Looking for Cervical ADR or ACD Experiences

KL Aguilar · #1 (**permalink**) 11-28-2006, 08:51 PM

I have a bulge at C3-4 and bone spurs pushing into my spinal cord and my esophagus at C5-6 and 6-7. My spinal cord is narrowed to .8 mm at C5-6 and .9 mm at C6-7.

I have seen three surgeons and gotten three different recommendations. Surgeon 1 recommends a four-level fusion with a plate. Surgeon 2 recommends a two-level artificial disc replacement (ADR) at C5-6 and 6-7. Surgeon 3 recommends a anterior cervical discectomy (ACD) without fusion at C5-6 and 6-7 and a cervical endoscopic discectomy in which only the bulging part of the disc is removed (CED) at 3-4.

Surgeon 1 is the local worker's comp surgeon. Surgeons 2 and 3 are very experienced, respected surgeons who try to avoid fusions.

I would like to hear from cervies who have either ADR or ACD.

fortitudine · #2 (**permalink**) 12-01-2006, 02:51 AM

Hi KL

Your surgical recommendations are almost identical to mine! I have cord compression at c3/4 and 4/5. Surgeon #1 - the local guy, which means 'free' here in Canada - wants to do a posterior (ouch!) plated 3-level fusion (including c2/3 since 'the level above usually goes and it would be easier to do it now'). He had no ADR experience at the time, in fact the first 25-person trial for the Bryan was just starting here.

Surgeon #2 (USA) offered ACD at 3/4 and ACDF at 4/5 as there is a possible instability there. (Different radiologists disagree)

Surgeon #3 (Europe) offered 2-level ADR with slight possibility of having to fuse 4/5.

Surgeon #4 was a sort of half-baked consult and he offered 1 level ADR and one level ACDF if I remember correctly

I'm guessing that your surgeon #2 might be the one I consulted in California, He is in his early 60s. When I called his assistant to say I wasn't going ahead with him, he called me himself to warn me away from ADR.

In any case, that was early 2005, and a year and a half later I have done nothing, although I had decided to go with ADR and surgeon #3. Circumstances have forced me to reschedule or cancel 4 or 5 times!

Meanwhile there is a neurosurgeon in Canada who has collaborated with surgeon #3 on papers, and is doing 2-level cervical ADR ( five or six to date). I sent him my films for a consult months ago. Perhaps by the time he looks at them I will be able to get ADR for free in Canada!

KL Aguilar · #3 (**permalink**) 12-01-2006, 05:12 AM

Hi Fortitudine,

Surgeon 3 is in California, and is probably the same person you saw. I know he is an excellent surgeon and I have a lot of respect for him, but I don't know about a two-level ACD without fusion. As for your option of a free ADR in Canada, hmmm. It might be cheaper in the long run to have ADR with a much more experienced surgeon. There is a surgeon in Santa Monica, Dr. Rick Delamarter, who is cutting through the vertebrae, removing spurs, and closing the vertabrae with some kind of brace, but leaving a bigger space for the spinal cord. I am going to research this option more.

fortitudine · #4 (**permalink**) 12-02-2006, 03:40 AM

Is Dr. Delamarter doing some kind of laminectomy? Or something new? Can you let us know when you learn more?

There's something called an open door laminectomy where they make a sort of hinge out of the bone around the spinous process, I think.

KL Aguilar · #5 (**permalink**) 12-02-2006, 05:05 AM

Dr. Delamarter's surgery:

http://www.laspineinstitute.com/Laminoplasty.htm

fortitudine · #6 (**permalink**) 12-03-2006, 01:57 AM

I don't know that any form of laminectomy is a really great option. There seem to be a lot of people who had multi-level lami's years ago who are now dealing with instability, and the resulting problems.

The lami is an old surgery- although this 'open-door' that Dr. Delamarter does is farily new - and it cuts through the neck muscles at the back, as far as I understand it, so while it doesn't involve fusion, it has its own challenges.