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Old 05-19-2010, 01:43 PM   #1
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ADR or Fusion for double cervical

Hey everyone! I've posted my mri on another post but to make it short c-5-c-6 cord contact and flattening and encroaching on c-6 nerve root . C-6-C-7 herniation effacing CSF space without cord contact.

1st-2nd Neurosurgeon's said double anterior diskectomy with fusion.

3rd NS said ADR Artificial Disc Replacement for one C-5 C-6 and I would have to get another MRI to determine if the 2nd ADR is really needed otherwise he thought maybe I could hold off awhile on the 2nd. It looks like he uses the Pro Disc. Anyone have experience with that?

I have Blue Cross Blue Shield in NJ. Anyone have ADR approved for cervical with BCBS? Thanks!

I had surgery scheduled with fusion but put that off right now to explore the ADR because I found out this (fusion) may be a problem with my job.

 
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Old 05-19-2010, 03:13 PM   #2
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Re: ADR or Fusion for double cervical

it may have changed byt when I looked into 2 ADR's for the cervical spine last yer, the FDA had not approved the surgery. As of June last year, you can only have 1 ADR in the neck. Maybe that is why he's suggesting you hold off for now because it is not yet approved.

Has anyone suggested a laminoplasty instead of a fusion? A laminoplasty rebuilds the back of the spine to make more room and allow the cord to move away from the compression and they can open up the area where the nerves leave the spine at the same time. No fusion is done so full movement is preserved. Do a search on the word.

I know that they are doing this surgery at Columbia-New York Presbyterian and I can't imagine it's not being done at some of the other big medical centers because they've been doing in Boston for several years.....at least 10.

Just another suggestion.

Jenny

 
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Old 05-19-2010, 06:28 PM   #3
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Re: ADR or Fusion for double cervical

Hi Jenny The NS did say he did double ADR but not too sure if that was for BCBS. It's crazy because I called BCBS and they told me I would need a surgical code or something which is specific to what is done the way I understand it so I can't really get that until they actually schedule it. With that I should find out next week as I already have my MRI set for tomorrow. Excited though because I was worried about a double fusion and hope I have a chance at the ADR.

What did you do in place of that when you looked into it?

 
Old 05-19-2010, 06:45 PM   #4
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Re: ADR or Fusion for double cervical

I had a 4 level laminoplasty originally and then 3 months later I broke 3 vertebrae and partially dislocated 5 vertebrae and ended up with a 6 vertebrae fusion( C3 to T1). Last year there was concern that I might have herniated the disk between C3 and C2 and I looked into an ADR for the one area and that was when I was told that it can't be done that high. So I asked a few more questions about how many can be done in the neck and was told 1 ADR at that time. 2 was pending the approval of the FDA...maybe it has been approved.

So the only options I have left in my neck are fusions if anything else goes wrong...one of the problems once you fuse. Once you start fusing, you give up the options of ADR's and other none fusion surgeries. Pays to know your options ahead of time and the consequences of the surgery you do choose.

good luck..............Jenny

 
Old 05-19-2010, 08:11 PM   #5
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Re: ADR or Fusion for double cervical

Sorry you are going through all of that Jenny. I didn't know that about the options being limited once you choose fusion. That is what is great about these boards because some things you never realize to ask because the NS doesn't mention it. How is your range of motion now with the fusions?

Maybe the C-2 C-3 are too small? I was amazed at how small the ADR really is, looking at it today in the NS office. In photo's it look's so big.!

 
Old 05-19-2010, 08:32 PM   #6
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Re: ADR or Fusion for double cervical

No, the doc said it has to do with them not wanting the ADR that close to the brain stem. ADR's aren't perfect. They have a history of making "dust" around them as they grind down the plastic parts inside(and probably some of the metal too) and they just don't want that stuff that close to the brain and the possibility of it moving upward into the brain. It is advised for the lower areas of the cervical spine only.

I'm okay with motion. Lost about 25% of my neck motion but I still drive and do just about everything I used to but with more care. I did go on disability though. I was partially paralyzed after the fusion and no one knew when or if it would resolve(it did) so I applied and am still on it. At 58 and having battled osteoarthritis since a teen and rheumatoid arthritis for the past 5 years, I was too tired to go back to work even though I'm much better. And I'm glad I did because it seems that each time I get over one thing, I get another. Getting old can be hell.

Hi to NJ...I was born in Orange.

Jenny

 
Old 05-20-2010, 05:35 PM   #7
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Re: ADR or Fusion for double cervical

Orange right down the parkway! I was just out that way the other day. That's good you can do everything you did before. Interesting about the dust and the NS did mention something about that. I did a search on dust and ADR and it brings up many articles about the dust and milling of the bone. So the question is which is worse the risks of the fusion or the risk of the dust?

 
Old 05-20-2010, 06:26 PM   #8
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Re: ADR or Fusion for double cervical

I just read the Pro disc is made of ultra-high molecular weight polyethylene. It sure is plastic.

 
Old 05-20-2010, 06:30 PM   #9
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Re: ADR or Fusion for double cervical

Ultra high molecular weight polyethylene has over 40 years of clinical history as a successful biomaterial for use in hip, knee, and most recently (since the 1980s), for spine implants.

This is a good sign that it has been used for 40 years.

 
Old 05-20-2010, 07:11 PM   #10
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Re: ADR or Fusion for double cervical

Hi Dwayne....yeah, grew up in Chatham.

I know the polymer has been used for a long time but that doesn't mean it doesn't degrade. In a replaced joint like a knee or a hip it stays encapsulated in the joint. In the spine, there is a direct connection with the brain at the neck.....the fluid that surrounds the spinal cord is the same fluid that surrounds the brain and it all mixes together. If the plastic dust were to get into the fluid, then it makes it's way into the brain. No joint capsule to contain it. Even if it doesn't get into the fluid, just having it around the vertebra, it could make it's way upward and if it's high enough in the spine, could it work it's way into the brain? That seems to be the big question.

Oh well.....it doesn't affect me and you are doing your homework so I know you'll have some question for that doc of yours. I see my doc in 3 weeks and well see what is wrong now. I know I have more problems it's just a question of what?

Take care..................Jenny

 
Old 05-21-2010, 06:44 AM   #11
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Re: ADR or Fusion for double cervical

Hey Jenny, Chatham is really a nice town. Partly I grew up partly in Livingston and for North New Jersey that whole area was really nice. I think the farther away you get from the GW bridge the less congested it gets. They are even repaving 280! Before that is was terrible to drive on the concrete part. My back was killing me after a drive on that!

You make a good point and sounds like you are knowledgeable about that. I will have to ask my NS upon the next visit. The idea of a double fusion as a truck driver really scares me more then the risks he was telling me about the ADR. I guess everything comes with a risk we all can't control to a certain point even with the best surgeons.

 
Old 05-21-2010, 10:46 AM   #12
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Re: ADR or Fusion for double cervical

I remember Livingston!

You are so right about assessing the risks and going with what will help you the most for the long run. As a truck driver, you must be afraid of not being able to turn your head enough to get good vision(my husband is one too). Ask your NS about how much rotation you'd lose with a fusion. I only lost about 25 % and I'm C3 to T1. It's the length of my fusion that caused the loss. But I was driving 5 weeks post-op(illegally but I was....not legal to drive while in a hard brace). I just made sure I had no intersections that weren't 4 way stops.

But with a 3 vertebrae fusion low in the neck, you may not lose anything at all in regards to rotation. It's the higher ones and the long ones where you lose rotation. Moving your head up and down should not be much of an issue but I can see where rotation definitely is.....ask! And you should check with the DOT and see if they have any rules regarding neck fusions and ability to rotate the head to see. Whoever does your DOT physicals might know or just call the DOT and ask. Maybe it's on-line? That might be a big influence on your decision and an NS wouldn't know about those things.

My NS did the laminoplasty with me initially because I am a watercolor painter and I need to look down at my paper....the one form of painting where an easel doesn't work. I have started painting again with the fusion and it's hard....can't look down for that long so I'm trying to modify how I do it. Took me over 3 years to get up the guts to try again as I couldn't bring myself to even try in fear of being disappointed. Again, you might want to ask about a laminoplasty as it preserves motion while relieving the compression. And no hard neck brace after surgery so you can return to work much sooner than after a fusion. You're looking at at least 3 months out with a fusion. I was back to work in 2 1/2 weeks, part-time with the laminoplasty. You only need a soft collar.

I'm glad you are doing your homework. You ll do fine no matter which way you decide to go.

Hugs...................Jenny

 
Old 05-23-2010, 08:03 AM   #13
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Re: ADR or Fusion for double cervical

I looked up laminoplasty and watched a video. Wow! I didn't know they had a procedure like that. It is amazing what they can do in cutting the bone and bringing it out like that. The only thing personally I would wonder if the disc would bulge out more then you would be in for another surgery? What was the recovery like in the pain in that area? Does the pain flair up ever?

You are right Jenny I am concerned about the range of motion and the pressure in sitting especially in the impact of the roads. You know NJ roads! The federal government likes to use old trucks so the suspension isn't alway's that great. I called a DOT doctor and he said that as long as the surgeon clears the person they are ok. My NS said it's no problem but it would take 3 months since I do heavy lifting etc. but I'm sure that is if there is no complications of course.

 
Old 05-23-2010, 09:13 AM   #14
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Re: ADR or Fusion for double cervical

I had the laminoplasty on 4 vertebrae...3,4,5 and 6. It was painful as they have to cut muscles in the back of the neck but I was off pain meds in 6 days and back to work at 2 1/2 weeks but only part time. I was supposed to be full time at 6 1/2 weeks but ended up having my gall bladder fail and had that surgery 6 weeks after the neck.

I suspect that they tilted my neck back way too far in doing the anesthesia for that because when I went home, it started to hurt a lot more and 5 weeks after that, the bone grafts they put it....I broke 3 of the 4 while sitting in a recliner.....they just snapped. I think someone over did it trying to get that tube down my throat and may have caused at least 1 or 2 of the vertebrae to move out of place. When the 3 bone grafts broke, all my vertebrae slipped further out of alignment. And one of the bone grafts fell into the spinal canal and impaled my spinal cord.

So I never got to enjoy the laminoplasty. I've spoken to people at my doc's office who have had it and it's been great for them. Many of them were construction people who needed the neck motion like you do. From what my doc's PA said, he's not doing more of those than he is fusions.

It's at least something to look into and see if you are a candidate for the surgery. My understanding from my doc was that the disk can continue to move out of place but they add almost a 1/2 inch of space so that's a lot of room. And if it does impact the cord, if the bones are stable, they just remove the disk from the front. But you should have a lot of time before that happens.

Can't hurt to ask about it and if your NS doesn't do it, see someone who does for a second opinion. Make some calls and see who does it. As I said, I know the NS people at Columbia-Presbyterian in NYC do it.

Jenny

 
Old 05-23-2010, 05:32 PM   #15
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Re: ADR or Fusion for double cervical

Former Morris Plains checking in :-) Now far away in AZ but miss NJ.

When I was being evaluated for my cervical surgery the surgeon said I could consider ADR but he said insurance would be a hurdle and he wasn't quite ready to do two levels of ADR. He also said that since I have a history of lumbar spine problems it was probably best to go for a fusion. I did and it was a great decision. The ACDF is one of the easiest surgeries I've been through and I've lost minimal range of motion. I did buy a panoramic rear view mirror for driving as I don't want to strain my neck in turning. I woke up after surgery with most of the nerve pain down my arm being gone. So the surgical pain is very easy to deal with since the nerve pain was gone. Searing nerve pain is just the worst.

I am now likely facing either adding C4 to the fusion or some other kind of surgery. Before I had my C5-C7 ACDF I had symptoms of pain down the arm and into my fingers. Now it is the same pain but just into the bicep area most of the time, but occasional down the arm the whole way.

If my doc suggests redoing the ACDF to add C4 I'll be fine with that. Though this laminoplasty is very interesting.
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Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

 
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