Go Back   ISPINE.ORG Forum > Main forums > iSpine
Register FAQ Members List Calendar Search Today's Posts Mark Forums Read

iSpine Discuss Heterotopic ossification in ProDisc-C???? in the Main forums forums; thanks - I should probably add that I'm not trying to be deliberately difficult by raising the topic - I want ...

Reply
 
LinkBack Thread Tools Display Modes
  #11 (permalink)  
Old 03-06-2007, 05:20 AM
Member
 
Join Date: Nov 2006
Posts: 34
Default

thanks - I should probably add that I'm not trying to be deliberately difficult by raising the topic - I want this technology to work as much as anyone and think that we're all lucky to have the options available today that we do.
(and wish they were available a little closer to home from my own perspective but thats another story).

There are also known problems with fusion so even if there are some problems with ADR they still need to be compared contextually to the problems with fusion. (e.g. with fusions there are problems with the anterior plates that don't occur with ADR because there's no plating, problems with hip graft site for autograft fusions that don't occur with ADR etc.).

Sahuaro my laymans understanding is that the milling for the bryan is much more extensive than for the other discs (prestige and prodisc). As I understand it, with the other discs they use a tool to cut a relatively small slot(s) for the disc to lock into, while with the bryan they gouge/drill out a fairly large hollow that the ends of the disc fit into.



Rob
__________________
snowboarding injury 1997 landed on head, some subluxation of cervical vertebrae no surgery, some ongoing neck and shoulder pain but bearable.

surfing injury 2004 - transient paralysis from neck down for 15 seconds, resolved fully - herniated c5/c6 disc plus some bulging at c3/4/5. Initially had dermatome pain after injury which resolved - general parasthesia in arms/legs was fairly mild after injury but has been worsening.
Reply With Quote
  #12 (permalink)  
Old 03-07-2007, 07:25 PM
mmglobal's Avatar
Administrator
 
Join Date: Sep 2006
Posts: 2,508
Default

I don't think you are being difficult, Rob. These are tough questions and unfortunately, when you decide what to do, you still won't have all the answers as they don't exist yet.

Yes, with the Bryan disc, there is much more milling and the process is complicated and difficult. They must mill a negative in the bone that provides a 'cup' that the prosthesis fits into. Imagine the jig that is used to mill into both the superior and inferior endplates. Too many steps... to easy to get it wrong. I don't have the Bryan data at my fingertips and am relying on memory and impressions made when I attended the sessions where Bryan experience was presented.

For me, this really highlights the problem with the data and with this whole process. There is no question in my mind that there is a huge disconnect between the data and the experience. Especially with an extra-difficult surgery, there will be a greater disparity between the more skilled and experienced surgeons and the ones that are less so. I know several top surgeons that have done many Bryan procedures, but all of them stopped using Bryan when newer designs became available. They all talk about HO rates and the difficulty of the surgery. However, when I see Bryan data presented at the conferences, it looks much the same as for the other cervical discs. (And for the lumbar discs, and for fusion, and for.....) Maybe they all use the same computer program and it's stuck... only outputting 85% success rate, regardless of the input.

Regarding avoiding HO... I believe that it comes along with doing excellent carpentry. It comes with experience. There is a trade-off at many places in the surgery. Unless you have totally regular shaped end plates, some remodeling will be in order. How much? Too much or inappropriate remodeling and you increase the risk of HO, subsidence, migration. Too little remodeling and you don't have a good platform for the prosthesis, increasing the risk of migration, toggling (motion of the prosthesis), or ??? Use of bone wax may reduce the risk of HO, but inappropriate use of bone wax will come along with an entirely new set of risks. Again... experience, care, skilled surgeon are paramount.

Regarding Sahauro's question about theoretical vs. numbers... I don't know. My impression is that they abandoned Bryan because there was something that was much better... not because of HO rates. If there was only a choice between Bryan and fusion, I suspect that they would still be doing Bryan procedures where ADR is indicated and that, as with other surgeries, better surgeons will have better success.

Mark
__________________
1997 MVA
2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
Life After Surgery Website
President: Global Patient Network, Inc.
Founder: www.iSpine.org

Last edited by mmglobal; 03-07-2007 at 08:08 PM.
Reply With Quote
  #13 (permalink)  
Old 03-07-2007, 11:16 PM
Member
 
Join Date: Nov 2006
Posts: 34
Default

good comments - thanks again Mark.
__________________
snowboarding injury 1997 landed on head, some subluxation of cervical vertebrae no surgery, some ongoing neck and shoulder pain but bearable.

surfing injury 2004 - transient paralysis from neck down for 15 seconds, resolved fully - herniated c5/c6 disc plus some bulging at c3/4/5. Initially had dermatome pain after injury which resolved - general parasthesia in arms/legs was fairly mild after injury but has been worsening.
Reply With Quote
  #14 (permalink)  
Old 03-08-2007, 02:28 AM
Senior Member
 
Join Date: Oct 2006
Location: arizona
Posts: 255
Default

Yes, thank you Rob and Mark. Mark, you must get tired of having to emphasize the importance of choice of surgeon, but please realize how important these exchanges are!
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT. The time now is 05:51 PM.


Powered by vBulletin® Version 3.7.2
Copyright ©2000 - 2017, Jelsoft Enterprises Ltd.