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

[Maria]

Steve,
Did I just read another post about how great you're feeling?? All-right! So you're discs look a bit tilted and here and there~ as long as you feel good and there's nothing really wrong w/the discs placement or how they're sitting, what they're doing~ it's seems like how you feel is what's most important not how you look

Really glad to read how well you're doing

[Kathy]

That's weird that the won't see you, I had surgery in Florida and they are doing all my follow up.

[steve55]

Originally Posted by Kathy Earhart

That's weird that the won't see you, I had surgery in Florida and they are doing all my follow up.

That's because they are participating in your disc's study : )

[steve55]

Originally Posted by Maria

Steve,
Did I just read another post about how great you're feeling?? All-right! So you're discs look a bit tilted and here and there~ as long as you feel good and there's nothing really wrong w/the discs placement or how they're sitting, what they're doing~ it's seems like how you feel is what's most important not how you look

Really glad to read how well you're doing

Completely agree. : ) I was only concerned about the long term implications,...i.e. Stress on facets etc.

[Kathy]

Yeah, I guess the trial thing is why the agreed to keep seeing me. I am surprised there is not an ADR dr in the DFW area who would be willing to do your follow-up. You would think that since Dr. B is widely known in the spinal world, that they wouldn't have a problem with it. What hospital is Dr B out of? Is it Stenum? Alphaklinik? ProSpine?

I agree about if you are feeling fine now; but would worry about long term implications. These look similar to the x-rays shown in the horror stories about Stenum in months past. The one lady in a wheelchair (can't remember her name), said she felt great at first. Then, the guy, John I think?, that had a bad experience (Mark commented on the poor placement of his). What do you think Mark? It doesn't look right to me?

[Kathy]

Found those threads, and the before x-ray, I can't really tell anything was wrong; but it shows the progression. L4-5 Charite ADR Stenum

Here is the other one:
L4-5 & L5-S1 Chartie Stenum - kc0iet

On another question. Have you/did you follow all the post surgery orders? Not sure the exact ones for cervical; but for lumbar it was no bending, twisting, lifting, etc. Did you fall or anything? Just curious, as I am terrified of my discs moving out of place. I am always relieved to see my new images, to know everything is where it is supposed to be. Oh, do you have any of your earlier images? Do they look like this? Just curious.

Oh, just read this in the old post, what Mark said (mmglobal) regarding the discs being gone, which takes the pain away; but is still not a 'success'. Here, I am copying and posting a portion of that post, as he explained it better than I can. (underlining mine)

Originally Posted by mmglobal

"First, notice the angulation of the Charite’ plates on the first picture. The implant is not centered well. This is causing the upper plate to ‘fall off’, lower on the left side of the image. This demonstrates one of the problems with mobile core devices. When this occurs, the core is pushed to the extreme right and stays there. That increases the angulation and increases the forces that push the core more off center in the wrong direction. This is why the Activ-L eliminated the lateral movement of the core. Every mobile core device I’ve seen will do this. Properly implanted it’s much less of an issue. I’ve had 2 clients with M6 cervical discs explanted, one for problems much like I just described, another one for serious complications that may have been exacerbated for these reasons. (Yes, they were both Stenum patients. I know of a third, but I was not involved in the case. I did get to examine the explanted disc though.)

That brings us to the second picture. Notice how far the back of the upper plate is from the back of the vertebral body. Notice how the teeth of the plate are literally on top of the anterior margin of the vertebral body. There is the appearance of more vertebra because of an anterior osteophytes. This kind of alignment increases the risk of migration by many orders of magnitude. I see these types of films presented at the conferences as if they are a device issue, but this is not a device issue. The picture of the configuration before migration is one of a disaster waiting to happen. The surgeon should know that and be focused on proper placement. The doctors at Stenum say that there are anatomical reasons that may make it impossible to get the disc further back. That is absolute BS. I have NEVER seen this type of failure from any of the other surgeons I work with because they take care to get it right. Accepting sloppy work because you are lazy, hurried or just not careful may not cause problems most of the time. However, when the stakes are soooooo very high, accepting sloppy work may doom patients that would have otherwise been successful, to lives of pain, meds, revision surgeries and more.

After I went to Stenum with MrBee, I made excuses for them, saying that they are probably doing the surgery the way they were taught to do it years ago. The reply from one of my favorite surgeons was, “If you are a bricklayer or a librarian, that may be OK. But if you are an astronaut, an airline pilot, race care driver or a surgeon, you have to be learning all the time. That is not an excuse.”

Here is a picture that I extracted from the original Stenum-and-back website. This picture stayed up there for many years until the patient community got wise to what it really showed.



I want everyone to keep in mind that this is the image of a successful surgery. The author of the website may even be in better shape than me. They point to images like this as if it’s evidence that it’s OK to do surgery this way. However, you do NOT want any ADR implanted this way. If the patient’s disc was his pain generator and they took it out, he experiences success. If he gets away with the horrible placement, that is dumb luck, not appropriate surgical technique. At the conferences they discuss the sequelae of configurations like this: increased risk of complications like migration and subsidence. In addition, there is the expectation of accelerated wear and degeneration of posterior elements, possibly adjacent levels (due to inappropriate kinematics), AND of the prosthesis itself. It’s like driving with your tires out of alignment.

Does this mean it WILL happen? Absolutely not! All it does is increase your risk. Poor surgery does not guarantee failure just as perfect surgery does not guarantee success. If anyone wants to have poor surgery because it’s OK most of the time, I would suggest that they don’t fully understand the issues."

[Cindylou]

I agree, looks can be deceiving. I remember when I saw some of my first x-rays of my 3 level lumbar discs, they didn't look right either. But then my doctor following me up here explained why. It's hard for me to imagine that Dr. B could have messed up...that said, I would still exercise caution and send them to him and have him read them for you, or Fenk-Meyer. Keep us posted.

Take care,

Cindylou

[steve55]

My US doc said he didn't see anything wrong with the x rays and if anything, it shows the ADR's are moving well. He said I might think I was standing perfectly straight at time of the x ray but I was probably leaning a few degrees to one side without realizing it.

Mark is running these by dr b in the next few days. We'll see what he says. But yes, I am very pain free now, so that should be a good sign.

[Kathy]

Just curious, who is your post-adr surgeon? Did he/she explain why they were moving in different directions? It just seems like if you were leaning in one direction, the discs would all be tilted in the same direction. How come the bottom one looks like the two metal ends are touching? Is this the nova disc design, where it can move that much? Is it a metal on metal device? Restrained or unrestrained? Does it have a polyurethane core? I had never heard of the nova until you got it, and don't know anything about it, so just curious. I am very interested in why and how things work.

Just curious what Mark has said regarding this. I don't understand how what he said about the previous x-rays from the Stenum debate wouldn't apply here. I am confused!

[Michelle Maree]

Could it be because it is a 3 level ADR?

Is prodisc not approved for 3 levels in the US yet?

Excuse me for being uninformed, but maybe that is part of it.

I guess some people think we are volunteering to be guinea pigs before all the studies have been done and confirmed that more than 2 levels is safe and replicatable.

There is always going to be huge risks envolved when dealing with cutting edge medicine especially where the spine is concerned.
With ADR we are all pioneers of relatively unchartered territory.

But when you are in constant pain, dont have a life and suicide sometimes seems like a good option, sometimes we are willing to take this risk especially when we see it has worked for others.

It is easy for others to think you have made a stupid mistake, but have they ever had a spinal injury and been in your position?

Im sad Steve that you were one it didnt work for but I think there is still hope and you will be helped soon.

Michelle.

[Cheryl]

Steve,

I continue to be amazed at how well you are handling this. I've felt like dirt, had the silent treatments as well with these spine doctors. Your feelings really hit home.

Great job, I wish you the best.


Cheryl

[steve55]

Well, some potentially Awesome news! Dr John regan, of Beverly Hills, CA called me Sunday evening at 9pm and we spoke for about 10 minutes. He knew I was about to pull the trigger with Dr Bitan Monday morning for $15K and he said he can do it for $10,000!! (Plus they will also get 70% of my Humana payout for the fusion costs). His billing assistant is working with the hospital side and contacting humana to confirm his Quote. Its supposed to include all fees such as hospital fees, anesthesiologist , his fees, ...the whole shabang. I told him how much I appreciated that and thanked him for taking the time to call me, something very few doctors would do, especially the heavy hitters, Im sure they are busy enough as it is. Of course, it was a result of my urging Mark to contact him for me and ask him to call me. So Mark finally did come through for me in arranging this connection. We'll see if it comes to fruition. I should hear back by tommorrow. My aunt lives in Beverly hills so it would be kind of nice to have her available to watch over me after the surgury. I planned on sticking with Dr Bitan, after all, he was quick with his responses. But $5,000 is a HUGE difference!! And Dr Regan was very cordial on the phone similar to Dr Bitan. So, why would I not save $5,000?

Thanks for all the support everyone. I hope my experience will be of benefit for future patients who are facing ADR revisions.

[Cindylou]

Steve, this sounds like some potentially really good news. I sure hope this comes through for you. Let us know what you find out tomorrow. I do so admire your attitude and pressing forward gumption. Here's praying that pain free days are right around the corner for you!

[dshobbies]

Steve,

I think either dr. will do a fantastic job for you. Staying with your aunt will also help you save on hotel costs.

When is this likely to happen?

[Joe56]

Note to those considering older ball in socket designs which can get a bit out of control in multi-level cases, consider the M6 implant, it appears the new designs will have controled motion to help with this. I am looking at Stenum Hospital for 2-3 levels.

[JKDE302]

^ Joe56 do you know anyone who has the M6 implant...

[mmglobal]

Joe, I disagree with the concept that the M6 provides stability that is not present with the ball and socket style ADR's. I presume that the theory is that the woven 'annulus' provides additional help here. I've seen the M6 and it's a very interesting design. In theory, I do like what the pseudo annulus does... presumably providing some dampening of the motion at the ADR levels. However, I do not see this helping the 'out of control' concept of multi-level ADR.

The M6 is a mobile core device and, in practice, I see it having the same problem as other mobile core devices. If something provides some off-kilter loading, the core gets pushed to one side and it stays there. Search this forum for the word tiddly-winks and you'll find what I've written about mobile core devices. I have seen several M6 configurations that have this problem. It is a problem in single-level cases too but gets exaggerated in multi-level cases, especially if there is incorrect placement. (I have 3 clients who have had m6's explanted and know more.)

The ball and socket designs that have mobile cores (including the M6) will have this problem more than the stationary core designs. Having said that, I spoke to a friend tonight. He is the first patient in the world with a 4-level Mobi-C (highly mobile core) and is several years post-op with no stability issues at all.

I'm going to COPY the M6 posts to the M6 vs. ProDisc thread (M6 Cervical vs ProDisc) that was started a few days ago. This thread is very long and involved and devoted to Steve's ordeal.

All the best.

Mark

[Joe56]

Mark,
I understand your concerns. What I have learned is that the Spinal Kinetics guys studied the physical characteristics of the human disc and placed these parameters into their test computers, then they began the process of prototyping an implant that replicated these characteristics. The result was a disc that might just be the first to actually deserve the name “artificial disc”. The goal of course is to return the spine to normal function. Now we both know that as the damage from years of degeneration progresses the other structures and tissues become unable to respond normally. The selection of candidates is critical. Surgeon placement errors and patients whose bodies just can’t keep the implants in place will always come up, but overall I think the goal of returning to a normal function is attractive. These guys at Stenum seem to have done the most and should have it down.

Joe

[ans]

I don't stop by enough but read your nightmare story and am glad you're on the mend.

I never thought that bone stimulators' efficacy was questioned.

Good luck to you.

Best, Allan