I'm new here. I've been a spiney since my auto accident in August 1997. My first surgery was a microdiscectomy/laminotomy on a 15mm protrusion on L4-5 in February 2000. I've been on disability, on opiates, Neurontin, and anti-depressants most of the time since then. My second surgery was a microdiscectomy/laminotomy on a 14mm protrusion at L5-S1.

By the summer of 2002, I'd had no life for almost 3 years, unable to take part in the most innocuous activities, like going to parties or out to dinner or to the theatre. I was in horrible pain and on knarly meds 24/7.

In September 2002, I went to Munich for a 2-level SB Charite III procedure performed by Dr. Zeegers. I was simply looking for a reduction in pain. After 3 spine surgeries, I fully expected to be a chronic painer for the rest of my life... I was just looking to be able to work and function again.

My recovery has been 50,000 times better than I could possibly have imagined. At 2 weeks post-op, I started tapering off the narcotics. It was complete at 6-weeks. That was over 4 months ago and I haven't had a narcotic since. 3 weeks later I took my last anti=depressant and I've never looked back. Before I was 3 months post-op, I was riding my bike all over the place, taking the dogs for walks on rollerblades, working out in the gym, playing tennis and swimming. At 4 months post-op, I started SCUBA diving and skiing, and have even played soccer (in a non-competitive environment... with friends who are not looking to clobber me!)

Although I am not 100%, I can live, function well and can smile a natural smile... not force it out through a grimace. I'm mostly pain-free, very active and medication free (except for anti-inflammatories.)

This brings me to the subject of my post.... ADR misinformation. I had learned about ADR 2 1/2 years ago, but had discounted them because of some 'information' I'd heard. It came from a reliable source and I had no reason to doubt it.

2 years later, I discovered that I was now the source of a rumor and I had no idea whether or not it was true. I then decided to challenge every piece of information I got. I would no longer accept generalities and rumors. Only facts that came with something to substantiate them would be considered. What I discovered, was that much of what I had heard was not well researched, understood, or was just plain false. Even from my doctors, what I'd thought were informed, expert opinions were just knee-jerk, uninformed reactions or rumors.

I have no regrets. We make the best decisions we can with the information we have at the time. However, if accurate, reliable information had been readily available, I'd have had my surgery 2 years earlier.

During the 2 years that I continued to research ADR, I discovered that much of the discussion surrounds issues that are irrelevant. Either the data is too old to be useful, or the issues being discussed are great in theory, but in practice, they are just not relevant.

I'm hoping that this thread will be the start of a useful discussion about ADR technology and issues. I am not a doctor, I'm just a computer nerd who's been through spinal hell and came out 5 years later, OK. I've done a lot of research and am happy to share everything I've learned. My opinions are just that... my opinions. We all need to make our own decisions and my only hope is to help others who are living their own spinal hell, make more informed decisions.

I have no axe to grind. I think that both the Charite and ProDisc are excellent solutions, properly implanted in a properly selected patient. Improperly implanted or implanted in an improperly selected patient can be a disaster.

Mark

------------------

2/25/00 Microdiscectomy/laminotomy L4-5, 10x15x7 mm left paracentral protrusion

9/23/00 CANCELED L4-S1 360 fusion CANCELED

9/15/01 emergency microdiscectomy L5-S1, 14x13x10 mm left paracentral protrusion

Both discectomies helped with hip/leg/foot symptoms, but left the underlying back pain. Residual left foot pain and numbness. Lost axial reflex (left ankle).

*** My expectations were high, but Dr. Zeegers far exceeded them!!!

*** L4-5 and L5-S1 Disc Replacement (SB Charite III) 9/20/02 by Dr. Zeegers, Munich, Germany ***




[This message has been edited by moderator1 (edited 03-14-2003).]

Originally posted by lakezurich:
I had a discussion with a spine surgeon regarding a new lumbar fusion implant and during the discussion also asked him about his opinion on artificial discs, Prosdisc as well.

He has a pretty strong opinion: It does not make sense at all and he would never use them. You gain 3º which compared to a fusion is very short of nothing and simply for this reason it does not make sense to use them.

To achieve this you may face considerable difficulties (migration and potential damage to the vertebraes among the most important) which could create real problems later on. He is of the oppinion that the hype these artificial discs create are pure marketing gimmicks.

He also gave me an advice which I feel is important:
When considering a spine operation always get an opinion of a surgeon with at least 100 operations per YEAR. Also try to get an opinion of an orthopedic suregon as well, and not only of a neurosurgeon because orthopedic surgeons have a better understanding of mechanics.



Normal spine ranges of motion are:

Flexion - 10º
Extension - 5º
Lateral bending - +-5º

ProDisc ranges of motion are:

Flexion - 13º
Extension - 7º
Lateral bending - +- 10º

I don't know where the quoted information came from. My information comes from the ProDisc literature given to me under the FDA clinical trial. I doubt that SpineSolutions would be fudging numbers that are common knowledge to any orthopaedic surgeon, or numbers that can easily be measured.

I don't have the numbers for the Charite, but I've held a ProDisc and a Charite, side-by-side. I can assure you that the range of motion for these devices are similar. Both exceed the normal range of motion for your normal discs.

You may ask, "why would they implant a joint that is hyper-mobile... wouldn't that be a problem?" You must understand that they are not replacing the entire disc. After gaining access to the disc from the front, they cut a window that is just large enough to insert the prosthesis. Then, they remove the disc nucleus material, including the highly innervated tissue on the dorsal part of the annulus that is causing your discogenic pain. The endplates are then cleaned up, the prosthesis is inserted and the window in the annulus is sewn shut. All of the structures (annulus, ligaments, etc...) that limit the range of motion of your healthy spine are what limit the range of motion for the prosthesis. (This is why instability is a contra-indication for ADR. If your spine is unstable, it won't properly constrain the prosthesis.)

I don't know how much research the surgeon quoted above did, but the statement "You gain 3º which compared to a fusion is very short of nothing and simply for this reason it does not make sense to use them." is simply false. It's unfortunate that so many patients are left with the responsibility for determining the difference between a well-researched, informed opinion and an uninformed opinion. We are used to believing what our doctors tell us.

Regarding migration and endplate damage. With over 5000 Charite's and 2000 ProDiscs worldwide, does the quoted surgeon have any information about rates for these complications? I don't know the numbers, but I'd be willing to bet that the migration rate for artificial discs is far less than it is for fusion hardware. How about endplate damage for a failed ALIF with cages... especially cages that are drilled and screwed through the endplates. So, is the reservation about these potential complications well researched and informed? I wonder what specific information he has that would allow him to say that all the fuss about artificial discs are from "pure marketing gimmicks?"

I hope this is clear. My ordeal ended with my successful 2-level artificial disc surgery in Munich in September, 2002. I now play tennis, ski, SCUBA dive, rock-climb, etc... That's after 3 spine surgeries, endless meds and no life for 3 years. I was sightseeing around Munich less than 2 weeks after my surgery. After 3 straight years on opiates, Neurontin, and anti-depressants, I started tapering off the meds at 2 weeks post=op. At 6 weeks post-op I took my last narcotic. That was over 4 months ago and I haven't had one since. That is some marketing gimmick, isn't it!

Challenge everything... discuss it until you understand it. Continue to explore it and 6 months later, you'll discover that what you thought you'd understood was all wrong. This is a difficult process... keep working at it.

Good luck!

Mark

I don't have time to review old posts looking for things like what I posted above. If there are issues that you'd like to discuss, post them on this thread and I'll do my best.

Remember, I'm just a patient. However, I'm still learning more about ADR and I still communicate regularly with several top ADR surgeons. If there are questions I can't answer, I can usually get their opinons relatively quickly.

Even their opinions are biased towards the device they use. It's still difficult to decide which issues are relevant and how much weight to apply to them. Also, every advantage of each feature or procedure comes with a corresponding disadvantage. That is why determining the pros and cons of each difference is so difficult.

Mark

Hi Mark,
Just wanted to say that I'm really happy for you that you're able to get back into life after your final surgery. I also think it's great that you took the time to write all the information for people here to see. I'm pretty young, and I may need something like a disc replacement in the future, although I'm hoping I'll be okay for the rest of my life. Only time will tell.

Congratulations on being pain free!

------------------
Had right pain down butt/leg/toes for over 2 years.
MRI confirmed L5-S1 disc herniation
Discogram confirmed L5-S1 disc tear
Tried chiro, PT, epi steriod injections, more PT... to no avail
Insurance denied IDET
Had L5-S1 hemilaminectomy with microdiscectomy on 2/18/03 - now pain free!!!

etoile du nord, thanks for the note.

I hope you never get that far. Hopefully, if your problems progress, they'll know methods of prevention instead or needing such massive repairs like ADR or fusion. If they could keep the disc space from collapsing, they could keep other elements of the spine from breaking down too. Prosthetic Disc Nucleus looks promising here. It sure will be great when we won't see such large numbers of people with chronic debilitating back pain.

Good luck and thanks again!

Mark

Mark

I too have researched ADR a lot in the last couple of months and am still finding information that has no factual basis. I'm amazed at the number of doctors I've seen who have only "heard" about it, but are still willing to offer their professional opinion on it without having any of the facts.

My research has made me believe that ADR is my best option at this point. The other choices I have are pretty grim (just my opinion) - live a life of chronic pain, or a 3-level fusion. I know there are a lot of successful fusions out there, but once its done, you can't go back. I'm not an ADR candidate for any clinical trials in the US - too many degenerated levels - but I meet the criteria for ADR in Europe (ProDisc) since they've been doing it so much longer. I may end up being one of the few 3-level ProDisc recipients. While 3 levels may sound a bit daunting, I have better odds for recovery than what I've been told by my OSS here in the US. Nothing is ever a guarantee, but 85-90% odds for ADR look much better than the 55-65% odds I've been given for fusion surgery.

Have you done much research into Prosthetic Disc Nucleus? I've tried finding info on the net about PDN, but can't find much. The doc mentioned PDN as a possibility for maybe one of the three discs along with the ADR, but I'm not able to find much about it.

Any suggestions?

Spines-r-us,

I communicate regularly with one of the doctors who's pioneering PDN. He's working with the manufacturer, suggesting changes and trying them out.

Today, I received answers to some of my PDN questions:

>> What is the most levels you've done PDN on?
Only single level implantations. We don`t feel this technique to be adequate for multi-level cases.

>> Have you combined PDN with the other technologies?
No, and we are not planning to do so in the near future.

>> Is PDN far enough along to do prophylactically on a degenerating disc, before it causes serious problems?
No.

As you can see from his answers, it's still early for PDN, but still, it's very promising.

Mark

Mark:

Looking back through all my pages of notes, I think the doc said nucleoplasty. I do have some info on that, but hopefully PDN will be coming along soon also. Looks like some very promising changes and additions to "traditional" spine surgery on the horizon!

Hi Mark
Congratulations on your successful outcome. I only hope that I may have the same result in the future.

A little about my situation: I have 3 degenerated disks but the one giving me all the pain is L-5/ S-1. I have had discectomies on the 2 disks above and also an IDET on one of them. These 2 disks are pain free, the one giving me the trouble is L-5/ S-1. I had had an unsuccessful IDET at that level.The Drs. concensus is a 3 level fusion in which I am not going to do. I feel (and 2 Drs.) that I am a good candidate for a ADR when they are available in the USA. I do not have any leg pain, just back pain.

My questions are:

How were you able to get this done in Germany?

How much did it cost?

How do you do any follow-up?

Did you insurance pick up any costs?

How were your accomodations etc...arranged in Munich?

What did they require before you left USA?

Is there someone that I could contact to discuss my situation?

I have many questions but if you could answer these to start with I would be gratefull. I am a 41 years old, very active and still want to ski, golf, play sports with my 2 young boys.

Thanks for your input,
Mark

Mark,

I believe that the earliest the Charite could be approved would be mid 2004. Then the doctors will no longer have to follow the study guidelines and will be able to venture into multi-level procedures. That will be good for some, but the downside will be that the doctors will be starting a new learning curve as they learn where to apply ADR. (More importantly will be the learning curve about where NOT to apply it.)

I had communicated with Zeegers in the summer of 2001. He agreed that I was a good candidate and I could schedule the surgery. Since I'd had a huge increase in leg/foot symptoms, I decided to have an MRI in the states. When I discovered that I had a 14mm protrusion, I was still afraid about taking the huge leap for ADR or fusion. I viewed it as an opportunity to do a more minor surgery, rehab, then I could reevaluate my situation. Maybe I'd be lucky and would find that a discectomied L5-S1 would solve my problem.

A year later, when I was ready to throw in the towel, I just told them that Zeegers already said I was a candidate, so let's schedule the surgery. I wanted 4 weeks out. They offered me 3 or 6. I took 3 weeks and got all the arrangements made without difficulty.

Your situation about no leg pain, only back pain is good. That artificial disc procedure is made to address discogenic back pain. If you have facet problems or other sources of back pain, the surgery will not address them. Often, resolution of leg pain occurs because some nerve compression is relieved when
the disc space is restored, but that's gravy. The procedure is aimed at the discogenic pain.

>>> How were you able to get this done in Germany? Some of this is addressed above. Before I left, I had decided that the ProDisc had the advantage and had discussed having surgery with Dr. Bertagnoli, also in Germany. I consider him to be the top ProDisc surgeon in the world. But, I could not get any references. I did have over 10 patients I'd communicated with and they all told the same story that I tell now.... excellent facilities, excellent care. To quote another patient: "I live in New York, work in the medical field, have excellent insurance and have access to the best medical care the US has to offer. But, if anything else goes wrong with my back, I'm going back to Munich."

So, when it was time to decide, I felt that he references and recommendations for Zeegers , trumped my percieved advantage that I'd given to the ProDisc. (I still think the ProDisc is an excellent solution, but I no longer think it holds an advantage over the Charite. I'll be happy to discuss the differences as part of another conversation.)

>>> How much did it cost? Are you sitting down? You are not going to believe this. A 4-level discogram (performed by Zeegers... that is very important), an MRI (better quality than in the US), the surgery, the hospital stay, all the aftercare, everything... no surprises, exactly as estimated was... $22,000. Add another 5 or 6K for travel expenses. We could have saved a couple of thousand if we'd planned better. Remember I actually had 20 days to get everything done.

>>> How do you do any follow-up? I have a local OS who I follow up with. I'm educating him on ADR. If anything happens related to ADR, I have Dr. Regan at Cedars Sinai available to me. He's in the clinical trial and I have an excellent relationship with him.

>>> Did you insurance pick up any costs? Ask me in a couple of months. I have Blue Shield of California. I expect them to fight, but I expect to win. They should pay for foreign surgery as for any out of network provider... 50% of their allowed amount. That should be about 400% of my actual cost! We'll see. I'm waiting for all my invoices to be tranlated into English now. I've been slow at getting this done. Even so, I'd have done this at 5 times the price. I refinanced my house for this. I put it all on credit cards while I was over there.

>>> How were your accomodations etc...arranged in Munich? The hospital is about 1/2 mile from the Queens Hotel. They provide a significant business to them with all their back an knee surgeries. They made the reservations. We never had a language problem at the hotel or the clinic.

>>> What did they require before you left USA? I just communicated with Zeegers, sent him films, etc... Once he says you are a candidate, you schedule the surgery with his assistant. If you can get your films in e-mailable format (.jpg files), you could get it all done via email.

>>> Is there someone that I could contact to discuss my situation? You must do your own internet searches. We are not allowed to post email addresses here, or I'd give you mine and help you get going.

I'm very happy to help. This was such an ordeal for me, I'm glad that I can provide some hope and some accurate information to people who are going through the same hell.

Mark.



[This message has been edited by moderator1 (edited 03-14-2003).]

Hi Mark

Thank you for taking the time to respond to my message. That is a lot of great info. and just might be my ticket out of this rollercoaster ride we all know to well. I had a few more questions if you don’t mind, and I also included a rough diary on my back history.

You mention that you would of preferred to use the Prodisc, why?

The costs you incurred are amazingly low. I am sure my insurance company has paid way more than that and I am right back where I was before starting my rollercoaster ride from hell. Do you have a rough breakdown of your costs?

What was your rehab. Like from the surgery to the plane ride home? After?

What is the lifespan of your implants and will you have to do the whole thing over again in 20 years or so?

If I could hold out for a year or two do you think it would be worth it? ( I know you cannot feel my pain but probably have had simular symptoms) and I also worry about the “learning curve”. There will only be a handfull of Drs. who have even done the one level proceedure. It may be a few more years untill they have enough experience just to be competent with that , let alone multi levels. So I really may have 4 or 5 years to wait. If you could give me your thoughts on that, I would be gratefull.

Could you play golf if you wanted to?

Thanks again for your thoughts and insight,

Mark


1998 discectomy L-3,4/ L-4,5
1999 Discogram L-3,4/ l-4,5/ L-5, S-1
1999 IDET L-3,4
2000 Rhizotomy Facet Joints L-3,4
2001 Discogram L-3,4/ L-4,5/ L-5, S-1
2001 IDET L-5, S-1
1998-2002 Various cortisone injections ( more than 20)
2003 trying to avoid 3-level fusion and waiting for ADR to be FDA approved

Surfdaddy:

Re: ProDisc - At the time, I felt that the insertion tools really did make the procedure easier and less error-prone. I have since discovered the downside. That is key. Every difference between the devices comes with advantages AND disadvantages.

Before I continue, let me reiterate... either device, properly implanted in a properly selected patient is an excellent solution to many of our spine problems. When I talk about which device has the advantage, I want to be clear that when all is said and done, they are so close, it's a coin toss. That's why I went to the place that I could get references from in spite of the perceived slight advantage of one device over the other.

If you talk to a ProDisc surgeon, he'll tell you why the ProDisc is easier to insert and that the Charite has a tendancy to 'run' in an unpredictable direction when the cleats are pressed into the bone. If you talk to a Charite surgeon, he'll explain the downside of the keel, the need for a perfectly straight approach, and that with a little experience, gaining proper placement of the plates is straightforward.

The key is experience.... either device implanted by an experienced surgeon is likely to be placed properly. However, with the ProDisc, if the slot is not chiseled in the right place, you are done. There is no moving it. I know one patient who's ProDisc was implanted too far posterior, so the prosthesis extends beyond the posterior margin of the vertebra. It forms something like a disc bulge. He's in much more pain 1 year post op than he ever was before the surgery. With the ProDisc, moving or removing the plate is much less a possiblity than with the Charite.

With the ProDisc, you must have a perfectly straight approach in order to get the tools in position. If you present a difficult approach, then placement of the prosthesis becomes a compromise. With the Charite, if one side is difficult, they'll move to the other side. There is no such, perfectly straight in, requirement.

Again... all this discussion is 100% trumped by the experience of the surgeon!

I also liked the way the ProDisc becomes a 2-piece device. The floating core of the Charite made me nervous. ProDisc proponents will cite that the design eliminates the risk of subluxation (dislocation of the core.) Again, if subluxation is not an issue with the Charite, this discussion is completely irrelevant. You may not realize that the annulus is left intact. After the prosthesis is inserted, the window in the annulus is sewn shut. The core is not going anywhere!

BTW, I'm having something of a setback now. Some nerve pain and other radicular symptoms have cropped up. I have new x-rays that show proper placement... nothing has moved. I have heard from other post-ADR patients that occasional flare-ups of nerve pain is not unusual... just as it is with other lumbar surgeries.

I can't go get the cost breakdowns now. Just assume that the percentages remain about the same. I think the prostheses are about 2 or 3K each. They'll probably be 8-10K in the states! MRI - 600. Discogram - 1500??? The rest is shared between hospital and doctors.... it's so inexpensive compared to the states. Oh yes, there was a brace for $1,000 too.... all part of the 22K.

Plane ride home was better than the plane ride there. Although, I came home on 120mg/day of Oxycontin, but went there on 60/day. Remember that I was already sightseeing before the trip home. I did have to extend my stay there.... I had planned on returning at 10 days, but needed to extend to 15. I had a bad reaction to meds and suffered from some back problems unrelated to the surgery. I'd suffered with horrible spasms and pain throughout my back prior to my surgery. They got worse after the surgery so when I should have been improving, I was getting worse. We started some Pt and that really settled things down so that at the 10 day mark, I started sightseeing. BTW, therapists came and opened the clinic on Sat, Sun and a national holiday, just for me. The way everyone there went above and beyond was wonderful.

Rehab; I came home at 15 days and immediately started tapering off the meds. I had been on opiates for 3 straight years. It took 4 weeks to get to zero, plus another of withdrawals. So, my first 5 weeks were dominated by withdrawal symptoms... that was a great time for me to heal. When the withdrawals were done at week 7, I felt wonderful. I started swimming and riding my bike. I started PT, rode my bike to PT, started rollerblading with the dogs... It was mostly good times since week 7... just a few minor setbacks.

I don't think the lifespan of the device is much of an issue. They've explanted a set (I don't know the details of why, how long, etc... I just know the hype) and found no measurable wear on the plates, no detectable wear debris, and expected and tolerable deformation of the core. I would think that if the core wore out, that they could replace just the core. We'll have to wait years to see how this all shakes out. I intend to try to wear mine out. In any case, with fusion as the option, I'd do this every 5 years if need be.

I felt that I had to be bad enough to justify doing a fusion before I made the leap to do such a large surgery. I do know a patient who's life wasn't too bad before, but is horrible now. This is spine surgery and under the best of circumstances is risky and without guaranteed success. If you are risking permanent damage by waiting... if you have serious nerve compression... if your discs are so flat that you are destroying the facets by waiting... earlier is better than later. However, if you have reasonable disc height, aren't developing instability, don't have neuro-deficit that is advancing, then you can wait. Only you will know when it's time.

I couldn't play golf, sing or play the piano before the surgery!!! I have played some tennis, but when I played very hard... I beat my 19 year-old son who played varsity in high school, 6-1 6-1... I had something of a setback after that. All my activities, kept within a reasonable range have been fine. I have skied (black diamond runs), been rock climbing, played soccer (in a non competative environment)..... If you are already a golfer, I wouldn't anticipate a problem.

Remember though that being pain-free is probably not a reasonable expectation.... in undertaking such a serious surgery, the focus should be on being able to function again... returning to sports is gravy.

Good luck,

Mark

Originally posted by lakezurich:

...I am not at all impressed by your figures about charite though. This is 750 surgeries over 10 years, less than 75 per year. Simply by looking at these figures I am not willing to believe that this is a success story having so few operations. The ortho surgeons I know do between 100-600 opereations per YEAR, the majority between 200-400. Maybe I am a bit biased however because as I once mentioned, I am myself involved in the introduction of a new fusion implant with almost as many patients as charite but over a much shorter time span. Again, also not as a medical person but I have acquired some knowledge about fusions and of course I am also looking over the fence, i.e. artificial discs. I had a discussion with a surgeon of a large spine center yesterday on which my remarks were based and I must confess that after having had discussions with a few surgeons that are all working at centers doing well above 200 operations/surgeons, I firmly believe that artificial discs are not ready for implant. Unfortunately, because progress is very necessary, as today's fusion outcome is by no means satisfactory. I am assisting one of the parties which is trying to bring relieve, hopefully there are others. From my knowledge today, I have to assume that atifical discs are simply a jump too far, the natural step should be making fusions work. Hopefully, artificial discs will work in ten years by now, but I doubt they will before.


And another post...


...
What I feel is important however: I think you should discuss it as fast as possible with an orth surgeon of your trust. One that does at least well over 100 operations per year because if the does less he is not experienced enough and likely had not had enough "problem" cases which may help him assess your situation....


One of the things I discovered during my ordeal is that reliable sources are not reliable in all cases. My sources of misinformation that caused me to dismiss ADR 2 years before my surgery were people who I trusted (and still trust). They had been reliable sources in the past, so I tended to believe them. I see the same thing with LakeZurich. I've looked at many of his posts. He's helped a lot of people with some very good advice and I applaud his efforts. The surgeon's advice that he's quoting is probably a reliable source on many topics, but, as you can see from my earlier post about range of motion of the prostheses, he's probably not a good source for information about ADR.

During my ordeal, I probably saw 15 surgeons. 1/2 of them said things like, "come on in and get your 2-level fusion and you'll be playing soccer in a year." All of those guys I call fusion factories and they all did somewhere near 200 fusion a year.

In my opinion, they suffer from the "I've got a hammer, so everything looks like a nail" syndrome. I believe that this is why we see so many failed fusions. With ADR, you'll see much discussion about patient selection. You must demonstrate the pathology that will be solved by ADR, or else you are not a good candidate. With many surgeons, especially with the fusion factories, they seem to think fusion is the ultimate surgery that they hope will fix most, if not all, sources of low back pain.

The idea that Zeegers advice is not based on enough experience because he has averaged 75 disc replacement procedures/year over the last 10 years is ridiculous. That does not take into account his total number of surgeries. He does more than just ADR. Is the total experience of 750 surgeries over 10 years somehow less valuable than 750 surgeries over 4 years? There isn't another surgeon in the world who's done more ADR procedures than Dr. Zeegers.

Fortunately, we all get to decide who we want to believe. We can change our minds as we learn more. We'll find that those we get good advice from, we can also get bad advice from. For my money, I'll be happy to take advice regarding ADR from the surgeons with the most ADR experience. As far as listening to doctors who do 600 surgeries a year... I think I'll stay away from them. If they do surgery 2 days a week, 44 weeks a year, that's almost 14 surgeries/week or 7 a day. If they do surgery 3 days a week, I wonder how they properly evaluate, do follow-up on their patients, or run their practice in the other 2 days.

Listen to all the doctors and make your own decision. But, dismissing the opinion about ADR of the most experienced ADR surgeon in the world, because he doesn't have enough experience would seem foolhardy to me!

Mark

you mentioned pdr. my surgeon has offered this as a possible solution for me. i am finding it hard to decide as it is difficult to get info on this procedure.
i am from australia and my surgeon recently attended some seminar in france so he has only just learnt about this procedure not yet performed it.
he is taking until my next visit in june to give me time to decide and also get himself more acquanted?.
i get alot of pain in my hips, and in my back l4/5 and l5/s1 are my affected disks. he suggested that this operation would be less invasive than total disk relacement.
he advised that if i did not act soon i would not be a candidate for this surgery. i don't want to wait too long but unsure if i really want surgery at all. he has also spoken about a wallis ( have you heard about this? its like a clip that pulls together on one side to give more disk space on the other) my surgeon sugested one of each procedure. still has not done diskogram so not definate yet. i think as i have made it clear i didn't want surgery in the past he is giving me the time to research my self.

if you can throw any advise down here it would be appreciated. all costs will be covered by workers comp.

Kristen:

I'm assuming that you are talking about PDN (prosthetic disc nucleus)? I have not studied it extensively, but I have discussed it with a doctor who's been pioneering that technology. Dr. Bertagnoli (top ProDisc surgeon) has been working with the manufacturer, changing the shape of the implants, etc... My impression is that it's still very early. They will not consider multi-level PDN. Please remember that my opinion on this is worthless.

It's a great idea... a less invasive procedure that can be performed earlier in the degeneration process, so additional elements of your spine don't get further damaged. I sure hope we see it working like that. Please keep us posted as you learn about it.

As for the other device, I've not studied it at all and have not info to offer. It sounds like your surgeon is agressively pursuing new technologies. That is great, but it also brings extra risks. It's good that you are down in Oz, so you have these technologies available to you. I know a couple of people down there who are currently scheduled for ADR surgery.

I'm hoping to go to the a conference in May where I'll meet all the major players in spine arthroplasty. If I learn anything relevant, I'll post it here.

Good luck!

Mark

Mark thank you for all that you've posted on pdr.I am very interested to see if I am a candidate for the surgery as my ortho has suggested fusion.There doesn't seem to be any trials going on here or near Massachusetts that I may be referred to.Would appreciate info on contacting Munich for evaluation.Thanks in advance.

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hurtinmass

Hurtin:

A lot of people confuse my recommendations of the German surgeons. I had my surgery at the AlphaKlinik in Munich with Dr. Zeegers. They do not use PDN.

Dr. Bertagnoli at St. Elisabeth in Straubing Germany is the doctor who's been pioneering PDN. Mark

I'm assuming that you are talking about PDN (prosthetic disc nucleus)? I have not studied it extensively, but I have discussed it with a doctor who's been pioneering that technology. Dr. Bertagnoli (top ProDisc surgeon) has been working with the manufacturer, changing the shape of the implants, etc... My impression is that it's still very early. They will not consider multi-level PDN. Please remember that my opinion on this is worthless.

if this has to do with pro disc and more then 1 level they do it. i had l4-5 l5-s1 done january 28th

jackie

Jackie, congratulations on your 2-level disc replacement. How are you doing? You're about 2 1/2 months post-op now.... please let us know how you are progressing. I'm looking forward to hearing of your success.

Mark

PS... PDN is different than ADR. The prosthetic disc nucleus is a soft implant that replaces the disc nucleus and can be inserted arthroscopically. It's like a pillow that absorbs water and forms a very stiff gel. It is intended to restore some structural integrity to a collapsed disc, with a less invasive procedure than total disc replacement (ProDisc or Charite).

Mark...

I am sure that everyone reading this listserve appreciates what you contribute even if they don't agree with your opinions. Hopefully, you are feeling well. My two-month problem does not compare to what you've been through.

Even so, I have been reading everything that I can get my hands on regarding the disc replacement clinical trials being conducted here in the USA. Unfortunately, my extrusion is between L2 - L3 and everything that I have read thus far has addressed problems with discs between L4 and S1 for the Charite III and L3 and S1 for the Prodisc.

Has anyone in Europe replaced a disc at the L2 - L3 level and if not, do you think that it might be done sometime in the future?

My injury occurred 7.5 weeks ago and I have been going to physical therapy for three weeks. The initial non-aggressive approach was at my request. The two opinions that I received from physicians were that a disc at this level does not usually respond to non-aggressive treatment. There has been some improvement but I would really like to get off the Percocet and get my life back.

Complicating my condition is the fact the disc between L3 - L4 is black on the MRI which, I was told, indicates a loss of fluid content. Additionally, I had a piece of the disc between L4 - L5 removed in 1991, seven or eight years after the accident occurred that damaged that disc. That disc is not giving me any problems.

A need for a fusion has not been indicated and I would not want one. Nothing that I have read about that procedure is appeals to me.

So my desire is to have the disc between L2 - L3 replaced, if warranted, and I would be willing to travel to Europe to have it done because it is not likely that it could be done in the USA for several more years.

My present problem affects my left leg and hip....some numbness, reduced mobility and strength...complete loss of left knee-jerk reflex.....I can sit but arising from that position is traumatic...sitting on a toilet seat causes immediate trauma...unable to bend at the waist to tie my shoe or pick up things.....sleep is achieved by napping for short periods of time....I cannot make it through the night without getting up to deal with the pain once or twice each evening....
So, once again, are you aware of anyone receiving a disc replacement at L2 – L3?

Thank you for your time and efforts on my behalf.

Rich

Rich,

L2-3 shouldn't be a problem for either the ProDisc or the Charite'. You don't see them discussed because typically, lumbar problems occur lower in the spine.

Your case seem to be pretty emergent because of the severe radiculopathy you are experiencing. My understanding is that pain and numbness will usually get better when the nerve irritation is resolved (unless the nerve impingement has been severe for a long time... more than a few months)... but loss of reflex usually doesn't return. I still have no axial reflex in my left ankle 2 years after my L5-S1 discectomy relieved the nerve impingement.

Most surgeons wouldn't consider such a serious surgery on such a new problem, but with your black disc and severe radicular symptoms, that might not be an issue.

Don't rush into anything... ADR is a huge surgery with significant risks. Do your homework... make informed decisions. Don't believe what you read on the internet!

Good luck.

15.MRI.GUY