Choosing ADR or fusion

[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.

[WayDownInCoCrMo]

Hi Fuzzy,

Yours makes sense - when you say your current disc height is 12mm, and that is the exact heigh of the device.

But, not meaning to 'nit-pick' ... if your pre-op height was 4mm, and you gained 12mm, then it should be 16mm. But, I guess they removed the disc material, so you must have actually only gained 8mm ????

Most important though, is that you note that the new disc height is basically the same as your natural disc heights ... so that your nerve root probably wasnt stretched nearly as much as it was decompressed back to normal ... and ... your facets will be callibrated (so long as they had not already become hypertophic)

Here is an article that describes (obvious to some) this concept with disc height and the facets:
http://www.spineuniverse.com/article...sion-2389.html

...
If your disc thins and can't handle movement as effectively, then the facet joints can become overworked. Facet joints stabilize the spine by controlling movement, but when a disc loses height, the facet joints lose alignment and have to readjust their movement. They can become overworked because the disc isn't doing its part to control the spine's movement—that's a lot of pressure on the facets.

If the facet joints are overworked, then the cartilage can wear away. Cartilage is meant to protect the joint and make movement easier. However, it can degenerate, leading to more facet joint problems. Without cartilage, the facets can move too much; this is called overriding.

If the facet joints are overriding, then bone spurs can develop. Bone spurs are your body's way of trying to protect itself. These bony overgrowths, also called osteophytes, are meant to stop the facets' excessive movement. A side effect of bone spurs, though, is that they can pinch nerves as they grow into the area where the nerves are exiting the spine.

[fuzzy]

Ok I was a little too general so I looked up the surgery report again. It took weeks for the anesthesia to wear off so it seems so all that is a little bit of a haze.

Yes, now after the surgery all my levels are the same, at about 12mm center height.

The ADR they implanted was only 8.5mm (and "XL" size) but the diskspace looks to be more then that now. I gained a couple of mm at the fusion level as it too was reduced, just not as bad as L4/L5 where I was hitting bone on bone on extension which must have sheared of some of the disc acc to DR. Z., causing the neuro problems. So now I gained a net of about 8mm at L4/L5. The fusion level was about 7mm and now is 12mm. Dr. Z. used a 11mm STALIF peek spacer with 12mm bone grafts...as per surgery report. So 8mm at ADR level + 5mm gain at L5/S1 comes out to 13mm which adds up exactly to the before and after change in my bodyheight and the xray looks nice and symmetrical. Now that it is all aligned right all kinds of problems are gone including all the "mechanical" ones. Bone on bone crunching, pain, "locking up", wrong move really bad pain etc totally stiff in low back (now gone). I think if one has these kinds of problems (for years...)then one might be a good candidate for ADR. I am sure that not having all that stiffness is better for the rest of my spine in the long term, lets hope.

Regarding the facets. I never had problems with the facets and my degeneration had been going on for years. I think my disc height had been reduced for 10 or more years with no damage to the facets, it seems. In fact when I fell off my motorbike as a teenager the ortho warned me that there was trouble ahead for my spine and to be careful what I do. This was in Germany at age 16.