Post dynesys removal experience

johnb · #1 (**permalink**) 03-03-2009, 01:00 AM

Well, I'm 4 months out from dynesys removal. The removal recovery was much more painful than putting it in and my surgeon couldn't tell me why. I did get a reprieve from the nerve pain that developed shortly after having it put in but it has returned in both legs the last few weeks. It comes on much stronger when I'm standing and I'm curious about being evaluated in a load bearing position. It is painful but I don't sense any weakness and have no burning, just your bread and butter sharp pain here and there but mostly dull cramping aches. For the first time in a year, I went out with some friends to sort of test things out. We just went a few miles down the road and watched a friend of mine who plays guitar. I've had nerve pain ever since and I'm gonna have to go back on Lyrica or "Morontin". My local back pain isn't too bad except that I get a sharp pain on the lower left on occassion. The pain on this side after surgery was like a lightning bolt. It was the worst pain I've ever had and I'm not new at this. Also, some of my facets have auto fused inside the capsule. I don't have a scan to prove this 100% but I can tell that fusion has occured when I flex my spine. That explains why I don't have a certain lower back pain that I had pre surgery. After discussing this with my surgeon, he concluded that I did have facet pain and he did note a loss of motion and concluded that my facets had fused within the capsule just as cerviequeens had. I responded with, "well, good thing I didn't have an ADR at that level" and he concurred. That was the original plan a few years ago. I could still do a hybrid but I'm not sold on today's ADR technology. I realize some do great but I don't have the tolerance for the risk in my situation and my facets aren't great higher up. I had no idea my facets were that bad. I'm really interested in the new elastomer designs and we will have data on those in a few years since trials have started.

So what's next? Well, I'm gonna see a neuro that did my Aunt's fusion. She likes him (she barely likes anyone but don't tell her I said that) and I've heard good things about their practice. He's actually done research on cervical ADR's so I hope to get a balance perspective of old and new. They are selective which means they aren't an aggressive surgery factory. The main goal is to find out where the irritation originates from and go from there and have my spine evaluated by a new professional. Then I'll make informed decisions in a systematic manner.

John

mmglobal · #2 (**permalink**) 03-03-2009, 03:48 PM

John, what a bummer that your history takes you (I think) to where you were before the surgeries, plus the added damage of putting the Dynesys in and taking it out, plus more degeneration. The original surgery was done to correct a problem. What does the Dynesys surgeon say is the next step?

I understand the feeling that motion preservation technology will improve, but also wonder what is less risky... especially if one is talking about multi-level fusion as the alternative. (I don't know if this is what is being considered in your case.)

Note that some painful facets are resolved with ADR because of restoring disc height, realigining facets, restoring closer to normal kinematics, etc... Obviously, some will still experience worsening facet problems and I'm not sure the doctors know who will be who and each case is truly unique.

I'm babysitting a toddler now... gotta run... more later.

Mark

johnb · #3 (**permalink**) 03-03-2009, 04:52 PM

I'm not using the same surgeon anymore. I don't think an ADR would be appropriate at a level where facets have fused. I've read other comments about facets being improved by ADR but there is no clinical evidence to support that. Maybe if the facets are at early stages of degeneration but my surgeon said that he is seeing facet problems in many of his ADR patients and it is inconclusive whether they had some problems before or the disc caused them according to him. He also said that he has seen some problems with ADR's that don't match the disc height. One of my friend's brother has a charite done 3 years ago with him and is doing very well. It's all about indications and matching patients with appropriate treatments.

I'm not going to speculate on what treatment is going to be done in the future. My nerve pain needs to be found and addressed in the least riskiest way possible with consideration for future spinal problems too. Determining the state of my spine by a competent and HONEST physician(s) is the main goal. I have 2 degenerated discs that are no longer painful. However, stenosis is a factor now that they have lost height. Do you remove a disc that isn't painful or should you decompress around it? I don't have to worry about instability at levels where facets have fused. It's basically a posterior fusion with less grafting. I'm certainly not going to have a multilevel ADR. Too risky for ME. Others may have more tolerance for that kind of risk. Then again, I don't want a stif spine at my age and accelerate the disease process. The good thing is, I've done atleast a 1000 hours of my own research while I was laid up after my surgical failure and I'm informed now.

I've had disc disease for over 15 years now and I don't have ANY of the same back pain I had when the only thing that was wrong with my spine was annular tears and some initial drying/desication. The pain I had then was completely different then what I have now which is 95% nerve pain. No facet pain and no discogenic pain. In light of this, I wondering if radical long segmental fusion or ADR is appropriate? In hindsight, I know the difference in sensations. THe IDET I had years ago solved the old type of back pain but I ended up with a new one which was facet pain after my L5/S1 collapsed which accelated my facet pain. Facet pain was much more painful than discogenic pain, especially in the latter years. Something else noteworthy, I noticed a heating sensation in my back on the sides where the facets are shortly after they dynesys implantation. That was my facet joints fusion when the bone and bone quit moving against each other. The areas where bone is fusing (being created) is hotter than normal bone for biochemical reasons that are beyond the scope of this discussion. It is amazing what you can learn when you are laid up with a laptop in bed for days on end. discogram was not concordant for pain at L5/S1 after it collapsed in height.

John

trkdoc714 · #4 (**permalink**) 03-04-2009, 12:01 AM

Good luck at Peachtree, John. You've certainly done your research. You'll be a great partner for your surgeon.

By the way, have you noticed a lot of places/ streets/ businesses are named "Peachtree" around here?

Godspeed,

Bob

Kathy · #5 (**permalink**) 03-04-2009, 05:00 AM

John,
I pray that you find a great dr to help you find out what is wrong. I think that was one of the hardest parts of pain, when you don't know what the heck is wrong with you. I spent 3 years in that situation, where no dr would admit or tell me, what was wrong. It wasn't until I got to TBI that someone decided to be honest and tell it like it is. I am glad that you seem to be doing better post-removal than before. I wish you the best of luck and hope you get to the bottom of this soon.
Kathy

johnb · #6 (**permalink**) 03-04-2009, 07:01 PM

Kathy,

I appreciate the kind words and am glad you are in good hands. Good luck with resolution of your pain.

John

Justin · #7 (**permalink**) 03-04-2009, 08:00 PM

John,

Thanks for sharing your story and I am sorry to hear all that you have been through. I hope things start getting better for you. Best of luck and keep your head up.

Keep the community posted on your progress.

(OK, now I'm officially checking out of the forum for awhile. As always my PM box is open and I'll be checking it frequently.)

johnb · #8 (**permalink**) 03-08-2009, 07:02 AM

I approached my removal decision is systematic manner based on recent info and factored in the risk that comes with future uncertainty. There were a few presenstations at NASS 2008 on the dynesys that I can post under articles. One concluded that there was correlation with dynesys causing adjacent problems further up the spine. My surgeon confirmed this. Of course, the natural disease process is still not totally understood but that was one factor. Seeing that my nerves felt worse, why risk more degeneration thus complicating future treatments? Either that study or the next one concluded that dynesys did not help discs heal (I was told by my surgeon that dynesys would help heal my discs and this was a big factor in my decision to have the implant). Conversely, degeneration continues with the implant according to the studies. Another factor was risking screw breakage if left in place. Why risk that considering I was more disabled? As far as HA coated screws, they were billed for but my surgeon told me he did not use them once and earlier told me he did use them in his practice. So which is it dude? Get your damn story straight. This is my spine we are talking about

Are you starting to understand my frustration here? I will add that I'm feeling much better mentally than I was this time last year when I was ready to drive off a cliff Thelma and Louise style. I've worked with my stabalizatione exercises and am damn sore but a good kind of sore. I've managed to walk about a half mile per day and it doesn't aggravate the nerve pain too much. Atleast not enough to not do it. There was a lot of atrophy as my muscles were shaking when I first started.

Also, I found a nifty database at FDA.gov that lists adverse device reactions reported to the FDA. These are the dynesys submissions MAUDE Database Many of the screw breakages happened at or before 4 years.

I believe that the DSS will have less chance of screw breakage at is more dynamic putting less sudden force on the screws as the dynesys is a "mostly rigid" implant. Calling it semi rigid really a misnomer in my must humble opinion.

John

trkdoc714 · #9 (**permalink**) 03-08-2009, 02:06 PM

John,

I had my wife read your last post. She was almost a victim of your original surgical clinic. Although relieved, she's very sympithetic to your struggle. The same clinic was ready to fuse 4 cervical vertibrae since one disc was ruptured.

Our prayers are with you.

Bob

johnb · #10 (**permalink**) 03-08-2009, 08:36 PM

I'm gonna leave their names out of all this unless someone wants to talk with my privately. I've worked in sales for the majority of my working career. I never considered myself a "salesman" but more of a consultant. I never used any closing techniques that you get with telemarketers, many used car sales men, or time share folks. If you've been around long enough, you've come into contact with commission sales people that just want to influence you with whatever persuasive trick so they can get paid. My approach was, if I help solve this person's problem, then compensation will flow naturally and I'll pick up referrals and it worked very well for me professionally. However, I've worked with people that use the "sales techniques" such as "standing room" only or the all time favorite "suggestive close". I can almost guarantee that these surgeons have participated in sales training as I recognized sales techniques. Back in early 2002, they got busted defrauding medicare and had to pay back millions. There was a high profile case in our newpaper where a young man was paralyzed from misplaced pedicle screws. As I've said before, the surgeon I used is very skilled. Two people I know first hand, one with a charite and the other a fusion, are doing extremely well. I imagine you hone your technique when your real good at talking folks into surgery.