Dear Diane & Dale,
Congratulations on your successes (including families, children, friends and puppies.) I would love to have a puppy myself, but for Anastasia - with a destroyed leg and weakened back, having a boisterous puppy is probably not a good idea - no matter how much I beg.
Thanks for the concern about me ... but trust me, feeling sorry for me is the last thing anyone should do. I have no pain and a full life.
My point here is to emphasis that I did a hell of a lot of research ... only to find out later that it was all lies. I heard this from several German surgeons too.
I'm not beating myself up on our ADR decision ... we were sure we chose the best surgeon with the best device ... given everything we
read,
studies,
comparisons,
wear rates, ... everything. If I could have done more, (like I didnt do with the knee surgery), then I would be distraught with guilt.
What I'm disturbed about, is that
no-one even discussed fusion. Maybe it was our pure bad-luck to be living in Germany. Maybe its was our dumb luck to have read through ADRsupport at all the oozing praise of these surgeons. I studied everything, and eventually came up with the conclusions that:
1) The Prodisc has a 94% success rate in 60 year olds,
98.2% success in single-levels with average ages in the 45+ range, and no bad outcomes - compared to much worse results with the Charite. According to Dr. B. My 31 year-old wife had 1 level (l4/5) DDD, everything else perfect ... (but that was according to images from nearly 1 year before the ADR surgery.) Now I know those Prodisc numbers are not class I data. Not that it is relevant to our situation - since my wife was not a candidate at all. If she was a perfect candidate, I think everyone would agree that choosing a device with 98.2% success is better than something with
64% success, versus 58% for (BAK) fusion. Or maybe we should revisit, and look at the
Charite vs. Prodisc, with 93.9% (Charite) vs 83.3% (Prodisc). In any case, the FDA's results on the Prodisc were more like 53% ... but I didnt know that at the time.
2.) The AK and Sten'm are financially driven institutions, according to several German doctors. However, Dr. B. appeared as an academic. I like professors - they are only interested in improving humanity. They dont care about money. They will take a special interest in every patient. That is what I thought. Too bad they ignored our begging for a review session ... since 5 months before, and 3 months after the surgery. The surgeon Never even visited for a moment. Now I suspect he is probably more financially involved than all the rest combined.
3) I believed that the other institutions were assembly machines. We had already seen how the knee surgeon at AK never even saw us ... even after 4 extremely painful trips. He was too busy in his assembly line. We were foolish enough to trust the salesman, that they were going to do as written - check for a torn medial meniscus. They lied. We have written reports from many surgeons (including German), that her Patella was perfectly healthy. But, in any case, I was totally stricken when the ADR surgeon never even visited once afterwards. We were in the hospital 7 days, and in a hotel nearby 2 weeks. We begged ... and were totally ignored.
4) I read that fusion is horrible compared to ADR. That there is a 9% chance of revision surgery with fusion, lots of blood loss, an extremely long recovery period, a need for posterior screws, a high rate of morbidity with ICB (iliac crest bone), you will be stiff as a grandma, and the rest of your discs will blow sequentially. That, as I recall it, was my honest perception. You will note, none of the ADR kliniks tell you about the modern versions of fusion with 99% fusion rates, no need for ICB due to rhBMP-2 (bone morphogenic protein), the new PEEK cages which are MRI translucent, the minimally invasive (MAST) fusion techniques ... or even the micro-invasive techniques of injecting BMP into the disc which has been shown to stimulation regeneration. Even those damned trials compare ADR against failed fusion techniques (BAK). Its Criminal.
5) I was told that, in the case of failure of the Prodisc, it would be simple to revise it to either a different device or a fusion. I was not told that every surgeon in Germany would refuse to revise, because the scarring over of the veins would make it impossible to remove except laterally. It was not revealed that lateral explantation would require a huge osteotomy (remove of vertebral bone) ... and severing of the sympathetic nerves running through the psoas - leading to horrors that you dont want to hear about. I
found this all out later. Of course, you cant expect your surgeon to tell you all those details ... but you can expect someone (i.e. Synthes) to have addressed the concern ... since we can in fact expect a lot of them to fail.
6) I was not told that, the Prodisc only comes in 3 sizes (10, 12, 14mm), while the Charite has a lot more - down to 6.5mm in height. Also, the Prodisc has a minimum lordosis of 6 degrees, so if your natural segmental lordosis is very small, they will jam this thing in you, bending you backwards into hyperlordosis, permanently. If your natural disc height is small, then the Prodisc will jack you up ... and guess what ... its not just about distraction. Its your whole spinal unit. Its designed to fit perfectly ... which means the facet joints are only designed to work with an exact height of the disc. Its like a gate. If you mess up the hinge's height, the latch completely misses. Except, in spines, the missing causes tearing and crushing of facet cartilage. This probably explains the 32% facet degeneration
reported post ADR.
In summary, we have been run over by the loco of ADR, its financially conflicted proponents who publish outlandishly high rates of success, zeolots who present only the positives on ADR ... and not the litany of dangers. We have naively thought that certain surgeons are only academically driven, when it turns out that they have a huge financial interest. We were fooled into thinking the surgeon would make a thorough review beforehand, choose the best possible solution out of all available, and that he would give every bit of concern and compassion in follow-up ... not treat us as a legal nuisance.
So, anyway. Sharman is asking for advice about ADR vs. Fusion ... and everyone is saying - you need to educate yourself ... or praising the thoroughness on his questions... or talking on some other subject (uh, me included). But no one will address the questions directly ... we are basically saying go find your information elsewhere - while also saying that info is bogus. We all believe that ADR is better than fusion ... at least in the short run ... if all the patient selection criteria are met ... and the surgeon is highly trained and skilled ... and the surgeon is not financially biased to use an inappropriate device or technique ... and the patient has a thorough understanding of the risks and expectations (15% pain reduction = success), and the surgeon is going to openly and honestly take responsibility for whatever results instead of trying to cover up a major blunder and just hope the patient goes away ... like all the others.
I leave you with a few key quotations:
"Disk replacement is appropriate during the narrow time window when degeneration is limited only to the disc and signs of instability or degeneration of the posterior elements have not yet appeared. Limited by this time window and the inclusion criteria dictated by the US Food and Drug Administration (FDA) for disk replacement,
only 7.7% of patients admitted for lumbar spine fusion during the study period were found suitable for disk replacement. "
http://www.orthosupersite.com/print.asp?rID=25668
"the FDA and DePuy Spine recognize the limitations of the available data. They restrict use to a relatively narrow indication"
medscape
"Disc Arthroplasty changed my practice completely: Today, after 6 years experience, Disc Arthroplasty has replaced ~ 90% of my Fusion Procedures!" Dr. B.
"Reoperation Rate After Instrumented Posterior Lumbar Interbody Fusion: In the present study of 1680 patients, the revision rate amounts to 13.2%"
"Suboptimal patient selection and/or surgical technique accounted for the majority of failed disc arthroplasties."
spine
Article which debunks adjacent segment degen with fusion