ACDF Post-op pain, headache, neck & shoulder

[Leila006]

Hello everyone.  On March 31, 2010, I underwent an ACDF.  Pain management was challenging bc I have such adverse reactions to most narcotics.  After trying a battery of pain meds I was sent home on methodone (5 mg) and Valium (5 mg) and Zofran (4 mg) for nausea, three days later on April 3rd.  (Let me add, I live alone and it took my insurance company 21 days to approve a Home Health Aide.  Though I did not lift anything, I did have to dress and bathe myself; change my own dressings, fix my meals, etc.)  On April 16, I was given a SPinalPak II Stimulator to help the fusion.  I was told wo wear it for 3 moths, 24 hrs a day.  

On April 26, the Methadone caused severe vomiting so I had to discontinue it.  I take the Valium at night because it makes me fall asleep within 20 minutes of taking it.  I'm also experiencing neck & shoulder pain and headaches daily beginning this week.   I have an appt with pain management practice who handled my care in the hospital for an alternate pain medication.  

I'm due to go back to work on Mon., May 10, 2010.  I'm an Assistant Principal at a large elementary school.  Although I will be assigned clerical duties only, I'm still concerned since that might entail lots of sitting.  Has anyone gone back to work this soon after an ACDF?  Did you still require pain meds?  If so, what worked that did not cause you to be drowsy?  I can't work in pain but I can't be drowsy on the job, either.  I'd appreciate all the suggestions any of you could offer me.

Thanks,
Leila

[Leila006]

Dear Kalvin,
Thank you for responding.  My dr originally told me I could return to work in 2 wks; so, I told my job I'd be back in 4 wks. Mind you, I was just getting the stitches removed @ 2 wks post op. Hmmm.  Then I read my paperwork that was submitted to the job that said probable return to work: May 30th (which was 8 wks time).  I asked the Physician Assistant and she said, the recovery time is usually 2 to 3 months but if I felt I could go back to work earlier, they would allow me to.  By then, changing the dates would have been problematic, so I will return on May 10th and take one day at a time and see how I do.  If I can't do it, I'll leave again.  I'm not lazy or a slacker and my boss knows this but if I don't allow myself fully recover I won't work anywhere else, ever again.

My sister took me out yesterday since it was such a beautiful day (85 degrees - NYC) but we ended up being out for 7.5 hrs. Though my activity was limited, I think just being in a car that long was too much.  I also noticed that in one of the stores, I kept dropping things again. I hadn't experienced that since the surgery.  Maybe my muscles were just exhausted.  I came home feeling like someone tried to decapitate me.  The pain in the "front" of my neck and shoulder were unreal.  I stood in a hot shower for 10 -15 minutes just trying to relieve the pain.  Afterwards, I took 2 Extra Strength Tylenols (NO codeine) and a Valium and went to bed. I woke up @ 6:30 am still in pain so I ate a bowl of oatmeal; took 2 more Tylenols and another Valium and went back to sleep. I feel better now but not as good as before.  I have to remember totake things slowly, I guess.  I've never had surgery before so this is a new experience for me.

I do receive PT at home; 2x's/wk.  My Physical therapist took me out of the hard brace and put me in the soft collar (as per surgeon's ok).  PT said my neck needs to get used to holding up my head on its own and it can't do that in the hard brace but I think I should wear the hard brace while riding in somone's car (sinvce I can't drive yet)  to give my neck more support and wear the soft collar when I'm inside the house or seated at work. I know my PT is the professional but I can't help but htink that he was home pain free last night.  I will; however, talk to him again when he comes to the house this week for his professional advice before self treating.  LOL

Have a great day and again thanks for your thoughts, encouragement and suggestions.  Will keep in touch.

Leila

[Leila006]

Dear Tuck,
Thanks for your good wishes.

My sister took me out yesterday since it was such a beautiful day (85 degrees - NYC) but we ended up being out for 7.5 hrs. Though my activity was limited, I think just being in a car that long was too much.  I also noticed that in one of the stores, I kept dropping things again, something I haven't experienced since the surgery.  Maybe muscles were just exhausted.

I came home feeling like someone tried to decapitate me.  The pain in the front of my neck and shoulder were unreal.  I just stood in a hot shower for 10 -15 minutes to try to relieve the pain.  We ordered some food from a local restaurant (Dallas - BBQ) and I was anle to eat 1 chicken wing and a 1 slice of cucumber from my salad.  I then took 2 Extra Strength Tylenols (no codeine) and a Valium and went to bed. I woke up @ 6:30 am and ate a bowl of oatmeal, 2 more Tylenols and another Valium and went back to sleep.  

I hope I can make it thru a 9 hr work day.  I think I'll put my Principal on alert that I will do the best I can but I cannot predict how I'll be able to function.  I've just  realized that I'm really returning to work 5.5 wks post op.  

We'll see what the pain dr has in his little bag of tricks.  I've also decided to wear the hard brace while riding in somone's car (sinvce I can't drive yet).  Maybe that will give me more support and where the soft collar when I'm inside and seated.  My Physical therapist said my neck needs to get used to holding up my head on its own and it can't do that in the hard brace but I'm sure he was home pain free last night.  I will talk to him again when he comes to the house this week.

Again thanks and I promise to keep you updated.

Leila

[Leila006]

ACDF stands for Anterior Cervical Disectomy with Fusion.  The surgeon opens up front of neck, pushing aside the trachea and other muscles, exposing the vertebrae in the neck and removes the damaged levels of discs (for me: C5-C6 and C6-C7).  He then drills/cut away the problem causing bony areas, enlarging the spaces where the spinal cord and nerves travel so that the cord and nerves are no longer compressed and flattened (as it was in my case).  Then he makes an incision at the ilieac crest (hip bone); drills through the outer hip bone and removes some of the bone marrow.  He uses that marrow to rebuild the neck at the areas where he removed the discs, etc so there are no empty spaces left (creating a fusion between my cervical vertebrae and the bone marrow from my hip).  He then adds metal plates and titanium screws to hold everything in place so that nothing that he has done collapses.  Then he closes the incision of the neck up and puts you in a hard brace to keep your neck from moving. Oh yeah, I forgot to say, he also closes up the hip incision too.  (LOL).  Hopes this lay person description of the procedure helps.

Thank you for your suggestions.  I will consider them all and talk to my doctor on Tuesday.  Since I'm not an hourly employee, I can't work half days.  Hopefully the lighter work load will help; maybe not.  My sister took me out yesterday since it was such a beautiful day but we ended up being out for 7.5 hrs. Thoufg my activity was limited, I think even being in a car that long was too much.  I came home feeling like someone tried to decapitate me.  The pain in my neck and shoulder were unreal.  I hope I can make it thru a 9 hr work day.  I'll let you knopw what the doc says about the meds on Tuesday.

Thqanks,
Leila

[Kalvin]

I remember you, didn't you post on here several months back? I hope this surgery takes care of your pain for you. Sounded like you were having a pretty rough time back then.

I had a ACDF five years ago and it took about 16-18 weeks before I could get back to work. I did have additional spine issues going on at that time that weren't related to the surgery, so don't let my time frame scare you. The other thing is I had a very physical job back then, so our situations are different. My surgeon did say 6-8 weeks for sedentary type positions and for me he just said longer.

I was still in a lot of pain when I went back to work, and I had to take medication for it otherwise I wouldn't have been able to function. I wasn't going to sit around and wait until I didn't have any pain, I would have never gotten back to work.

These surgeries take a lot out of you, and take a long time to recover from, at 6 weeks your still at the beginning. Its going to take a while longer and your going to have some pain. Its normal. I didn't see you mention anything about Physical Therapy, it's an important part of the recovery process. Once your Doctor feels its safe he/she should be sending you.

Take Care and I hope you get your meds straightened out.

[Dee1956]

Hi I do not know what an ACDF is other than surgery.  If the methadone helped you from March 31st to April 26th, why did they think it was that that caused your vomiting?  Could you break them in half to only take 2.5 mg?  Or, because they have a long half life, take one every other day?  Most operations take a minimum of 6 to 8 weeks to heal (this is just my opinion I am not a doctor but a patient of surgery)  Also there is something called Toradol where the initial dose is an injection then you take pills after that.  It is supposed to be good for someone who has been on narcotics.  Also there is Tramadol which my friend swears by.  She doesn't like the sleepy feeling of narcotics and this helps, I can't remember the brand name but I am sure you could find by looking up Tramadol.  Can you get more time off?  Can you talk to the doctor, ask him what is a "normal" time to heal?  Everyone's body is different and we all take different times to heal.  I would definitely ask the doctor and if not happy with answer get a second opinion
I know it is hard, I had back surgery and the doc said 2 weeks and I could go back to work.  Well I forced myself after 3, when I went to see him, he said "oh, most people take 6 to 8 weeks"  It would have been nice if he had shared that with me.  I wish you lots of luck and will pray that you get some answers.  Could you go back part time?  Just a thought

[Tuckamore]

Hi Leila,

I am sorry that you had not home health care for so long and are still experiencing pain. My uncle just went through this procedure 2 weeks ago. They removed 2 vertebra and three disc. His pain is minimal. It is controlled with 10mg of hydrocodone 3 to 4 times per day. I assume that is a drug you cannot tolerate.

Recovery time generally lasts 4 to 6 weeks. X-rays may be taken after several weeks to verify that fusion is occurring. The surgeon will decide when to release you back to work at your follow-up visit. Normally you can return to work with light duty activities after 6 weeks but every body is different.

You are just about 4 or 5 weeks post-op. Your body went through a lot of trauma and will take time to heal. I am glad that you will soon be seeing a PMP. When do you have your next follow-up with your surgeon? Your fusion healing should be evaluated soon. Sometimes a disc can herniate above or below a fusion. So good imaging is important.

I wish you the very best and hope that you will soon find a resolution to your pain. Please let us know how you are progressing. Members will offer additional suggestions and opinions. Be cautious and rest as ordered.

Take Care,
~Tuck