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Old 03-11-2003, 09:42 PM   #1
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Post ADR misinformation

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).]

 
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Old 03-11-2003, 09:47 PM   #2
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Quote:
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


 
Old 03-11-2003, 10:05 PM   #3
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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

 
Old 03-12-2003, 06:53 PM   #4
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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!!!
__________________
L5-S1 hemilaminectomy with microdiscectomy on 2/18/03 - very successful
Currently daily low back pain with BANG! spasms, considering L5-S1 fusion.
MRI shows severe L5-S1 disc disease

 
Old 03-12-2003, 07:24 PM   #5
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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

 
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