CERVICAL STENOSIS RADICULOPATHY - PART 5 - ACDF
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- เผยแพร่เมื่อ 24 ส.ค. 2019
- Click notation in top right to go to the updated version of this video. Corrected the missing media at timestamp 10:21.
This video discusses a potential surgical option for someone with a pinched nerve in the neck called the Anterior Cervical Discectomy and Fusion (ACDF).
#thespineguy #acdf #pinchednerve #spinesurgeon #anteriorcervicaldiscectomyandfusion #cervicalradiculopathy #californiaorthpedicsandspine
Dr. Brian W. Su, MD
Spine Surgeon
Chief Development and Strategy Officer | California Orthopedics and Spine
Medical Director of Spine Surgery | Marin General Hospital
Director | Marin Healthcare District Board
Chairman | Marin Specialty Surgery Center
Yelp:
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Contact two locations:
www.caorthospine.com/
415-927-5300
2 Bon Air Road, Suite 120
Larkspur, CA 94939
7100 Redwood Blvd, Suite 200
Novato, CA 94945
Curriculum Vitae:
www.caorthospine.com/brian-su...
FTC: This video is not sponsored.
Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Information obtained from this video should not be taken in lieu of your own medical provider's advice and treatment plan. Please consult directly with a physician or other healthcare professional regarding any diagnosis or treatment plan options. Content provided on this TH-cam channel is for informational purposes only and should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose , treat, cure or prevent disease.
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By the way, your videos are great, especially with patients, who had never had these procedures, and are scared. Seeing every step, and the precautions taken, and your knowledge is so greatful and so appreciated by all watching. God Bless you Dr. Su.
Wow, thank you so much for making this plain. I just had this surgery completed on January 13, 2022. On C5-C7. I was in fear at first because I suppose to have had this done in 2019. Each time my pain got worse and I ended up back at the Dr. office. I say all that to say I feel great no complications, if you are needing ACDF go ahead and pray about it first then get it done better early than late in life.
May I ask how you feel now? I'm terrified to have this done but have spent last year having rizotomi five times last year twice already this year.. I'm running out of options.. how long were you in hospital? Pain post op? How long before you can resume normal activities? Thanks in advance..
Thank you for sharing your experience!
@@christinefinn6180 Hello, I’m sorry for the late response. Now that it’s been 6 months later, I feel great! I don’t have many headaches as before I was told that it takes normally one year for everything to heal completely. After I got the surgery I was kept in the hospital overnight for observation and sent home with Percocet and muscle relaxers. Post op was 2, 4, 6 weeks. Week 2 (remove stitches). I had to wear a neck brace for six weeks 24/7 (except for showering) that was the most difficult part for me because I had to sleep with it on 🙄 what helped was after scheduling my surgery date my husband and I bought a new bed that inclines so this helped tremendously. I work in an outpatient office so I went back to work after 1 week I couldn’t drive for the first 4 weeks. My husband took great care of me he wouldn’t allow me to drive for almost 2 months he took me to work and picked me up. Once the brace were removed I had a lot of stiffness and shoulder pain so I had to do exercises to loosen up the muscles or if you have a pado that would help a lot. My scar has healed good since I’m brown skinned I have a little keloid but not bad enough to get steroid injections. My Dr., Dr Roy said to me if the keloid gets any bigger I would need the injection. Overall I’m glad I got the surgery because no one wants to be in pain everyday. I understand the fear of this, trust me I ran for two years, but pray about it and make sure you have the best Dr. I pray all goes well for you now an in the days to come!😊🙏🏽🙏🏽
Thank you so much Dr. I am going to have it done on my C4, C5, C6, and I am scared, but with the information you gave, makes me feel better:)
Wow I learned so much. Will have 2 level ACDF next month and you explained so much so well. Thanks
Thank you for explaining everything including postop recovery, timeline for recovery, fusion, and activity. That’s so helpful and so many surgeons don’t explain everything.
Thank you for that great information. Watched all the videos and very useful when I go to see my ortho about my neck. Definitely put me at more ease about the whole issue.
Such a well done and informative video. Very appreciative of the information.
Thanks for all your easy-to-understand videos!
I’ve just had my 2-level ACDF surgery on Tuesday. It was a difficult decision and I hope it will turn out well.
I have documented my decision to go for surgery, made a video on my TH-cam channel on 14 November. I referred to your videos and also added links to your channel, I hope you don’t mind me sharing your content.
Please keep making these type of content, it’s very helpful!
I love that you are sharing content
Thank so very much for this video 🙏
Doctor, THANK YOU!)
Thank you so much as you have taken fear away so that I could become paralyzed from either the surgery or the pinched nerve. 8 months ago, the pinched nerve cause me to lose complete control on my right leg, where I couldn't use the leg. It eventually went away, about 3 months. The Dr said if that happens again, I need to tell her and she would refer me for surgery.
Thank you
I had 4,5,6,7 fusion. October 2018 and have new narrowing at 3-4 and 7-8
One of the best presentations on this subject, I've seen. I've had cervical disc degeneration in a few spots, for the last 5 years. No pain, just stiffness in the neck, limited ROM and occasional tingling in my fingers. Assume that this will eventually progress into the pain I've heard most ACDF recipients talk about. Is it ever the case that ACDF is performed proactively, prior to reporting pain symptoms?
Surgery should never be done preventatively. Just because you see something on the MRI or something on the MRI is actually symptomatic if you can live with the pain you should not have an operation. The only exception is if you have a dislocated neck from a trauma or if you have severe spinal cord compression leading to significant weakness, difficulty with fine motor skills, and balance problems. As a disclaimer you should always consult your spine surgeon and this is not considered medical advice.
@@DrBrianSuTheSpineGuy That makes perfect sense. Only subject yourself to the knife, when absolutely necessary. Appreciate the quick response.
Great informative videos. I'm on wk 5 from having Diskectomy and fusion. I'm experiencing pain as I did before even though x-ray looks perfect and I've been extremely careful and I'm quite fit. Upon examination Dr feels ultrasound is needed but looks fine. My neck, shoulder traps are quite tense and stuff like steel. He is sending me for Botox in my neck . Is this common?
I had C2-T1 fused and rods and pins from C2-T2. I still have thickening of the brachial nerve at the root on C5-7 and extreme pain going through the scapula down to my hand and a claw hand. Could you do a video on the brachial nerve and surgery options on the nerve? Would you do a virtual visit for a second option?
This is a great video, it puts my mind at ease. I especially like the part about Manning going back to win the Super Bowl after a two level cervical fusion. Just curious, what factors make you decide whether to use a bone graft or a cage?
Bone grafts are typically a set shape because they are donated from human bone. I personally make an intra op decision because plastic and metal cages have more sizing options and for fusion I like as large of a footprint as possible. If I can get a wider cage compared to bone graft I tend to use the cage.
PEEK and Metal cages often come in more varying sizes (width and depth) than machined allograft. My preference is to use a 3D printed metal cage if the space can accommodate it. Metal cages are somewhat new. Allograft is still considered the gold standard and I use it approximately half of the time.
Both using a bone graft or cage with substitute bone graft lead to very good outcomes and fusion rates. Often it depends on the anatomical structure and size of the disc. You should consult your spine surgeon or make a zoom appointment with me by calling 415-925-7300. as a disclaimer this is not considered to be a substitute for medical advice from your physician
Hi, thank you so much for the informative video. I had an 2 level C5-C7 acdf 15 days ago. My surgeon was sure he was going to do 2 level disc replacement with the medtronics prestige device. However, he went in and said it wasn't possible and had to do the fusion instead. I was really bummed, however I trust his judgement and he said I was the first patient in all his years. that after looking at the studies I was a good candidate for the disc replacement but ended up doing a fusion. My biggest issue is the swallowing and I am a CRNA and I was totally unprepared and freaked out by the discomfort. It feels like my throat is closing and it is hard to swallow. I have to crush my meds and only eat smoothies and very liquid soups. When does this go away? I have a swallowing study next week and the PA thought I may need steroids but I think this would impede the fusion.Why do some people just wear a soft collar or an Aspen collar for 6 weeks and some have to wear the hard collar for 12 weeks, which is my situation. I am very concerned about the neck muscles and it seems there is such a variety of collar situations for the exact acdf I had. Thank you and sorry for the long essay.
Swallowing is always an issue. In general it gets better after 2 to 6 weeks. If it persists after 6 to 12 weeks you should get a swallowing study. Oral steroids can be useful early on for this.
I had a c7-t1 fusion done in 2006. I just had a posterior laminectomy and discektomy at t1-t2. Enjoy the years of relief you get from this before the next level goes, not to mention the long term damage to your voice. There are way better methods available now.
What are the better methods?
Thank you. Very clear and informative as always. Can you have an MRI on any part of your body if you have had an ACDF due to the metal used in the procedure?
Yes
lumbar spine L4-L5 and L5-S1 disc
space narrowing and have also pinch nerves problem. please show the respective exercise and your
opinions. thank you.
Is c34 harder level to fuse our put artfical disc in. Can you use skin crease? I was told c34 you need higher skin approach
Each level requires a different height of skin incision. Most anterior cervical fusions or disc replacements that are done at c34 require an incision a few centimeters below the jawline. It is not a harder procedure to perform but does have an increased risk of difficulty swallowing after surgery although it is typically not an issue. You can always make a zoom appointment with me by calling 415-927-5300. As a disclaimer this is not considered to be a substitute for medical advice from your physician
Thank you for this GREAT informative video, I just had done my C5 C6 C7 ACDF. I am on week 3 post op, rollercoaster of emotions. I have a 2 year old baby along with another on the way, absolutely killing me i am restricted from playing with her and carrying her. Will taking calcium and vitamin D supplements assist with fusion? Thank you so much
Those have not been shown to help increase fusion rates. typically I do not allow patients to take anti-inflammatories like ibuprofen because they are known to prevent bone from healing. Tylenol is okay. bone stimulators can increase fusion rates and that is something you may want to pursue with your spine surgeon. I usually use it for patients who have more than a two level fusion because there is an increased chance of non-union. Some insurances do not pay for it. Of course you should always seek the advice of your own physician.
@@DrBrianSuTheSpineGuy awesome Dr Brian much appreciated, be safe and thanks again for the awesome content. Be safe!
Hi Dr Su,I am having a 3 level fusion next month.My surgeon tells I can go back to work after 6 weeks,at the 6 week mark he will evaluate me and I may be on light duty or not.I am a nurse assistant on a busy medical floor and I do a lot of turning and lifting of patients.Everything I have read says not to lift more than 20 pounds the first 3 months,I wondered if you could give me your advice.Thank you
Every surgeon has something different in terms of limitation of activity.
Another great video!
How often do you have to do a ACDF with a corpectomy?
It is rare unless there's pressure behind the spinal cord.
@@DrBrianSuTheSpineGuy thank you. It seems most ACDFs are between c4-c6. What is your take on c7-t1? I’m not seeing anything on procedures for this area. Is it that uncommon?
I had this surgery in January 2019 I’ve been in excruciating pain ever since I have been doing epidural pain injections and I even had an ablation procedure nothing is working what do you recommend
Cervical??
simo134 yes cervical
I am sorry you not are not feeling well. there can be many reasons for persistent pain after an anterior cervical fusion. Some of these include non-union persistent stenosis, or facet joint distraction. Every case is unique and it depends on where your pain is and what the imaging studies show. You can always make a zoom appointment with me by calling my office at 415-927-5300. As a disclaimer this is not considered to be a substitute for medical advice from your physician.
Do you have to go back in and remove the hardware? Or is it left in?
Hardware is typically left in.
One surgeon told me he does allograft bone. Other says he uses cage with bone from surgical site. What is best option for best fusion rate? I had prior cervical posterior formantomy and half facet on left removed
Allograft bone is the gold standard but there is also good preliminary data using PEEK cages and metal cages filled with bone substitute. I would recommend going with something your surgeon is most comfortable with.
The fusion rates between using a structural bone graft called structural allograft is similar to the use of a cage with bone graft substitute. Every patient is different and I would rely on what the surgeon is comfortable with. As a disclaimer this is not a substitute for medical advice from your physician.
Thank you so much. I have my surgery August 26. I am wondering how much taller I will be after having 2 levels done?
Depending on what height the grafts are and what your pre surgical collapse is you can definitely gain some height.
Hi doctor during an acdf does it address uncoveterbal spurring ??
Yes, the uncinate spurring is typically what causes pinching of the nerve. after the disc is taken out small instruments are used to take the bone spurs off of the nerve. As a disclaimer this is not considered to be a substitute for medical advice from your physician.
Thank you dr Brian su.
I would like to ask you why do the patients develop cysts in the spine after fusion or disc replacement. Is is because of osteolysis?
It is because with the disc replacement there is still motion. They should not develop cysts if there is a fusion
@@DrBrianSuTheSpineGuy could I please contact you through your email.
Hello Dr.
I was all scheduled for ACDF surgery, and after much thought felt I needed more info and opinion for my particular situation.
I live in Newport Beach Ca. Is there anyway I can send you copy of my MRI disc and report to get your opinion. I’m a 58 year old female and wonder how this happened? They were going to do c4,5,6,7 ! I don’t have arm pain but some pain in left hand at thumb pad… thank you Susan Auerbach
You can make a virtual appointment with me at California orthopedics and spine
I would like to see a Video regarding the SI/Sacroiliac Joints Dysfunction, treatments and possible surgery options... Quick questions on your donated Cadaver bone. Besides being irradiated, wouldn't my body reject the bone? It still has a different DNA code in it's marrow? Maybe that might be the reason why it might not bond. Do I have to take medication, like a Kidney transplant so my body doesn't reject the donated Cadaver disc bone? Also, can a Discectomy be done without fusing a metal plate?..🤔Maybe in the future, a Plate Shaped from a irradiated Cadaver Hip Bone, using a laser printer, would eliminate using metal plates.
Yes I will be doing an si joint video. Stay tuned.
@@DrBrianSuTheSpineGuy Thank you Dr. Su, looking forward to your video.
What is true rate of adjacent segment disease rate at one level c5 6? And what is percent fusing rate
This is covered in the video. The true rate of adjacent level degeneration is different than the rate of adjacent level disease. The distinction is that adjacent level degeneration is a radiographic finding seen on x-ray or mri. adjacent level disease is whether or not you have symptoms like neck pain or arm pain related to that degeneration. The former is approximately 3% per year per level and the latter is 1% per year per level. Thank you for your comment. as a disclaimer this is not considered a substitute for medical advice from your physician.
Hello, I have been trying to find out the answer to this question but can't find it. I have had 2 ACDF's one exactly 10 yrs after the other. I am having severe pain and other problems with my neck. It has been 6 yrs since I've had my second one. The first one was c5-c6-c6-c7 and the second was c4-c5. My question is... Is there a possibility I will have to have this surgery again?
The rate of adjacent level degeneration on radiographic imaging is 3% per year per level. The rate of needing surgery at an adjacent level is 1% per year per level. As the number of levels fused increases the incidence of adjacent level disease increases. In your situation there's probably a 10 to 30% chance you will need surgery again in your lifetime for the adjacent level. As a disclaimer You should always consult your spine surgeon and this is not considered medical advice.
@@DrBrianSuTheSpineGuy thank you for your lot for your fast response. I do need to see a neurosurgeon. I just hate the idea of having the surgery for a 3rd time. But the pain now is worse than it ever was.
You asked me to watch this video.. may I ask after fusion horse riding as in competitive jumping?! If you can do NFL superbowl!! I would love you to review my MRI I've had a year of rizotomi both supine and prone.. root nerve abolation.. was discussion re spinal cord stimulation and biowave but maybe looking to refer to someone here in Ireland.. it's seriously impacted my life over the last two nearly three years I have huge pain threshold fusion scares me big time..
After a successful fusion impact sports are allowed. I would have to review your case.
@@DrBrianSuTheSpineGuy wish you were here in Ireland!!
Back with my pain specialist he is refer to neurosurgeon as rhizotomy not working so new MRI and possibly fusion C5/6 but obviously depends what has changed in 15 months.. your videos give me optimism..
31 year old got accident 2 times got spinal cord injury both leg paralysis help him to walk please need opinion how I can contact you to treatment of patient we are ready to pay all the amount
please replay
0:50 ACDF
6:53
Unfortunately, the introduction of PEEK cages into US hospital for use in the cervical spine was done thru fraud. The vast majority of them were all labeled as non-cervical VBR devices for use below the neck in the thoracolumbar spine. But examining the patents and 510K FDA applications show the construction specs and design rationale matching the morphometry and curvature unique to the cervical spine. It was a pervasive bait-n-switch scam, labeling it one thing when it was really another. Cartels used the same type of scam to traffic illegal goods across US borders labeled, packaged and disguise as legitimate-looking goods. While FDA has since permitted those illegally, mislabeled cages to be relabeled for the actual use, the whole scam shows how easy it is to game the FDA. Either the agency was inept, duped or in on the fix. Even today, many of the top-selling PEEK cervical cages are even labeled "contraindicated for cervical implantation." www.statnews.com/2016/08/15/medtronic-medical-device-surgery-fda/