removal of bone spurring during cervical ADR

[rob_zzz]

Hi,

Has anyone thats had ADR or ACDF surgery had bone spurs removed during surgery? If so do you know how it is done, and how was your overall surgical outcome? Has anyone had surgery from Dr Bertagnoli that involved removal of bone spurring along with the disc - and how did you fare afterwards?

It sounds to me like removing bone spurs could be a risky procedure compared to just pulling out disc fragments - what are others opinions on this - or is it fairly standard practice?

thanks,
Rob

[fortitudine]

Rob,
Bone spurring is very common. In fact it is my main problem, spurs sticking into the cord. Most docs remove it - that's what Dr. B. will definitely do for me and I know he's done it for others.

[rob_zzz]

thanks fortitudine,

I'm not sure if I actually have bone spurring or not though the edges of the vertebrae do look like they're getting pointier and the last scan talked about uncovertebral joint spurring increasing. I wasn't aware of this before (no other radiologist has ever mentioned uncovertebral joint spurring - my surgeon did mumble the word osteophytes once when looking through my scans earlier on a couple of years ago but I didn't really catch what he was saying and knew very little back then).

Anyway its good to hear that removing them is a routine part of surgery. I'm assuming Dr Bertagnoli has the appropriate tools then. (high speed burr was mentioned elsewhere).

cheers,
Rob

[necknose]

Hi Rob, Fortitudine:

One wonders whether or not the large bone spurs (bridging osteophytes) that commonly protrude from the front of cervical vertebra can be removed without provoking a cascade of: more bone growth, inflammation and ultimately degeneration of the treated levels which may lead/contribute to "auto-fusion". Apparently certain (out of USA) Dr.'s use "bone wax" to suppress bone re-growth where bone has been "ground off".

Does "bone wax" do the trick/is it effective? Does it last? Can it it be used in the vertebra canal as well as around the anterior (in this case an ADR procedure is mostly anterior) surface of the vertebral body?

The common "lore" in USA spine surgery particularly ADR surgery is to avoid removing bone in the areas discussed above for fear of causing a degenerative cascade resulting for example in auto-fusion at the treated levels.

Thoughts? Opinions?

Good luck.



BTW: With all due respect to the fantastic practitioners who implant the Prodisc-C what is the bone "reaction" to the keel notch cut into the vertebral body? If there is fear of a growth/inflamation cascade due to the removal of osteophytes on the exterior of the vertebra are the same consequences to be expected from bone remove from the outside of the vertebra?

[mmglobal]

In the cervical ADR procedures I've seen, when anterior osteophytes were present, they were 'nipped off' with a tool that looked much like a pair of cobblers pliers. I'm standing next to the doctor asking the same questions you are asking here. The bone wax does seal the 'fresh bone', but will eventually be resorbed. When the bone wax is gone, there are several factors that will reduce or eliminate the risk of the osteophytes reforming.

• The osteophyte formation is the response to a structural problem. The body is trying to fuse the segment. With ADR, the collapsed disc space and structural issues should be resolved.
• The fresh bone is no longer fresh and osteoblast/osteoclast (cells that contribute to bone growth) release should be over
• The anterior longitudinal ligament that is calcified and participating in this bridging effort is gone.
• I'm sure that there are many other contributing factors. Here is the place for the 'I'm not a doctor, just sharing my experiences, yada yada yada."

The posterior osteophytes are a completely separate issue. The process of removing them is quite different because they are not right out in front like the anterior osteophytes. The surgeons are limited with the tools that they can get to the back of the vertebral body through the disc space after the discectomy is complete. It's relatively easy to get the typical osteophytes that form on the dorsal rim of the vertebral body. The bigger they are, the farther they extend down (or up) the vertebral body and it becomes more difficult to reach them. (The tools can't turn a corner to get too far up or down, away from the disc space.) This is why when the osteophytes get too large, the ADR option becomes more difficult or impossible.

I've watched the discussion change a bit over the years and some doctors are able to do more as they gain more experience. I am particularly interested in this because I probably need 2-level cervical disc replacement and I have large posterior osteophytes and am worried about losing the ADR option. I get a cervical MRI at least once a year to keep tabs on this.

I have resurrected an old post that discussed this, plus the need for adequate decompression during ADR surgery on the Rebound Myelopathy thread.

Mark

[fortitudine]

NN

"The common "lore" in USA spine surgery particularly ADR surgery is to avoid removing bone in the areas discussed above for fear of causing a degenerative cascade resulting for example in auto-fusion at the treated levels."

I'm curious as to your sources for this info. It doesn't seems to make a lot of sense. The hip and knee orthopods do tons of bone removal and set in place metal prostheses without these kinds of issues being significant. I can't see that there's much of a difference, physiologically. Can you enlighten me?

[Roz]

Originally Posted by mmglobal

In the cervical ADR procedures I've seen, when anterior osteophytes were present, they were 'nipped off' with a tool that looked much like a pair of cobblers pliers. I'm standing next to the doctor asking the same questions you are asking here. The bone wax does seal the 'fresh bone', but will eventually be resorbed. When the bone wax is gone, there are several factors that will reduce or eliminate the risk of the osteophytes reforming.

• The osteophyte formation is the response to a structural problem. The body is trying to fuse the segment. With ADR, the collapsed disc space and structural issues should be resolved.
• The fresh bone is no longer fresh and osteoblast/osteoclast (cells that contribute to bone growth) release should be over
• The anterior longitudinal ligament that is calcified and participating in this bridging effort is gone.
• I'm sure that there are many other contributing factors. Here is the place for the 'I'm not a doctor, just sharing my experiences, yada yada yada."

The posterior osteophytes are a completely separate issue. The process of removing them is quite different because they are not right out in front like the anterior osteophytes. The surgeons are limited with the tools that they can get to the back of the vertebral body through the disc space after the discectomy is complete. It's relatively easy to get the typical osteophytes that form on the dorsal rim of the vertebral body. The bigger they are, the farther they extend down (or up) the vertebral body and it becomes more difficult to reach them. (The tools can't turn a corner to get too far up or down, away from the disc space.) This is why when the osteophytes get too large, the ADR option becomes more difficult or impossible.

I've watched the discussion change a bit over the years and some doctors are able to do more as they gain more experience. I am particularly interested in this because I probably need 2-level cervical disc replacement and I have large posterior osteophytes and am worried about losing the ADR option. I get a cervical MRI at least once a year to keep tabs on this.

I have resurrected an old post that discussed this, plus the need for adequate decompression during ADR surgery on the Rebound Myelopathy thread.

Mark

Hi Mark,

You seem to have alot of knowledge about these bone spurs. I had ADR C5-6 in august 2005 in Bangkok, Thailand. the surgeon Dr Nanthandej failed to remove the pre existing osteophytes prior to implanting the ADR. The result was auto fusion and nerve damage with the implant now subsiding according to Dr Bertagnoldi.

I asked him if it was possible to have a forectomy and he said NO because it does not resolve the problem and they will return. I cannot afford to treat in Germany and trying to have fundraisers to have the surgery but that is not going well due to the economy.

Do you know of anyone near Ohio ( Columbus) would take on a patient with no insurance- tried for Medicaid, am a student, with an international surgery that failed that needs the implant removed and replaced and the decompression done.

Do you have any information on whether it is medically necessary to remove the osteophytes that exist and that show severe forminal encrouchment even before the surgery prior to implanting the ADR is medically necessary? The hospital in Thailand did not disclose this and I never knew to ask.

Please advise

Roz