc? What is the determining factor or factors when deciding on surgery or non-Invasive treatment? I've had stenosis for years at C6 and C7, on the left side only, resulting in a pinched ulnar nerve, and primarily affecting my pinky and ring finger. Initially it was tingling and numbness, with occasional pain and weakness over the years. Is an ACDF still the suggested surgery if my pinched nerves and stenosis is only on one side and due to osteophytes and or foraminal narrowing, from a lifetime of bent over road bike riding and looking over my left shoulder for traffic. Could epidurals or facet injections of cortisone on the left side provide marked relief, and how long might that kind of relief last?
I appreciate that, and while I could send you copies of my x-rays, and MRI reports by email, and snail mail you discs of my DICOM files, I live in Los Angeles, so unless you give second opinions based strictly on imaging and reports, that's unavailable to me at this point. Although, relative to my first question, I would love to pick your brain about why ACDFs, are performed strictly from the front, irrespective of the name? Is it the structure of the spinal column and the arrangement of the muscles, that makes an anterior surgical approach the only logical one. Is disc removal and fusion part of the process, even if only dealing with asymmetrical pinched nerve root issues involving foramen and osteophytes? Thanks.
Hi I may have to get this surgery (multilevel) and am very worried I won’t be able to do sports or weight lifting in the gym. How likely is it I would be able to do those if I get this surgery?
The incidence of adjacent level disease to a fusion in the lumbar spine has been shown to be similar to that of the cervical spine. In general it is one to three percent per year per level. That means that in 10 years there is a 10 to 30% chance of having radiographic changes of degeneration at an adjacent level. It is important to note that degeneration seen on an X-ray or MRI does not always translate to need for surgery at that level.
Hello Dr Su, My wife has spine stenosis and nerve compression which giving her shoulder, arm pains. We are going to consult a Spine Center this week. 5 years back she was diagnosed with cervical radiculopathy(nerve pinch) and 2 years back MRI revealed some cord compression(disc herniation and bone spur). Her pain comes back once in 2 years and lasts for a month and goes away and comes back. We will consult a spine specialist now and see her progression. She only has low myelopathy based on your earlier video. Should we see Ortho Surgeon or Neuro Surgeon? Because both bone and spine is involved here? And many thanks for your videos and we are better prepared mentally to deal with this.
As long as they are somebody who is fellowship-trained in spine surgery then it does not matter if it's an orthopedic or neurosurgeon. I often say you shouldn't have either you should have a spine surgeon. Spine surgeon should be doing at least 200 cases a year and be exclusively spine
Hi, I went to see a Dr that uses Ultrasonic technology, what do you think of that? The operation is behind the Neck for this Cervical Stenosis Radiculopathy
It is one technology that is used to cut the bone. It is largely a marketing gimmick because there are plenty of other cutting instruments that are just as safe
Waiting on Neuro for this procedure . They are still in the process of neck injectionsto particular cervical bones to see which ones are the worst .Counting the cost no doubt. Still better than the %100 debilitating almost passing out pain that comes with problems .. Been at them for 12 years to check my neck . Anyhow when you hear hooves you think of horses not Zebras....@ years ago a Dr straight out of Uni said sounds klike a neck problems go for a CT scan .... 2 Years later See my first Neuro appointment verbatim " Oh you need surgery!" gald i listened to the Pain clinic nothing wrong with you stop being a hypocrite for 10 years .......You are exibiting drug seeking behaviour ... OF CoURSE I AM , i am in serious pain ........I am exactly seeking drugs to help to stop the Suicidal men from entering the brain ......
Thank you for great explaining Doctor. I'm going to undergo ACDF single level surgery soon due to Cervical Myelopathy with bad geit and weak lower and upper limbs with no any pain. My Neurosurgeon told me as this is a single level ACDF, plate/screws are not needed, but cage with bone grafting is enough for the fusion. What's your stand over this?
It's a good question. Technically fusion rates are the same but using a plate and screws helps hold it in a better position. And the United States most all surgeons will use a plate and screws
They stopped my surgery C5,C6, and C6 C7 and sent me to have nerve testing done. After getting the results back the brain surgeon said they the results show Severe Carpal tunnel syndrome in both hands. Its highest level means l need to have this done first. Why? He said it's all connected.
Typically it's hard to know if it's coming from the neck or the hands. If you're hand symptoms are the worst in the nerve testing says that you have carpal tunnel syndrome my advice is to do the carpal tunnel first because it is a simpler surgery with less recovery
Hi, I had four level ACDF bc of spinal stenosis and eventually (it takes time!) recovered. A quick question: Several years later (recently )I got rear ended and have whiplash. I am exhausted, in continuous pain, five months of physical therapy, I wonder if my ACDF makes my whiplash different. If you need ACDF, I don’t mean to alarm you! It’s just my bad luck another driver crashed into me. I am not blaming ACDF, I just wonder if patients recover from accidents differently.
There could be many reasons for pain after a cervical fusion and a car accident. The first thing to make sure is that you have a solid fusion. That is best done with a non contrast CT scan. I would then get an MRI to make sure there is no nerve compression above or below the fusion. It is highly likely that you have cervical facet joint syndrome above or below the fusion. Cervical facet joint syndrome commonly occurs after a car accident. You can learn about cervical facet syndrome in my video. As a disclaimer this is not considered medical advice and you should always consult with your spine surgeon.
@@DrBrianSuTheSpineGuy Dr. Su - just a note to thank you for your videos. They were so helpful to me in selecting both a surgeon and surgery. I wish I was on the west coast or I would have gone to you! I wound up finding some great surgeons on the east coast (Riew in NYC and Harrop in Phila) and eventually decided on Harrop's recommendation for a 4 level ACDF. I had surgery 9 days ago and woke up to no pain, and have not had any at all since, aside from some very slight shoulder aches the first few days. I haven't even needed any pain meds aside from some tylenol those first few days. It's been miraculous. Thank you again for what you do. These videos were SO helpful to me, as my case apparently was pretty tricky so I got widely varying surgical recommendations.
I had an acdf with allograph at the 5/6 level in 1995. I have been in pain ever since. When at its worst it irritates all the muscles around it so I have very frequent muscle spasms and muscle soreness and limited range of motion. The doctors say that nothing is showing up except normal degenerative changes. I'm miserable and feel like I have nowhere to go from here.
Go see Dr. Lanman. Look into reversing fusions. I'm having 3 reversals done next month. He uses disc replacements and you can possibly get your mobility back
C5-6 C6-7 for me, although I have to wait until they try medication (not working), steroid injections (which I don't like the sound of), then maybe surgery. I'd prefer going straight to surgery (which I hate having) as the meds and steroid's are only a delay for surgery and they don't cure the condition. But, no surgeon or Dr. will let me skip the meds and steroids as they say surgery is a final step. So confused, considering I am going to need the surgery regardless of the meds and steroids and my condition is only going to get worse and my pain is going to increase. Nice video series on this subject, as it has helped me understand where I should be with this.
There are several good studies to show that this can be treated without surgery quite effectively so if it were my neck I would try non-surgical treatments first as I've outlined in the videos
My pain has been with me for five years after a car accident. I’ve tried all the conservative treatments. My spinal surgeon told me he would like me to try epidermal injection or nerve ablation before surgery, however my PMR doctor said neither of those procedures would help me. My problem area is c5-6. My arm and shoulder blade pain sometimes comes and goes but the neck pain is constant.
Based on reading clinical studies, it seems the rate of nonunion varies depending on what is placed during the fusion, for example structural allograft performs better than cages but not as well as autograft (one’s one bone). With such high rates of nonunion and high consequences (revision surgery) why wouldn’t all doctors use methods most likely to successfully fuse? From reading, I see that surgeons can get reimbursed for each cage place during a multilevel fusion as well as the reimbursement rate is higher for cages versus structural allograft, but this is not a good enough reason to choose the cage over the allograft. In my mind, unless there’s a good reason to choose the cage, this is not good medicine.
There are multiple reasons. Most surgeons are no longer using iliac crest autograft simply because it is painful for the patient. For many years we used allograft bone and some still do. Allograft bone is outstanding but it comes in limited sizes and angulations. Cages have the advantage of coming in multiple sizes and angulations which can sometimes be biomechanically better. The fusion rates for cages with the use of bone graft substitute like graft on our identical to allograft.
Dr so the vagus nerve phrenic nerve and long thoracic nerve is not in the way? I am concerned about those and the carotid artery also some people can't swallow and talk properly permanently. but posterior is more painful and harder recovery.
Hello Dr, I'm contemplating surgery C5-7. I've had the numbness and pain manageable for at least 10 years with ESI and still gets me at least 5 months without pain. If I have adjacent level problem, when do you stop fusing other level? Meaning eventually every level will have to be fused. Also, what about people with Osteoporosis? Can I don't do surgery and just do ESI every year?
@@DrBrianSuTheSpineGuy Thank you for your reply. I saw 4 Drs. and narrowed down to 2. One is offering the Nuvasive Simplify with less time recovery. I have arthritis, straight neck and some Ostheoporosis, Ineed to decide what option to do. Please what do you think will be better. I'm affraid not fusing due to OP but no Dr really care about it.
Resultados de traducción hi doctor Su, I have C4, C5, C6 in the cervical, but I went to 2 surgeons, one said that I don't need surgery that my nerves are fine, and the other says that I do,because it bites my nerves a lot and it hurts the head and shoulders (he will only put a metal only to separate the discs, because the C6 will separate by itself, etc, and I don't know what to do. Please help me, can I show you my MRI?. Thank you very much
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Very well explained… unfortunately my ACDF levels 4-5-5-6 after 4 years, I’m still struggling. It was a failure. I’m basically just taking it day by day with the meds. My. Neurosurgeon said that my spinal cord was damage and there was nothing left he could do, I hope for everyone to be as successful on their surgery.
Great video, I had mine done on Monday December 12th. I’m doing great, no more pain and tingling. Walked a mile today. What a difference.
❤❤❤I'm gonna claim that for myself!
Thank you for posting these videos!!! When it was clear I needed to get surgery they really helped me understand the myelopathy, the types of surgery available, and the risks so I was able to have better conversations with my surgeon. Showing your videos to my parents also helped them understand and be less fearful of what would happen. I had one level ACDF last week and am doing very well. Thank you again! :)
Thank you for more clarity on what to expect. This was so helpful to reduce my anxiety. I m having c4-5, c-5-6, c6-7. I have been and guess still scared a little. Wish you were doing my surgery, But think I have one of the best Doctors in the Atl. area.
I need this surgery and will have it in ATL. Can you update on how yours went and who your doctor was?
I worked in the OR in the UK for 30+ yrs. My father collapsed, paralysed, could only breath. Thankfully, I got him transferred to a surgeon I 1st assisted for. But, it took 7 days. After surgery( cage 2 levels) he started limb movement. In 3 mnth, fully walking independently. I use to love assisting this op. But, when you see the results 1st hand - it's beyond amazing !
I'm in UK aswell and my wife suffers from cervical myelopathy. This surgery sounds great how long did it take for your dad to get seen and operated on
This is THE best video I’ve found for ACDF. I feel so much more educated and informed. My surgery is 10/4/2023
This is so good. I had 3,4,5,6 fusion it has been 10 years. Now I am having pain and lack of function of pointer and middle finger in both hands. It wakes me at night. I drop things and I am 72. This helps with explaining surgery it was the easiest surgery I ever went through, and helped my pain intensity. I feel I have the post surgery arthritic changes. I did have replacement screw c7. 6 weeks after first surgery to put in larger screw. The first surgery took 6 hours. Thank you.
I had 3,4 , 5,6,7 injury fuslon
Awesome. It's been 8 years since my three level fusion in the cervical spine. I am just now learning from this video what it was! I have had pain and turns out my c6c7 did not fuse and the screws are loose. I would love to see a video entailing how that would be repaired. Great video.
Yes a non union video would be a good one. I'll put it on my list.
My screws broke in my neck fusion fond at my 6 month.exray. I've had ongoig issues over the 15plus years. I'm now experiencing multiple problems in my Vigus nerve I believe.
So sad you situation C4-c7 only 9 weeks from surgery but pain on the back neck is my problem maybe when stars PT help
Thank you Dr Su for taking the time to do this video, your video was very concise and educational. You are the Best!
My husband just had this surgery yesterday with Dr Hsu from Rothman in Pa. Everything you explained is how things have been going thus far. It was refreshing to hear your explanation.
These videos are fantastic. I was hoping to avoid surgery at all costs but these vids more than others have given me some optimism. Thanks.
this was such a great video. i am having the procedure done within the next 10 days. makes me feel tons better. thank you for addressing every question.
😎
Excellent video! You’ve put my mind at ease, as I am scheduled for this procedure next month. I got 17 years use out of my first surgery of C5-7 and now need to have C3-4 done. I was looking for answers regarding neck movement post op which you explained. Thank you.
Very thorough explanation. I am having my surgery 9.18.24. Been watching numerous success stories on YT and surgery explanations like this. Thank you for making it very plain.
Just had surgery last Dec. 14, 2022 and so far I'm doung well. Thank you so much for this wonderful video, I learned and understand more about ACDF.
Thank you so much for your clear explanation of this procedure, your knowledge and expertise is much appreciated ❤
I am having this procedure done on Wednesday. Watching this video is reassuring.
It's nice to have a better understanding of what the surgery was, what happened and its purpose. Thank you
Hi Dr Su finally had my C5/6/7 ACDF six weeks ago we have had many messages back and forth and my two discs were completely collapsed.. it’s been one hell of a journey but as soon as I was out of surgery there was immediate relief not only has height been restored disc space but also 24mm to 28mm at base skull.. curve corrected I can finally rest my head on car headrest when I drive!
I had my surgery February 17 and I'm doing awesome compared to before I had to have it or I was going to go paralyzed happy i did it because it started to affect my walking and. My feet would feel ice cold even if the heat was on 90 tingling burning in my legs omg I was going through it for months happy I had the surgery
Why would you go paralyze ?
@@Livinglyfestylecollcetion Sometimes the spinal cord is compressed, not only the nerves coming out the sides, and that can produce myelopathy such as the difficulty walking that the commenter mentioned. If there's trauma (such as a fall or a car crash) when the cervical spine is damaged by bone deterioration, bone spurs, and/or stenosis abd nerve comoresssion, the area is at higher risk of spinal cord injury than it would be otherwise. Spinal cord injury produces paralysis.
After the surgery what was your pain level?
Ty for the info I'm going for my surgery this week n yes I'm alittle nerves with the procedure but I'm hoping for the best an a speedy recovery
Thank you very much for doing this video! I’m very worried about my surgery & this makes me feel a little better.
How are you now?
Thank you for posting these video's, very helpful !!
You covered all of my questions. I really appreciated the visual aids. Thank you so much.
I have a C4 to C6 neck bulge with mild stenosis & Radiculopathy in the left arm . i’m also having neurological issues because of nerve impingement . this exactly what I have to have !
Thank you Dr. Brian for this very thorough explanation of ACDF. I met with a surgeon yesterday and frankly, I left thinking Hell No! While I am still not convinced that this procedure is worth it, your explanation makes a lot of sense. Right now I'm weighing my current discomfort level with the risks of surgery and that at best, there may only be a 50% improvement from what I understand.
Thank you for making the procedure clear
PS: using Peyton Manning as an example is not helpful 😂. I am a 66 year old grandmother. It's not an apples to apples thing at all, but I get your point...sort of.
👍Very informative ! Thanks ! 👍
❇️#ACDF 語意：由頸前方入路，清除病變的椎間盤全部後，置入充填物於原椎盤所在空間，再加以合金鋼板和螺釘固定，期待滿6-12月後該關節發生骨融合而被完全固定不可動。
🌹3:07 手術過程需時
一節:1 hr 兩節:1.5hr
三節:2hr
🌹手術圖示 5:15 5:43
🌹硬膜扯傷有時難完全避免，機會3％，但不被視為嚴重併發症，修補即可 6:23
🌹6:53 完全清除椎盤和磨去贅生骨刺後，置入適當高度Cage維持正常椎盤空間後，並植入骨以供融合，再用小合金板和螺釘鎖定相鄰的上下椎體，目的在確保接下來一年骨融合過程關節保持穩定。
🌹#NonUnion 術後不融合的機會10:52, 即使有，通常也不見得增加術後症狀惡化，其機會為:
一節融合術:10%
二節融合術:20%
三節融合術:30%
🌹術後活動受限程度12:03
🌹臨近的上下頸椎關節的術後加速退化病變現象adjacent level disease 12:55
#每年平均以3％增加，10年則是30％機會發生退化#加重(相對於未手術時的自然退化)。
而因adjacent level disease #10年後需再手術的機會是10％ 13:42
🌹融合術後頸圈穿戴:
14:24 一節融合: 軟頸圈戴6週
兩節或兩節以上融合: 硬頸圈戴3個月
14:36 術後三個月開始物理治療，滿4個月或可回GYM
🌹該節術後通常至少半年至一年才完全骨融合！
Thank's Dr Su Excellent - I was just scheduled for the exact procedure--It's a real education Thank you
Thank you! Today I am 14 days post op C3-C4-C5-C6. I see the dr tomorrow for my 2 week follow up. Great explanation
How painful was it after the surgery and how long did the pain last?
I really like your teaching technique. No frills, hand held word definition charts x MRI analysis with physical pointer and models that you draw on! Fantastic
Talk about a good video !!! Great job!
Thank you, this information is very helpful I'm having this procedure in October C5 C6 C7.
Thank you for sharing the way you explained everything puts me at ease even though I trust my neurosurgeon he did my back in 2015 with great success. I’ll be having ACDF 03-11-24
Please come back and tell us how it went
لماذا اعدت العمليه
@@اممنار-ع3ظHis surgeon had done a different operation on his lower back, so he trusted him to do this surgery on the neck.
You are an exceptional doctor!
You have allayed a lot my fears and anxiety about my cervical disc disease. I have multilevel foraminal stenosis c2-t1 , most likely arthritic . I’m dealing with the pain just fine PT, combining 200 mg Motrin and 500 acetaminophen 2 x per day . I take .5 of Xanax and I’ve been good with arm and shoulder pain . What has been a bigger concern is balance and gait disorder. I’m a long distance runner of more than 50 years and it’s been a struggle to find my 7:40 pace .
I’m 70.5 years old and love to lift and run . On one had offered anything but PT which i attend 3 x per week , it has helped .
I have an old non mri friendly pacemaker and it’s been a year of waiting to have imaging to better define anatomy. Should I see you in consult? Thank you sir !
You can have a virtual consultation by calling California orthopedics and spine.
@@DrBrianSuTheSpineGuy I will call for a virtual consultation. TY
Why does my neck pinching on my right side of my neck
I’m having surgery Monday January 17th I feel very comfortable with Dr Su and this video pulls it together, wish me luck 🍀
How did your procedure go? How do you feel now?
Watched several like this, and this was the best by far! 👍
I had this procedure done in 2002 after a fall on a concrete floor at work. I had C5-6 C6-7 level done with cadaver bone put in.
I had to fight with workman comp each and every step of the way. It took 14 and a half months to have an MRI and 22 and a half months to have the surgery.
After surgery, I developed a crack in the C7-T-1 level. My surgeon got tired of waiting for workmans comp to approve the revision, so he went ahead and did the second surgery. In doing do, he found the crack had healed. He removed the plate and I have it on my Keychain.
I have arthritis above and below my fusion. Heat helps.
I highly recommend this surgery if your surgeon says you need it. I am thankful I had it. It took the pain and numbness from my arms and hands.
This is an easy recovery. I say this after having both knees and my right hip replaced many years after my neck fusion.
Thank you I'll need this surgery eventually and I'm scared
I think I am going to need this surgery very soon....Ty for posting
Thanks a lot sir, all of my queries were covered in this video ❤
Thank you for reassuring me after I had this surgery. I was/am upset that I still have pain, 5 weeks post surgery. (I’ve recovered within 2 weeks after two knee replacements) but from what you say, I am overly optimistic.
It can take a year to get better.
Ok it’s a matter of time 9 weeks since mine and still have pain.
Now they are saying that even if it gets better it may grow back in 6 months nothing else ever grows back why do nerves?
Thank you. I watched all the videos. Just found out I have sever deterioration from c4-c7. Multiple pinched nerves on the right side. I’ll be seeing a spine surgeon next week. Pretty nervous. Out of all the surgeries I think I’d prefer the posterior one. If I qualify
There are pros and cons of each of the surgeries and hopefully by watching the videos you were able to get some guidance.
Dear doctor been diagnosised with stenosis watch all your videos have problem with c7 since I was in a job recently my pain is so severe my mum can't understand, had pain in my neck 😢 numbess in both my arms and legs pain in my lower back also had trouble walking, my Doctor has been amazing, can't get into the specialist till December , I have also been bleeding and problems with bowels and urine, however I tried going to a physiotherapist while waiting ,made me worse extreme pain from physiotherapy, and then I get on to utube with another Doctor saying what not to do when you have stenosis , he did it all, 😢 nobody understands how painful this condition is how to I help them understand I'm in extreme pain , appreciate your videos
❤ 2023 I had 3 level fusion neck 1st March 😢 yes still early pain but no more tingling just recieved bone stimulator now makes healing quicker. put this surgery off never do that !! you will feel better my doctor great I'm 71 2017 had fusion in back I still hurt exercise good thank you for your video . why did my Doctor not have me to wear neck brace ? things might have changed
Wearing a neck brace is based on each doctor
Does ACDF process remove the osteophytes which have been compressing the nerve roots at the nerve exits so it combines foraminotomy and well as diskectomy? I have stenosis in four places, two of which I think are giving the symptoms of pain and weakness down my right arm which are being described as severe stenosis which could compromise nerve roots, which they are. The surgeon wants to do an injection at c5/6 to see if it improves things by shrinking the nerve so as to diagnose the level, and then inject at one of the other levels if there is no improvement - I don't know if this will continue for the four levels, not if there is a difference from the first injection, I guess. The indications to suggest c5/6 injection first are because my thumb is affected. This video on ACDF does make it clear that posterior foraminotomy is now out of the picture and I can see why the surgeon has suggested the former because there is now further change in the disc (I had posterior decompression in 2004 or microdiscectomy as it was called which didn't involve removal of the disc though it was thinned out so as not to have a bulge again.) With the formation of osteophytes and discs together which I now see are being called discophytes I do have osteophytes across the nerve roots and what's been called tethering, so here's hoping fusion will take away this horrible nerve pain which is like a spider with electric feet running across my thumb pad and the deep cramp in the arm and hand will be lifted when with fusion the space is created and the pressure is lifted off. I am sorry to go on, but it is so hard to have this sharing of symptoms with people who are not experiencing this kind of spine manifestation and pain and I am so pleased to hear of people who are doing so well after surgery. My other question to Dr Su is given you say the bone fuses and grows together over the cage in six months to a year, can osteophytes form again over that period? Thank you and wishing all well in these comments with thanks to Dr Su for his sharing information in such a clear and dedicated way.
Once they fuse the osteophytes go away. The bone spurs are removed with the surgery.
That s extremely well explained. What about pain after surgery? How long is pain med taken post OP ? Do patients “feel” something different in their neck ? Thanks for that video 👊🏻
My patients are typically on pain medications that are prescription strength for about a week. You will have to consult your surgeon
Having this done in 2 weeks in St. Louis. Cant wait.
Hi Dr Su, thank you for this video. Just walked in, returning from a neurosurgery appointment where ACDF was discussed as an elective. What city do you practice out of?
I am near San Francisco. You can always call 415-925-8200 for a second opinion by video
Excellent, informative video. Thank you!
Thank you for explaining this. I am going to have a 4 level fusion next mo. I’m so terrified.
Do you have any physical therapy videos for the lumbar spine. I liked your video on PT for tech neck.
We will make some.
Thank you for the information, it was very easy to understand.
Dr. Su you are really awesome… i feel that I’m sitting at a class in Med school…! Can you kindly share your thoughts on chiropractic care for spine health or even things like herniated or bulged disc… is it beneficial or damaging?
I think it's no problem to use chiropractic care. The one danger is when there is severe Central cord compression. I've seen two cases of paralysis from acute manipulation. Otherwise it can be helpful particularly for cervical facet disease
I just had it done on July 29th,now starting the recovery process, I had C5, C6, and C7 and now I am wearing a Collar
Did you need a walker??
very interesting video. I had this surgery done on C3-C4 , after i broke my neck in an accident 5 years ago. I was completely paralysed but learned to walk again and gained some of my motor functions back. After 5 years, no more progress is noticable. I can't help but wonder if maybe my spinal cord can be fixed, if maybe something went wrong in the surgery... Do you have any suggestions or help for me? I really want things to be the same as before again, i'm 20 now and had my accident when i was 15
I would have to look at the imaging. You can make a zoom appointment by Calling california orthopedics and spine
Hi Dr Su, I would like to know what the stats are on revision for someone with hypermobile Ehlers Danlos needing ACDF single level C4/5? I'm 39, multi DDD, osteph. complex with foraminal stenosis and compression on c5.. not certain if fusion is best approach ...alsteuggling to find information of hEDS stats for cervical fusion. Any reference material suggestions will be appreciated. Regards from Namibia
In my experience a single level fuses quite well even in somebody that has connective tissue disorders. However, I think the concern is break down above and below because of hypermobility. As a disclaimer please consult your surgeon
Thank you Dr Su for explaining ACDF to us. You've made it so easy for me to understand and the "potential risk" associated with the procedure. I had a meeting with my Neurosurgeon/Spine Surgeon this week and the ACDF procedure came up as an option for me after years of suffering chronic neck. I'm not "mentally" ready for this procedure because of the risk or the success rate but are running out of options to manage my neck pain. I had RF denervation with disaster outcome (feeling of ant crawl/tingling sensation after the procedure) as well as facet joint injection done on separate occasions but both options done nothing to alleviate the pain. Is other options or breakthrough procedure in helping neck pain other than the 3 mentioned here? I heard about a new ultrasonic procedure but not sure if this is suitable for neck pain. Can you please provide your comment (if you can)? Thanks!
I would have to take a look at the imaging. You can call 415-925-8200 for a second opinion
A few weeks after a 2-level ACDF (c5-c7). Still dealing with residual parasthesia, but more dispersed and lesser in magnitude than it used to be, and the localized pain and tender spot central to the spine is gone. Unsurprisingly there was plenty of osteophyte complex and foraminal stenosis to go around. What was unusual was that there was an osteophyte rubbing on my esophagus which explains years of something I thought was normal: Pain while swallowing liquid while lying on my side? Had I known the significance, I’d have mentioned it to my specialists. I thought it was just something necks were not built to do.
I’m still dealing with dysphagia and dysphonia both (they’ve had a ride), and waking up in the morning feels almost as bad as it used to, but thankfully goes away with a short time in a soft collar. Looks like I’m going to be a slower in healing compared to my surgeon’s typical patients.
I don’t regret my surgery, though I wish it had been offered earlier - the MRIs showed a clear problem noted years ago, and yet I had to deal with a decade of repeated failures going the PT and epidural route, and a few springs on narcotics when the nerves got really bad.
Thank you for the information. I had an ACDF approximately six weeks ago of my C5-C6 and have been experiencing pain from the base of my neck down to my left shoulder, extending to my left hand’s pinky, ring, and middle fingers. According to my surgeon, I have permanent nerve damage, but the pain should subside over time.
Did you have pain down your arm before surgery?
I hope you are doing better now
You are awesome with your explanations
Can you please talk about opll and why corpectomy is the suitable surgery
Are these 'older' than 2yrs video's? or information? My surgeon (2023) said they no longer use cadaver bone grafts, and now will use other materials to recreate removed bone/disks. In my surgery, the 'bones' were too deteriorated to 'graft/replace", and a cage was used to fuse 3 disks--ouch!.. Was held 2 days overnight in hospital for observation, and at home on 3rd-7th day I noticed the 'swelling gradually' reduce, and with Opiod pain meds the resulting 'pain' and swelling was moderate to sort of about okay. I do still have some concern about my 22-day recovery state right now, with a feeling of a 'clump' in my throat when swallowing. Contacting my surgeon for earlier appointment with him (x-rays next week) -but surgeon not till April 19) to question what is going on with this odd swallowing throat feeling and motion issues. I had 3 disks fused, so did notice some ample-slight motion loss, but with turning, up/down motions I do have some mild-moderate pain I'm also concerned about. Did not receive a neck 'brace' at all, am concerned now about that, too. Unfortunately, I had to wait 4 full-months to get the surgery due to my insurance co's. pre-surgery requirements, even 6 PT sessions, which I found way more harmful and painful as I knew it would. I'm 62 yr old active male, well I was until last year due to this disk health issue! Just to add too: this is my 2nd surgery on different disks, this was c5-c6-c7, prior 17 years ago was c4 or 5 I think, and it went much better with that outdated? 'disk shaving"' technique. That was 1-disk arm/should pain from Right shoulder/arm to mild finger tingling-more arm pain, this was Left arm to severe finger tingling/lava-like pain up to neck and bad shoulder pain, and some upper back discomfort. PT seems to be the big industry2023 'push' these days, and honestly, I'm near 100% against it, unless forced, or because you haven't/don't "properly" exercise enough on your own to avoid the 'waste' I feel that PT is lauded about these days. I may be 100% wrong about PT, but it's not the save all cure all of 'most' issues it's presented like it is, imo. Also, epidural works imo, for about 50% of people, with wide varying results of how long they work/last on 'pinched nerve/disk' issues. But, Thank you for this informative video, and best of luck to anyone with similar cervical disk issues/problems. Avoid surgery? Probably best to "have it" to get more relief sooner, with less insurance $ waste/expense of: do this/that/and the other things to "see if it works," imo.
We currently use either metal, structural bone graft, or plastic called peek
@@DrBrianSuTheSpineGuy - Thank you for quick response, with mine, I believe metal was used. Will confirm/ask when appt. with my Surgeon occurs.
This was a wonderful video! Thank you so much!!!
I was recently diagnosed with pinched nerves on my C6 and L5 😥
Wonderful video!!!!
Great video well explained, how common is level 4 acdf, that seems to be the prognosis for me seeing another neurosuergon tomorrow, Thx for any info.
A four level is relatively uncommon but is the correct thing to do in certain situations. You can always make a virtual appointment with me
Problem: Numbness in arms, hands, and feet. Mild pain in neck, and more pain in lower back. Feet are dragging and I have balance issues. Pain level at moment is at a 2 in neck and a 6 in back. My original visit was about my back. I do have a nerve block scheduled for my back. The surgeon said that he would not even talk about my back until my neck was taken care of. He even said that I may get some relief in my back from the issue in my neck. Does this make sense?
Diagnosis: Cervical myelopathy
Solution:
Anterior cervical decompression and Fusion at 4-5 and 5-6.
Is the purposed surgery the same thing as Anterior cervical discectomy and fusion? Are discectomy and decompression the same?
Also, is that 2 levels or 3? I assume 2. Is it 4 and 5 or 5 and 6?
is there anyway for this to get better without surgery? The doctor said this would be a simple outpatient surgery with very little pain. He said I would have minor throat irritation. He said I’m lucky I’m not having more symptoms, meaning more pain. He wasn’t pushy and answered all my questions that I had at the time.
He said he could do the procedure at his clinic or at a hospital, Which ever I prefer.
Do you see any red flags? Is there any reason I could put this off? Like I said the pain is manageable
Yes it is the same thing as an acdf. I'm happy to give you a second opinion if you call California orthopedics and spine for a virtual appointment
You should watch the cervical stenosis video do I have to have surgery. Not everybody with severe spinal cord compression needs surgery. Is a disclaimer please consult with your physician or make a virtual appointment with me
Thanks for your reply! I’m assuming insurance would not cover the second opinion but I can check. Thanks again
I have been dealing with severe neck pain for a couple of years. I have beefed my dr’s for help. I have pain up into my jaw and back of my had. My left arm is heavily and weaker. They finally did an mri and said stenosis with facets. I’m afraid if itt isn’t fixed I will not be able to drive. I am so disappointed that the surgery won’t take away this pain😢
Hello Doctor ..... yes you have really explained it very well. Have have got this surgery done for C5-6-7. The surgery went off well but i still have pain in my shoulders and lower back. It's been 3 months since my surgery. Will this pain go or increase. Also they said that there is calcification on my other vertebra. Does that mean more operations to come.
You may consider another MRI and consider epidurals as well as maybe facet injections. You can call 415-925-8200 for a second opinion
thank you so much for this information!
I just had 3 level ACDF C4-C7
I have Moderate bilateral neural foraminal stenosis on the CT scan after!
I’m 6 weeks post op. I have 3 Interbody spacers.
Should I still have the bilateral stenosis even if there’s no definitive cord compression???
This is what the CT scan says the day after. They wanted to make sure there wasn’t any subsidence. Because I was complaining of dysphagia! So they CT scanned me the day after ACDF.
Yes very often there can be residuals to no assist that usually goes away once the fusion occurs. Please defer to your spine surgeon
@ he’s not a compassionate surgeon with the best bed manner. He hasn’t expressed to me how much to lift, or if I can lift a little more. Looked at my incision from his chair while we were both seated! I don’t think the NS cares. I think they just want numbers
I’d think a surgeon should feel the incision area for soft or hard tissue near area.
How I wish I could just walk in your facility and this service. I have compression on 2 discs 😭but no resources for surgery and my hands are almost nonfunctional
Now all i need to do is work out what do with my pace maker i can then make my return to heavy weight boxing .......Like a champ ...
Thanks for the detailed video, and thorough explanation of most of the issues. Is the reason that you go in through the front of the neck, because most of the musculature is in the back, or that once you move the trachea aside you have much easier access to the widest part of the disc? What is the determining factor or factors when deciding on surgery or non-Invasive treatment? I've had stenosis for years at C6 and C7, on the left side only, resulting in a pinched ulnar nerve, and primarily affecting my pinky and ring finger. Initially it was tingling and numbness, with occasional pain and weakness over the years. Is an ACDF still the suggested surgery if my pinched nerves and stenosis is only on one side and due to osteophytes and or foraminal narrowing, from a lifetime of bent over road bike riding and looking over my left shoulder for traffic. Could epidurals or facet injections of cortisone on the left side provide marked relief, and how long might that kind of relief last?
It depends what the imaging looks like you can call 415-925-8200 for a second opinion appointment with me
I appreciate that, and while I could send you copies of my x-rays, and MRI reports by email, and snail mail you discs of my DICOM files, I live in Los Angeles, so unless you give second opinions based strictly on imaging and reports, that's unavailable to me at this point. Although, relative to my first question, I would love to pick your brain about why ACDFs, are performed strictly from the front, irrespective of the name? Is it the structure of the spinal column and the arrangement of the muscles, that makes an anterior surgical approach the only logical one. Is disc removal and fusion part of the process, even if only dealing with asymmetrical pinched nerve root issues involving foramen and osteophytes? Thanks.
Hi I may have to get this surgery (multilevel) and am very worried I won’t be able to do sports or weight lifting in the gym. How likely is it I would be able to do those if I get this surgery?
You are not restricted at all once you are fused.
How common is adjacent disc disease after c56
The incidence of adjacent level disease to a fusion in the lumbar spine has been shown to be similar to that of the cervical spine. In general it is one to three percent per year per level. That means that in 10 years there is a 10 to 30% chance of having radiographic changes of degeneration at an adjacent level. It is important to note that degeneration seen on an X-ray or MRI does not always translate to need for surgery at that level.
Is it right for SURGEON to do this kind of surgery on someone without doing assessment or discussion with the person? Thank you for your videos.
Hello Dr Su, My wife has spine stenosis and nerve compression which giving her shoulder, arm pains. We are going to consult a Spine Center this week. 5 years back she was diagnosed with cervical radiculopathy(nerve pinch) and 2 years back MRI revealed some cord compression(disc herniation and bone spur). Her pain comes back once in 2 years and lasts for a month and goes away and comes back. We will consult a spine specialist now and see her progression. She only has low myelopathy based on your earlier video. Should we see Ortho Surgeon or Neuro Surgeon? Because both bone and spine is involved here? And many thanks for your videos and we are better prepared mentally to deal with this.
As long as they are somebody who is fellowship-trained in spine surgery then it does not matter if it's an orthopedic or neurosurgeon. I often say you shouldn't have either you should have a spine surgeon. Spine surgeon should be doing at least 200 cases a year and be exclusively spine
Hi, I went to see a Dr that uses Ultrasonic technology, what do you think of that? The operation is behind the Neck for this Cervical Stenosis Radiculopathy
It is one technology that is used to cut the bone. It is largely a marketing gimmick because there are plenty of other cutting instruments that are just as safe
Can I ask who the doctor was that used the ultrasonic technology? Thanks ❤
You can do Ultrasonic instead of the fusion?
I had one done 12 years ago. Going in for surgery again has something to do with the nerve and C4.
C4-c7 ACDF 9 weeks since my surgery but pain on the back of my neck como and goes no start my PT yet hope that help me
Thankyou for the information
Waiting on Neuro for this procedure . They are still in the process of neck injectionsto particular cervical bones to see which ones are the worst .Counting the cost no doubt. Still better than the %100 debilitating almost passing out pain that comes with problems .. Been at them for 12 years to check my neck . Anyhow when you hear hooves you think of horses not Zebras....@ years ago a Dr straight out of Uni said sounds klike a neck problems go for a CT scan .... 2 Years later See my first Neuro appointment verbatim " Oh you need surgery!" gald i listened to the Pain clinic nothing wrong with you stop being a hypocrite for 10 years .......You are exibiting drug seeking behaviour ... OF CoURSE I AM , i am in serious pain ........I am exactly seeking drugs to help to stop the Suicidal men from entering the brain ......
Very informative..thank you so much!
I am having C5 to T1 ACDF next week
Thank you for great explaining Doctor. I'm going to undergo ACDF single level surgery soon due to Cervical Myelopathy with bad geit and weak lower and upper limbs with no any pain. My Neurosurgeon told me as this is a single level ACDF, plate/screws are not needed, but cage with bone grafting is enough for the fusion. What's your stand over this?
It's a good question. Technically fusion rates are the same but using a plate and screws helps hold it in a better position. And the United States most all surgeons will use a plate and screws
They stopped my surgery C5,C6, and C6 C7 and sent me to have nerve testing done. After getting the results back the brain surgeon said they the results show Severe Carpal tunnel syndrome in both hands. Its highest level means l need to have this done first. Why? He said it's all connected.
Typically it's hard to know if it's coming from the neck or the hands. If you're hand symptoms are the worst in the nerve testing says that you have carpal tunnel syndrome my advice is to do the carpal tunnel first because it is a simpler surgery with less recovery
I just had this (C4-7) with bone graft. Why is the cage used sometimes?
Hi, I had four level ACDF bc of spinal stenosis and eventually (it takes time!) recovered. A quick question: Several years later (recently )I got rear ended and have whiplash. I am exhausted, in continuous pain, five months of physical therapy, I wonder if my ACDF makes my whiplash different. If you need ACDF, I don’t mean to alarm you! It’s just my bad luck another driver crashed into me. I am not blaming ACDF, I just wonder if patients recover from accidents differently.
There could be many reasons for pain after a cervical fusion and a car accident. The first thing to make sure is that you have a solid fusion. That is best done with a non contrast CT scan. I would then get an MRI to make sure there is no nerve compression above or below the fusion. It is highly likely that you have cervical facet joint syndrome above or below the fusion. Cervical facet joint syndrome commonly occurs after a car accident. You can learn about cervical facet syndrome in my video. As a disclaimer this is not considered medical advice and you should always consult with your spine surgeon.
No mention of a 4 level ACDF? I have two different recommendations from two respected surgeons. One is a 4 level ACDF.
Yes a four level is possible and I do that surgery. The data suggests using two two level plates is better than one four level plate.
@@DrBrianSuTheSpineGuy Dr. Su - just a note to thank you for your videos. They were so helpful to me in selecting both a surgeon and surgery. I wish I was on the west coast or I would have gone to you! I wound up finding some great surgeons on the east coast (Riew in NYC and Harrop in Phila) and eventually decided on Harrop's recommendation for a 4 level ACDF. I had surgery 9 days ago and woke up to no pain, and have not had any at all since, aside from some very slight shoulder aches the first few days. I haven't even needed any pain meds aside from some tylenol those first few days. It's been miraculous. Thank you again for what you do. These videos were SO helpful to me, as my case apparently was pretty tricky so I got widely varying surgical recommendations.
Thanks so much for the information. I have just been diagnosed to have this surgery. Is there no chance that injections will be an alternative option?
Yes please watch the non-surgical treatment for cervical radiculopathy. Most of the time it does not require surgery.
@@DrBrianSuTheSpineGuy Thank you!
I had an acdf with allograph at the 5/6 level in 1995. I have been in pain ever since. When at its worst it irritates all the muscles around it so I have very frequent muscle spasms and muscle soreness and limited range of motion. The doctors say that nothing is showing up except normal degenerative changes. I'm miserable and feel like I have nowhere to go from here.
I would start by making sure that you are fused with a CT scan or an x-ray. As a disclaimer please consult your surgeon
Go see Dr. Lanman. Look into reversing fusions. I'm having 3 reversals done next month. He uses disc replacements and you can possibly get your mobility back
C5-6 C6-7 for me, although I have to wait until they try medication (not working), steroid injections (which I don't like the sound of), then maybe surgery. I'd prefer going straight to surgery (which I hate having) as the meds and steroid's are only a delay for surgery and they don't cure the condition. But, no surgeon or Dr. will let me skip the meds and steroids as they say surgery is a final step. So confused, considering I am going to need the surgery regardless of the meds and steroids and my condition is only going to get worse and my pain is going to increase.
Nice video series on this subject, as it has helped me understand where I should be with this.
There are several good studies to show that this can be treated without surgery quite effectively so if it were my neck I would try non-surgical treatments first as I've outlined in the videos
My pain has been with me for five years after a car accident. I’ve tried all the conservative treatments. My spinal surgeon told me he would like me to try epidermal injection or nerve ablation before surgery, however my PMR doctor said neither of those procedures would help me. My problem area is c5-6. My arm and shoulder blade pain sometimes comes and goes but the neck pain is constant.
I had ACDF c3-c7 my movement is not good but there's no scar
I wish I could have a consultation with you, but I’m all the way in Florida
You can call California orthopedics and spine and schedule a zoom appointment with me
Based on reading clinical studies, it seems the rate of nonunion varies depending on what is placed during the fusion, for example structural allograft performs better than cages but not as well as autograft (one’s one bone). With such high rates of nonunion and high consequences (revision surgery) why wouldn’t all doctors use methods most likely to successfully fuse? From reading, I see that surgeons can get reimbursed for each cage place during a multilevel fusion as well as the reimbursement rate is higher for cages versus structural allograft, but this is not a good enough reason to choose the cage over the allograft. In my mind, unless there’s a good reason to choose the cage, this is not good medicine.
There are multiple reasons. Most surgeons are no longer using iliac crest autograft simply because it is painful for the patient. For many years we used allograft bone and some still do. Allograft bone is outstanding but it comes in limited sizes and angulations. Cages have the advantage of coming in multiple sizes and angulations which can sometimes be biomechanically better. The fusion rates for cages with the use of bone graft substitute like graft on our identical to allograft.
What is side effects of C6/C7 ACDF?
Dr so the vagus nerve phrenic nerve and long thoracic nerve is not in the way? I am concerned about those and the carotid artery also some people can't swallow and talk properly permanently. but posterior is more painful and harder recovery.
The phrenic and Vagus nerves are not an issue during the surgery
I have hardware in my neck but every time I go through a metal detector it don't beep
Hello Dr, I'm contemplating surgery C5-7. I've had the numbness and pain manageable for at least 10 years with ESI and still gets me at least 5 months without pain. If I have adjacent level problem, when do you stop fusing other level? Meaning eventually every level will have to be fused. Also, what about people with Osteoporosis? Can I don't do surgery and just do ESI every year?
The rate of adjacent level disease needing surgery is only 1% per year per level so at 10 years at 10% chance of needing revision surgery.
@@DrBrianSuTheSpineGuy Thank you for your reply. I saw 4 Drs. and narrowed down to 2. One is offering the Nuvasive Simplify with less time recovery. I have arthritis, straight neck and some Ostheoporosis, Ineed to decide what option to do. Please what do you think will be better. I'm affraid not fusing due to OP but no Dr really care about it.
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hi doctor Su, I have C4, C5, C6 in the cervical, but I went to 2 surgeons, one said that I don't need surgery that my nerves are fine, and the other says that I do,because it bites my nerves a lot and it hurts the head and shoulders (he will only put a metal only to separate the discs, because the C6 will separate by itself, etc, and I don't know what to do. Please help me, can I show you my MRI?. Thank you very much
You can make an appointment through California orthopedics and spine.