[mmglobal]

John's surgery was in October of 2004 as Havanna stated in her original post. It looks like the 2005 date is a simple typo.

Why now? Because kc0iet recently sought me out and I suggested that others could benefit from her experiences. Havanna's post is self explanatory. How does she have his films? Because patients email xrays and compare. I also have John's films. Willie's got 'em. So do Vikki, Carmen, Fred and probably many, many others. How do you know they are not some random films taken from the Charite' lawsuit? I knew John personally. They are his films. You may choose to believe or not believe whatever you think appropriate.

I'm sorry that some find this unpleasant. This is not good for the industry, not good for the site. It's great for the patients that it helps. It's not great for the patients that it hurts. I'm sorry that this caused such anxiety for Bob and his wife. There is no way for me to time what other people post and there is no good time. It is what it is and we all have to be adult and understand that internet information is a mixed bag.

People who remember all the way back to my original ADR forum that was the predecessor of this forum and adr support... back pain support group had a thread about Fred's subluxated core. Stenum's representative did come and explain. You'll see that he said:

Originally Posted by ADR-Jim on September 23, 2004

Please don't believe everything you hear, Fred's core did not "pop out", the lower plate failed to adhear to his previously fused vertebrea. A risk they knew of prior, he will have fusion at that level and ADR above in Oct. Also it is my implant on getadr.com and I am now 18 months with no pain, skiing, tennis, soccer, lifting up to 80lbs, no problems.

A risk that they knew of prior? One would think that if they were concerned about such a complication, they might have implanted the disc with the front teeth actually having some purchase in the vertebral body instead of hanging off the edge. Positioning is discussed more, below. (Here is the original thread from back in 2004) Back Pain Support Group: Charite core popping out???? Note that the thread was started by ADRJen who is a successful Stenum patient. She was the first person I called when I resurrected the surgical outcomes posts that I had started at BPSG. Here is her update: ADRJen Charite L5S1 Aug.2003.

Yes, I called Cindy when she posted that she was going to have a total hip replacement, but I remembered her positive SI injection. I suggested that she get evaluated by someone who has a 'bigger picture'. Based on her response, I offered to connect her to someone who specialized in SI joint dysfunction. She has now canceled her hip replacement surgery and has had a much smaller surgery that seems to have resolved her pain. She chose her path with a small assist from me and we have no idea what the future holds. Had I not called her, she would have endured a total hip replacement, and presumably the pain that was resolved by the SI surgery would still be there. I think I have 100 of her dollars.

Yes, I called Bob to convey what I know about Stenum. If anyone thinks that there is a difference between the call to Cindy and the call to Bob, that's fine... I can live with that. Some people may call this marketing. I'm either blessed or cursed with this mission and have never made a profit at this. I have not been paid by the doctors. (Bob, you should not post things that aren't true and you should question the motivation of those who are telling you things that are not true.) I have only worked for the patients.

I don't know why anyone would suggest that the death was "twisted into placing the blame on Dr. Ritter-Lang." What was posted was, Unfortunately, remaining in chronic pain and the stress of the ordeal took it's toll on John and his pain problem turned into a drug problem. The drugs took him from us.

Regarding positioning of the disc: from the Charite' installation manual (2004):
> page 13, step "confirm positioning": The Centre of the artificial disc should be 2mm dorsal of the sagittal midline. (this 2mm posterior positioning is restated on page 14 also)

> page 14, step "endplate insertion" - Load the selected endplate into the endplate insertion tips placing the more angled of the two endplates inferiorly.

> page 17, step "final positioning" - Verify the final position of the Charite' Artificial disc using flouroscopy. It is important that the prosthesis is in the correct position in the AP and Sagittal planes. If necessary, the position of the prosthesis can be altered by slightly using the appropriately sized Grooved Driver. In the event of a gross malposition, the entire prosthesis can be removed and reimplanted, by reversing the previous insertion steps.

There are three grossly malpositioned discs pictured on this page. One of them resulted in a successful outcome. Two of them resulted in disastrous outcomes. I wish I could say that the steady flow of these types of failures from Stenum has stopped, but it hasn't. I have clients with similar problems with Mavericks and M6 discs too.

Regarding the angled plates. The side of the plates with the teeth that provide the bone / metal interface are identical on the angled and flat versions of the plates. Endplate shape, density, etc are not relevant issues with regard the angled plate being up or down. It is about bringing the plates parallel to each other and perpendicular to the load that will be placed on them. Bob, would you share the documentation that says the plates may be reversed? The design of the Charite' has changed somewhat. Perhaps a different device has different technique. In any case, I'd love to see what you have. I'll be happy to share the 2004 installation manual if anyone likes.

When you stand on a chair, do you put your foot in the middle of the chair of all the way on the very edge? Would you rather the chair be on level ground or on a hill. What if you stand on the downhill edge of a chair on a hill? Don't take my word for any of this... ask an engineer.

I know a lot of happy Stenum patients and I look forward to hearing about the success of both Bob and his wife. They have every reason to look forward to success. As I've always maintained... properly implanted in a properly selected patients, all of the designs will be fine.

Sorry for the disjointed ramble... I have tried to address all the questions raised. It's been a long night. I hope this helps to clarify some things. I have more to say, but have to go.

Mark