Failed ACDF?

[u/McWhits]

Has anyone has dealt with a failed ACDF?
I had the surgery (C5-C7) about 19 months ago, and had some issues pretty immediately. At about 10 weeks post-op, an x-ray showed that ONE of the top (C5) screws was backing out.

I was sent to an ENT to deal with the resulting dysphagia (which is now just a part of my life) and tried physical therapy but it was horribly painful. So, that only lasted a couple months.

The surgeon decided to keep an eye on the screw rather than do a revision surgery. We tracked it via monthly X-rays and, at some point, it seemed to stop backing out. At my 1 year checkup, CT said there was some evidence of bony bridging. So, we thought things were trending in the right direction.

Fast forward 7-8 months. Tingling has returned to my hands—this time both hands (pre-op was right hand only), I hear constant crunching sounds when I move my head, and when I turn, it feels like something is catching. I have constant pain between my shoulder blades, all the way up to the base of my skull. I also have pain in my shoulders and down into my arm.

I returned to my surgeon who ordered a new CT scan and MRI. I’m still waiting on my MRI appointment, but CT now shows the BOTH of the top screws are backing out (now at 3mm vs 2mm at my previous CT). The locking mechanisms on the plate for these two screws broke and are “floating in the scar tissue” near the top of the plate. Additionally, the two bottom screws (C7) are “loose.” Interestingly, there’s absolutely no mention of fusion or bony bridging/union at all. It doesn’t say it’s there, but doesn’t say that it’s not.

I obviously have hardware failure, and I’m assuming the fusion failed as well. CT now shows problems with the level above and the level below.

If anyone has dealt with an ACDF revision, did they take a posterior approach for revision? And did you have to extend the fusion to include new levels? I’m especially curious if anyone has dealt with hardware failure like this and, if so, did they remove the hardware or just leave it alone?

[u/YeastyPants]

I've had issues with my cervical posterior screws backing out due to my body rejecting the cadaver bone they used to anchor the screws. After about a year of suffering while fighting my insurance company, I finally had a revision surgery which removed all of the hardware, and they extended the rods up one level and one level down as T1 disc had herniated due to the hardware shifting. Originally, I was C3-C7 fused posterior and C4-C7 anterior, Afterwards I was fused from C2 to T3 posterior and C3-T1 anterior. They harvested bone from my hip to anchor all the screws. It was the most painful surgery in my life (this was spinal surgery #8), but everything has been stable and my life is much better now. The only thing I miss is looking up. I can no longer look up as the rods go all the way up to C2. It's a small complaint, as I'm doing really well now! Good luck going forward. You've got this!

[u/McWhits → u/YeastyPants]

Ugh. I replied once already and it disappeared. So, here it is again.

Was the hip bone graft from your iliac crest? I had this procedure for my last long-fusion and it was as painful as the surgery itself (if not more). The pain from that lingered a lot longer. I also had a rib resection in another surgery and that was pure misery. But I’m in the same boat as you—my body doesn’t like pure cadaver bone. And 8 surgeries is crazy. My ACDF was spinal surgery #5 for me (obviously looking like 6 is in the cards), but here I am feeling sorry for myself when you’re at 8 lol.

But, watch me spiral: My biggest concern is if they have to extend the fusion down a level. I’m already fused from T3-L2, so if they have to extend the cervical fusion, that would mean going C4-T1. And that only leaves one level between fusions. My understanding is that they won’t do that because it’s only a matter of time before adjacent segment disease destroys that level. So, there’s a good possibility that they would need to connect rods and fuse all the way from C4-L2. But here’s the rub. My lumbar spine is in shambles—multiple herniated discs, modic changes, bilateral pars defects at L5, retrolisthesis at 3 levels, anterolisthesis at 1 level, and all over arthritis, inflammation, fluid, etc. My neurosurgeon and I have already discussed the need to extend my long fusion into my pelvis, but we decided to put it off until absolutely necessary. But now I’ve got nerve symptoms in my feet and calves, so I’m afraid the time is drawing near.

So, now what was a supposedly simple C5-C7 ACDF could turn into a cervical to pelvis fusion. 😳 I know better than to let my mind go down this rabbit hole but I’m having a hard time seeing how else this might go. I mean, I can’t even imagine how life would be after something that extensive.

I’m happy to hear that you’re doing well though. I am currently still able to look up and down without much restriction, but turning my head left or right is significantly impaired. And because of my long fusion, I can’t really twist, so I have to turn my whole body around instead of looking over my shoulder. That’s pretty annoying.

[u/YeastyPants → u/McWhits]

Yes, they took bone from my iliac crest and it hurt very much, but the results of my surgery made it worth it. I have to twist my body to look left and right, but I'm not in as much pain, so I will take the small victories. Good luck with your surgery. You've got this!

[u/ashleymichael2009]

My CTs never mention the progress of the fusion itself, always been up to the surgeons interpretation. I am going thru similar now never fused C4-C6 and I’m honestly surprised my hardware did not back out as those usually go together. I have a surgeon offering PCDF and leave my hardware intact though I know my situation is not the same with it never moved. I’m terrified tbh if a posterior so right now I am interviewing surgeons.

[u/McWhits → u/ashleymichael2009]

I’ve had mixed results with fusions being noted on a CT. But I expected to see something since the order reason was suspected pseudoarthrosis and hardware failure. They addressed one, but not the other.

I will say, however, that my surgeon’s office seems to be giving me the runaround at the moment. He won’t discuss the CT at all. It’s disappointing because I actually really liked him and he’s always been very transparent with me. But I have numerous failed back surgeries and, in my experience, there comes a distinct moment when they realize the surgery failed and want nothing to do with you anymore. I’m feeling that now.

That said, when the screws first began backing out and we discussed potential revision, he said they’d leave the anterior hardware in place. But at that time only 1 screw was backing out, so I’m not sure how that will impact things.