My 3 mo X ray - Discs tilted all over the place

[New-disc]

Good news Steve!!

Keep us posted when you feel up to it.

[dshobbies]

I'm so relieved that not only is the surgery over but also that he's doing well. I've heard bone infections are very difficult to treat. I wonder if he'll need follow-up treatment or is the removal of the ADR all that was needed?

If you read this, good wishes to you Steve!

Dale

[mmglobal]

Sahuaro, having been involved in over 500 cases now, I've seen way too much of the "less than 1% chance" types of problems.

I've only seen one other case of osteomyelitis and it came associated with discitis... an infection of the disc following a minimally invasive procedure. That case followed a typical pattern that included obvious infection parameters and very extreme pain just a few weeks after surgery.

[Bill1961]

Steve, I'm glad to hear you are on the other side and hopefully well on your way to recovery and a pain free life.

Mark, you mention that you've seen to many "less than 1% problems". Regardless of surgeons, is your reference to ADR? Or surgeries in general?

I have read many posts from ADR surgeries and there are many success stories, there are also many less than optimal results. ADR surgeries can probably be measured in the hundreds to a few thousand. I have also read about poor fusion outcomes as well, not nearly as many as you would think, considering there are some 200,000 fusions a year.

I'm starting to believe that the FDA has a reason to slow roll things and insurance companies might have reason to require long term data.

Myself I have a fusion from 2002 and (2)ADR's from 2009. I can tell you that the fusion was a piece of cake. No problems and was back to full activity 6 weeks later. The ADR's where more of a challenge to recover from. Maybe it was surgical expertise or dum luck?

I appreciate your thoughts.

[mmglobal]

Bill, I put "less than 1%" in quotes and said "type of problems" to make it clear that I'm not quoting any statistic. It really is not aimed at ADR... I'm just trying to illustrate my point that the harsh realities of spine surgeries really exist. 80% chance of success is not a slam dunk... neither is 90% (and I don't believe that any spine surgery comes with 90% chance of success.)

When I went to arbitration for the car accident that wrecked my spine, I was put into a 2% category and the defense that it's not really possible to be one of the 2% was very effective. Many of the types of problems that are supposed be so rare that we don't take the risks seriously, don't seem all that rare.

I agree that ADR success may be overstated, while in some circles, fusion success is understated. I learned very early in the process not to trust the numbers and I still don't trust them. Anyone who has worked with me knows that I believe that spine surgery should be avoided if possible and that I am frequently trying to clarify the harsh realities. There is no magic bullet.

In your case, "surgical expertise or dumb luck" may not be an either/or question. It may be the case that your bounce back from fusion would have been equally quick or quicker with ADR and that your bounce back from ADR would have been even worse if you had fusion. It's not necessarily that surgical expertise or luck are involved... it may be that the situation was completely different and that an optimum recovery was not possible from your ADR surgery regardless of what was done. I'm not suggesting that I know the answer and I also understand that it may be the case that you are right.

Having said all that, I'll still chose motion over fusion (if I'm a good candidate for motion preservation.) I believe that some patients who really need fusion avoid it way too long because of the fear created in the patient community. Fusion does not guarantee adjacent segment disease, just as ADR does not guarantee against it.

I've seen many presentations on failed spine surgery and specifically failed ADR. There is a frequent belief that a large percentage of the failed ADR cases would have failed with fusion as well, because the problem lies elsewhere, not in the treated discs. I also believe that many of the failed fusion cases would also have failed with ADR for the same reasons.

Do I believe that the insurance companies are dragging their feet because they have our best interest at heart. Absolutely not! I still don't understand why some insurance company bureaucrat gets to override the FDA and your doctor and deny access to FDA approved technology.

[Bill1961]

Mark,

I agree with a lot of what you mention. Low risks are generally disregarded when we are looking for an answer to our pain.

ADR sounds very appealing and fusions sound like a "death" sentence. So people can convince themselves ADR is the only solution. That could actually cause the number of less than desirable outcomes to rise.

As for insurance companies I also agree that they are not looking out for our best interest. They only look out for their shareholders. Which I don't completely understand. When I researched cost of a fusion vs. ADR in the States, fusion was more expensive. All I can think of is that maybe there is a belief that people will bypass conservative care if ADR is available? Thus increase the number of surgeries. Can't really think of another reason.

[Katie]

After the new lab report I just received regarding allergy testing for metals, I was wondering if it's possible that Steve was severely reactive to the metals that were implanted? It may have presented as an allergy when they 'opened him up'.

I had blood testing done on the recommendation of a poster, because of my known allergy to nickel. It turns out that I am highly allergic to just about every metal used in ADR, including Cobalt, Chromium, Molybdenum, Iron and Aluminum, as well as a few others. I am 'off the charts' with Nickel. Titanium is the only one that isn't extremely reactive with me.

I'd be curious to know if Steve could be reacting as I would have been, if I had followed through with the intended surgery months ago.

[steve55]

Well, Im 8 days since surgery and its been quite an experience to say the least. I didnt get the worse case scenario (corpectemies) nor the best case scenario (being able to keep my other 2 ADR's). I got something in the middle, 3 level fusion. Well, you win some and you lose some, that's life. Regarding Katie's inquiry about metal allergy, well, my lab culture did show positive for Staphylococcus aureus so we know what it was now. The range of possibilities as to how this happened varies. Its possible I picked it up during surgery in germany, or perhaps post surgery it found its way through my scars. Ive been told that no matter how many times a operating room is scrubbed down, it is still possible to get one of these staff infections during surgery. I also have psoraisis which often causes breaks (sometimes blood breaks) in my skin, so its possible that I got infected through that mode. Perhaps I was already infected before surgery and the implants and surgery provided a home for the bugs to collect at. The thing in all this is that IF you get an infection at the artificial implant location, they are extremely hard to get rid of. Blood doesnt flow in all cornerrs and crevices of any artificial implant and also, I read that the bacteria can form some kind of shield around themself when they have a artifical surface to stick to such that they are protected/dormant until conditions around them are ripe for them to spread again. Ive since read that many people with artificial implants (hips/knees) have simply had to have those implants pulled out in order to rid of the infection. Hence, the risk with ADR's. If you get a staph/infection of certian kinds, the infection may make its home on your ADR's, and then you have to have them removed in order to fix it. WOW!

Anyways, Ive been able to have a much more positive attitude about all this after reading more deeply into multi level fusions. Studies seem to show that fusions yield the same % successful relief of pain outcomes that ADR does. The only real significant difference comes in regards to adjacent level degeneration and range of motion (ROM mainly becomes an issue at 3 levels or more) . By speaking with one of the the nerological nurses (who handles spine patients for years), and reading internet articles to match, Ive since learned that the issue of adjacent level degeneration on the C spine usually occurs at C4-7, less common at C3/4 and hardly ever at C2/3 and C1/2, and C7/T1. So, if you get only a 1 level fusion, you are at much greater odds of adjacent level degeneration in the future at levels C4-7. But, once you already have c4 thru 7 fused, its less likely to have adjacent level issues in the future because the only spots left are less likely to degenerate. Of course, this can depend on the the patient's indivivual situation. Obviously a patient with a already compromised c7/T1 for example, may have adjacent level issues later at that location. Well, Mark can correct me if this is wrong but this is what my research has beared out so far.

My fusion is much easier (so far) than I expected. Ive needed very few pain pills (mostly just to take the edge off). The multi level ADR was far more painful and difficult neck and back wise than the fusion has been. But the hip issue where they took the bone graft is what makes this fusion far more difficult. The skin of my left thigh is about 80% numb but Ive been told this should clear up within a few months as the nerve is just inflamed due to the hip swelling. I spoke to a girl at the hotel I stayed at who had hip surgery and she said the same exact thing happened to her and after 2 months it cleared up. So, that put me at ease. Dr B said he grafts bone more in the top center of the hip rather than the very top part of the hip as most US surgeons would do. He said this results in a less painful recovery. In fact, when I woke up from surgery and since then, I have never had any pain in the hip from just a laying down position with or without meds. Dr B even made it a point to put me at ease after surgery by asking if I had any pain there. He was right, laying down I did not have any pain at all. It only hurts when I walk on it, but not so bad actually.

Apparently, Dr B says I am one for the books. So, I guess I have some minor claim to fame. LOL. I know they did take pictures of it all for their case studies. I guess Im the first patient who had a staph infection and didnt even show any signs of it, not even blood work!!! Not a single Doctor even thought of the possibility of a infection causing disc subsidence. Not even the great Dr Delamarter. I guess thats part of the reason why Syntheses covered everything for me, they too wanted to see for themselves what the hell was going on in my case and they may have been worried about potential legal issues with the disc seeing they couldnt explain why I was subsiding. And by the way, my bone density tests (tested at wrist, ankle and hip) were all solid!! No probs there. Anyways, I got a glance of what I think was some of the syntheses suits. I saw Dr B greet them in the waiting area as I was leaving.

Im doing pretty good at 7 days out, only back pain I have is from surgery. Hip is a little sore to walk on. These are all good signs so far. Since they used my own bone for the fusion, I expect to fuse quite fast too. Though it is harder for fusion to occur on multi level cases, hence the reason they used my own bone which as much as I hated to do that, I agree with them on that decision.

[steve55]

Here is the link that talks about why implants have to be removed once infection occurs on them. It explains how the bugs can defend themselves on implants! Amazing stuff

Lysostaphin Disrupts Staphylococcus aureus and Staphylococcus epidermidis Biofilms on Artificial Surfaces -- Wu et al. 47 (11): 3407 -- Antimicrobial Agents and Chemotherapy