Choosing ADR or fusion

[B13s]

Originally Posted by WayDownInCoCrMo

It would be great if you could post the names of the surgeons/kliniken who have more conservative views on ADR.

I don't have names at hand - would need to look at all my papers, but at least remember clinics:
1. Orthozentrum München - from ADR's they do Prodisc only and said that it would be difficult/impossible to remove it. Suggested PT, microdiscectomy, fussion.
2. Klinikum Grosshadern - again do only Prodisc, but suggested microdiscectomy and fussion down the road.
3. Alphaklinkik - ADR (Active-L).
4. Neurochirurgie Innenstadt München - ESI, microdiscectomy, said that ADR was a big thing 1-2 years ago but they do not recommend it anymore because they didn't have a very good experience (didn't ask why).
5. Neurochirurgie Dr.Obermüller & Dr.Fritsch - well, they do surgeries only (~2500 a year) - not a big surprise that they against ADR's. Recommended microdiscectomy - and I think I'll go for it...

[WayDownInCoCrMo]

Sorry for interrupting ans/blair/sharman ...

Thanks B13!

1. Orthozentrum München - Dr. Mayer and Siepe. You have probably seen their papers where they point out that Dr. B's results are $%^!
Therefore, I was really impressed with their candor ... Another surgeon told us that Dr. Mayer refused to ever take another Prodisc out ... because he had a very very bad experience. You guess.

5. Neurochirurgie Dr.Obermüller & Dr.Fritsch: I met one of them - very nice guy, fluent English too. They also offered to do a minimal-invasive on A way back in 2005 ... but we passed because they said it would be open-back ... i.e., not exactly micro. We eventually had it done by emergency with the AK ... which was endoscopic. They, of course, know nothing of ADR revisions.

Best wishes and regards ...
M

[B13s]

Originally Posted by WayDownInCoCrMo

Sorry for interrupting ans/blair/sharman ...

Thanks B13!

5. Neurochirurgie Dr.Obermüller & Dr.Fritsch: I met one of them - very nice guy, fluent English too. They also offered to do a minimal-invasive on A way back in 2005 ... but we passed because they said it would be open-back ... i.e., not exactly micro. We eventually had it done by emergency with the AK ... which was endoscopic. They, of course, know nothing of ADR revisions.

Best wishes and regards ...
M

Micro means using microscope And incision is quite small - ~ 2cm - you cannot really call it open-back.

[mmglobal]

Originally Posted by B13s

Micro means using microscope And incision is quite small - ~ 2cm - you cannot really call it open-back.

With a microscopic procedure, they are still needing to create wide access to the canal area. While the incision is small, there is a difference in the collateral damage that is done compared to an endoscopic procedure. I've observed many of both types of discectomies and the difference is pretty dramatic.

Note that there are trade-off and that micro-d surgeons will say that they can see better and accomplish more effective decompression.

I wonder if I'd be in better shape if I'd had endoscopic procedures instead of the 2 microdiscectomies I had prior to my ADR surgery.

For Diane's (my wife's) discectomy, we went to Hoogland at the AK and he did an excellent job decompressing a disc bulge that others would not consider doing endoscopically. While that surgery was successful in accomplishing what it was designed to do... she had a great recovery and continued to improve for 2.5 months. Unfortunately, the disc was too severely compromised and she went south again and ultimately had 2-level ProDisc with Bertagnoli last March. With her apparent success from her ADR procedure, we wonder how much better off she is having gone endoscopic instead of open?

Mark

[WayDownInCoCrMo]

Michelle: Thanks.
Its odd to hear that surgeons still use a ruler on Xrays. The radiographic analysis software is very advanced these days. Various papers reveal measurements in the order of microns (1/1000 mm). I was really impressed with the measurement tools in Jview. WE know it is exact because we know the exact height of the Prodisc implanted (11mm in the center).
Dicom,
http://www.pubmedcentral.nih.gov/art...?artid=1888420

Also - here for example, Dr. James Yue states the disc height increases:

Radiographic analysis revealed an affected disc height increase from 4 mm to 13 mm (P < 0.05) - James Yue

But, the Prodisc-L only comes in heights of 10, 12, 14mm. (that is the measure of the posterior, while there is a tilt on the upper plate so that the front is actually much more open). So, since the max disc height was 13mm - we can tell they never used a 14mm device. Since they remove the disc material, you can only have maximum 14mm Post-ADR. Disc height is extremely important (as noted by many surgeons) in that the increase is amplified in the fulcrum-effect on the facets. Think of a hammer pulling a nail - where the nail is where the facets are. The vertebral-body-lamina-facets have the same shape. The hammer-handle is the spinal column.

Thus this article authored by Yue and Bertagnoli:

"Patients with evidence of intra-articular facet degeneration, specifically evidence of joint space narrowing with or without cystic changes, were excluded from the study."

Also interesting in that article: The graphs in that report reveal that the regular & occasional use of Tramadol reduced from 27% pre-op to only 25% at 24 monts post-op ... for smokers, and 'reduced' from 26% to 30% for non-smokers.

I think we have to be realistic and realize that a lot of people will be experiencing permanent pain ... especially if their ADR device is 1.5x too tall, their Pre-OP facets are Grade IV arthritic, and their pre-op disc was collapsed to bone-on-bone. In this case, we can be sure it wont work-out for 98.2% of the patients. My guess is maybe the number should be backwards - like 98.2% failure ... kinda like tramadol usage reduces from 26% to 30%.

[Michelle]

Thanks Matt. I'm sure it was just what he had in his pocket at the time, looking at actual film X-rays. I never saw the official radiology report for those films, but when I looked back, he actually said it was 25mm, that 21 was the amount of height I'd gained from 4mm. What I actually asked him was how much height I'd gained overall, so I don't know what part of the disc he was measuring. Interesting at the heights of ProDisc available are so far different from that!

[fuzzy]

Disc height.


I gained 12mm in height after the surgery, the height of the Active-L disc. Measured on the xray with a ruler and measured myself before and after. All corresponds :-), Before the surgery there was only 4 mm AT MOST (in front) in disc height at L4/L5, disk space now 12mm, close to the levels above.

The height of the fusion level was unchanged.

Also I am closer to the height stated in my passport then I was before the surgery.

[Michelle]

Just a note about the disc height question. I don't have any info on normal disc height, or what sizes ProDisc comes in. All I know is what my surgeon told me: I watched him with a ruler measuring my X-ray before surgery, with 4mm between the vertebra, and after, with 21mm. That's just what he said. Matt&Anastasia, I wanted to say that I'm sorry that despite all diligence on your part, the research, the time, the questions asked, that it didn't work out for you! It seems you did everything you could, and to still have a bad outcome... I'm so sorry! It's so hard not to be excited by a procedure that worked for you, and want that success, thus that procedure for others, but it may not be right. Puts things in perspective. I'm sorry that you'll have permanent pain and damage! No one should have to live with that, but I hope you can find peace and happiness in this world, however you can! Hang in there, and thanks for sharing so much of your story!