HealthBoards

HealthBoards (http://www.healthboards.com/boards/)
-   Spinal Cord Disorders (http://www.healthboards.com/boards/spinal-cord-disorders/)
-   -   3 Level Cervical Fusion or go to Germany for ADR (http://www.healthboards.com/boards/spinal-cord-disorders/458116-3-level-cervical-fusion-go-germany-adr.html)

Zorro1p 12-30-2006 01:59 PM

3 Level Cervical Fusion or go to Germany for ADR
 
:confused:
Early this year, my neurosurgeon recommended I have a cervical spine fusion from C4-C7. At 51 years old, I thought this to be a giant surgery and began to look for alternatives. The main problem is a curve in my neck causing my spinal cord to rub up against it. Films show a spinal cord thinning in that area. I looked for alternative and really didn't find any in the USA. So I went to the Bonati Institute in June 2006, in Hudson, Florida to manage the pain in my neck and also the numbness in my right pinky. The pain was relieved but the numbness is still there. My hope was to postpone any fusion until there were Cervical Disc replacements being done. In September, 2006, I saw 20 participating hospitals in the USA doing these disc replacements. I went to speak to one of the Neurosurgeons at the Upstate Medical Center, in Syracuse NY. He told me I would "Never" be a disc replacement candidate, and if I did not schedule a fusion soon, that I would be a quadriplegic.

Needless to say I am now looking at alternatives. I simply don't understand why fusing bone in C4-C7 is better than replacing the discs.

I recently went to John Hopkins Hospital to get a 3rd opinion on my Kyphosis and Myelopathy. I specifically asked them why I should be fused rather than replacing the discs and their answer was that my spinal cord needed to be stabilized and that the movement allowed by disc replacements would likely worsen my Myelopathy.

Thoughts?:angel:

BobM 12-30-2006 02:46 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
I have had ACDF on C4/5/6/7 - the same levels you are talking about. My first surgery was in 2004, and I asked about ADR since I had read about it here and on other web sites. I was advised that the disk replacement technology was still in clinical trials (at least in the U.S.), and only on cases involving a single disk. So, there were issues with the maturity of the technology, the number of levels (at least about adjacent levels), and insurance coverage. I had both myelopathy and radiculopathy that were so advanced that I would have risked permanent damage to wait.

With so many levels fused I have lost some range of motion, and have some chronic pain now - but no where near as severe as it was before the surgeries. It seems like disk replacement instead of fusing - if there is confidence in the technology - might have eliminated some of my residual problems, but there evidently are concerns about those of us that have multiple levels that need 'fixing'.

Maybe ask your Drs if there are 'middle of the road' alternatives, like ADR for some levels and fusing for the rest - the idea being to retain as much range of motion as possible? Another question might be if levels are fused now, can artificial disks be 'retrofitted' down the road as ADR becomes more common?

Best of luck in whatever you end up with - for me the risk/certainty of permanent nerve damage the longer I waited was the compelling reason to go ahead with the ACDF operations.
Bob

PearlDoves 12-30-2006 04:05 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
I'm thinking that what the doc is saying is that because of the curve problem in your neck that a disc replacement would not help your situation just because of the mechanical aspect of your neck in general. If you had disc replacement you would still have the curve problem thus not helping your situation. It has nothing to really do with the discs, its the mechanics of your neck as a whole. I have kyphosis as well which was part my benifit of going thru with my fusion surgery so that it would help correct that curve. My discs were in pretty good condition so it was not a matter of discs alone, but the discs have to come out to stablize that spine and keep the spine from moving. A disc replacement for you would be pretty much be like taking out your disc and just putting it back in again but with a new one, which doesnt correct anything because your kyphosis will still be present due to you still having the full mobility of your spine, which in turn still causes stress on your spinal cord.

Its my feeling that you should take their advice and get going on surgery before you end up with permanent damage. The longer you wait the longer your recovery could potenially be. As they say "Time is Nerve". Every surgeon is likely to tell you the same thing whether in the usa or over seas. Having the fusion will indeed stablize your spine and help the curve of your spine because it won't be able to move in a way to cause the problem. Good luck to you and many blessings. I know its not easy and everybody wants the best outcome for themselves but I really feel fusion is the outcome that you need. I know you probably aren't looking forward to having a limited range of motion, but its better than not being able to walk or enjoy life the way you would like down the road.

Zorro1p 12-31-2006 07:58 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
Thanks for the response BobM and PearlDoves. I believe my Kyphosis is caused
the the lack of discs in c4-c7. Looking at the pictures, if the discs were removed and the space opened by either fusion or ADR, I believe the neck would straighten out. My fear is that fusion is permenent. If the ADRs fail, we can always go back and stabilize it using a plate ... I think. I only wish I could add some PDF of JPEG attachment to this thread.

I got feedback from Stenum which gave me this hope.
[COLOR="Blue"]
"Your films on CD and medical reports were received and evaluated by our senior consultants Drs Zechel and Dr Ritter-Lang.

Diagnosis:
Based on x-arys and myelogram (we requires new MRI, can be done at Stenum pre-op)
There is a kyphosation noted
C4/5: Degenerated Disc Disease
C5/6: Degenerated Disc Disease
C6/7: Degenerated Disc Disease

Therapy plan:
C4/5: artificial disc replacement
C5/6: artificial disc replacement
C6/7: artificial disc replacement

type of implant cervical: Prestige of Medtronic or Scient`x "[/COLOR]

ShepherdLady 12-31-2006 05:29 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
From what I have read about ADR, is they are starting to have problems with them. A disc is supposed to cushion and have some give to them. The artifical ones don't. They also have a tendancy to slip, back and forth. And I have also read that some people are filing suit over them as well.

I myself won't even consider them. JMO

But I wish you luck!

Zorro1p 01-01-2007 01:03 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
Hi ShepherdLady ..... I read some of your recent posts. You sound like you have my same problem and I hope all goes well for you in January! (Happy New Year)
Although there are lawsuits with ADRs ... I'm certain there are as many with fusion. I'll be interested in seeing your results in Feb .... I have not yet determined what to do .... but my thoughts still lean towards ADR .... I only hope that you get the best of results ....

Vegas74 01-16-2007 10:39 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
Go to Germany, if they dont think your a canadate for ADR they wont do it, they will do a fusion or what they feel is best they will give you all avaliable options and its your call-they dont force anything on you, but at least you'll be in a spot where you have options, the implants they use are not even being used in clinical trials here in the US-they are much more advanced and fixed some of the troubles with the "old" implants the FDA is doing trials with now(the FDA isnt your friend its a Govt beaurocy(SP?)), the consultation there is cheap, the trip is easy, and you can awalys leave.

ShepherdLady 01-16-2007 10:30 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
[QUOTE=Zorro1p;2719301]Hi ShepherdLady ..... I read some of your recent posts. You sound like you have my same problem and I hope all goes well for you in January! (Happy New Year)
Although there are lawsuits with ADRs ... I'm certain there are as many with fusion. I'll be interested in seeing your results in Feb .... I have not yet determined what to do .... but my thoughts still lean towards ADR .... I only hope that you get the best of results ....[/QUOTE]

Hi Zorro,

Well, fusion has been going on since the 50's and still is the gold standard of treatment. I bet there is some lawsuits that happen! Maybe because of the chance of non-fusion. But with the BMP being used more and more non-fusion may be the thing of the past. And of course there is always that chance of coming out of surgery with more pain than going in. EEK! But those are the chances we have to take I suppose.

Well, whatever way you chose to go, I really do wish you the best of luck! I truly do.

Just the ADR, here, I surely wouldn't. Not even the docs in Europe are using the Johnson & Johnson ADR they are pushing here.

But good luck to you, and if your having myelopathy symptoms, don't wait to long in whatever method you choose. :)

Zorro1p 01-17-2007 11:58 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
:dizzy: Well I've been in contact with 2 surgeons in Germany and I'm leaning toward Dr B. They want me to get a new MRI, so I'll get that scheduled in the next few weeks. They mentioned that I may need a forth level .... geeezzzz. No way will I do a 4 level fusion. wayyyy too scary.:eek:

I decided to wait until April to do it ... when the weather is better in Germany.

bw67 01-17-2007 02:37 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
did you look into DR. MERRILL REUTER at Advanced Orthopaedics of South Florida, in Lake Worth, FLA??

I had 5-6 different doctors recommend a two level acdf at C5-6 and C6-7. Dr Reuter was able to fix my herniations with an endoscopic procedure without fusion, and without removing the entire discs. He only removed the part that was leaking(the nucleus), lasered the tears shut, and then injected a gel made of my platelets into the discs to take the place of the nucleus.

I have no idea if he can do it at 3 levels, but I would highly recommend looking into it if you haven't done so, and then weighing your fusion vs ADR options...

Also see my post NON FUSION OPTION

good luck

BW

Zorro1p 01-17-2007 02:52 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
Hi,

I did something very similar at the Bonati Institure in June last year. My pain is gone now but I do need to fix the Kyphosis, so surgery is most likely the last option for me. Thanks for the feedback though ....

PNo 01-18-2007 10:58 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
I am fused C4-7 and I have no range of motion loss except very minimal looking down loss. Truthfully, I don't really feel the difference in there. I have residual pain issues and problems, but my case was complicated.

Disc replacement is only going to fix the alingment problem and give you height, it would not repair or stop any ongoing degenerative arthritic changes.

There are problems with fusions, but the alternative of permanent nerve damage or paralysis from not doing anything, makes the fusion reasonable for me.

The advice I would offer is that disc replacement is still very new, I could almost be convinced by a good doctor to maybe be a candidate for one level, but if someone were trying to get me to go for multiple levels, I think [B]I [/B]would run the other way.

Zorro1p 01-18-2007 11:21 AM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
WOW .... that's refreshing to hear! You're the very first person who's told me that you have range of motion. In so far as being taller, I would imagine both procedure require full disc removal and and insertion of a Bone or device to fill the correct gap.

What were your symptoms and problems? Kyphoisis and numbness in the arm and hand?

Thanks .....

Zorro1p 06-11-2007 01:09 PM

Re: 3 Level Cervical Fusion or go to Germany for ADR
 
Well .... I went to Germany and had a 3 level disc replacement by Dr. B.

I had been reading these boards for a year now and concluded that I would have Dr B. do my surgery. I had 3 levels of disc disease causing a kyphosis which in turn caused a mylopathy (stretching of my spinal cord). One year ago I went to the Bonati Institute in Hudson FL to get rid of the pain. I was pain free with the exception of a tingling in my right pinky. I needed to fix the mylopathy so I chose ADR over Fusion. I was out of the hospital in 3 days and touring the Straubing area. Since I had no pain going into surgery, I did expect pain coming out. Seeing that I'm about 1" taller now, the tendons and muscles are all stretched out, so I'm getting massages to ease this pain. I take Motrin once or twice a day, and I feel good. The Tingling in the hand seems to be getting better as well.

Now, I need to figure out how to get some form of insurance money for this. Seeing that the procedures for ADR and Fusion are basically the same (Open you up, Discectomy, trim the bones, and either insert bone or ADRs), some of this should get paid for. I'd appreciate any info you may have on this. I am employeed by IBM (they are self insured) and they turned me down 3 times when I went for pre-approval.:blob_fire


All times are GMT -7. The time now is 06:49 AM.