HELP: Desperately Need a Maverick ADR Removed

[mark-perth]

Hi Runner
Thanks for the kind words and support.
I would be happy to have a posterior fusion if I felt there was a bigger chance of success but I am extremely doubtfull especially when my surgeon doubted whether it would help.
I also am concerned that if it doesnt work I may not be able to get the disc out at all then. Thats probably why I would rather take a bigger risk in the hope of a better outcome. I really dont want to live a life with a morphine pump. Thanks for your help and ill keep you informed how I go with the docs.

Thanks for your help
Mark

[Michelle Maree]

Hi Mark,

I am sorry to be pessimistic, i guess I tell things the way I see them. But looking at your scans.How could they straighten the bones up for fusion if the disc is keeping the vertebra off centre? Wouldnt you need to remove the implant first to realign the vertabra?

[mark-perth]

Hi Michelle

Thanks for your message. I hope you have better luck if you decide to have an ADR than me, Just make sure U understand that it is damn hard to have it removed and alot more costly. I too was originally thinking about going to Germany but was talked out of it.
I dont wish to name my surgeon as I hold no grudge against him, He isnt in your state though. There is always a risk with any surgery unfortunately and even the best have results like mine. My surgeon has stuck by me and is wanting to continue helping me which I really appreciate and I still have the highest respect for him. My surgery took 7hrs so it was not an easy operation. He had done more than 100 lumbar ADR's plus many more cervical ADR's.
The biggest concern I have is that im not too keen on a posterior fusion especially as it may not help and dont wish to be stuck in pain with a crooked disc stuck in me. That will mean I need to have another operation which I really arent keen on. You can see the Xray doesnt look very good and I agree with you about whether a posterior fusion would work. I think that it may be able to straighten up the spine at that level but I cant see there being equal pressure on the ADR for it to be used as an interbody device supporting the spine and not cause any pain. My surgeon has said he will do another anterior operation to remove the disc if the posterior fusion doesnt work and has done 1 Maverick removal but has done many repeat anterior operations which helps. I agree that noone should ever put something in someone if they arent able to remove it. The reason my surgeon doesnt want to do an anterior operation first is because of the huge risk involved which is understandable. My only concern I have with my surgeon is that he isnt able to do a lateral operation if a repeat anterior operation failed, otherwise I would happily have him operate again.
Its impossible to know what to do.
Thanks for the reply and best of luck,

Mark

[mmglobal]

Michelle,

Keep in mind that people can have tilted vertebral bodies without off-center ADR. I've seen several cases of tilted vertebral bodies with on-center ADR. (Even more cases of tilted vertebral bodies with off-center ADR because of the obvious balance issues with the center of the joint that us not under the center of load.)

Also keep in mind that many people have posterior or posterolateral fusions without touching the collapsed disc space. You can have forces acting on the off-center ADR that are completely overridden by the stabilizing forces that may come from a nicely done fusion or posterior stabilization system installed behind the ADR. I've seen successful and unsuccessful fusions leaving the ADR in place. I've seen successful and unsuccessful fusions following explantation of poorly done ADR. I've seen successful and unsuccessful dynamic stabilization behind ADR with Dynesys, DSS and Coflex.

Each case is unique and depends upon what the true pain generators are and how successful the surgery is at correcting the structural issues associated with the poor configuration.

Note that it's possible that the obvious structural issues associated with the tilted vertebra may not be the pain generator or may not be the only pain generator.

mmglobal (it's too confusing having 2 mark's here. Mark, Mark... sounds like a hair-lipped dog barking.)

[mark-perth]

Hi Everyone,
Thanks for all the replys, they have definhately been helpful. I have plenty of Xrays and other scans from prior to the ADR that show a straight spine. The curve developed after the ADR. I have 3 Xrays after the ADR and it shows the curve getting worse around the disc with a very minor curve 4 days after the ADR. I also have a posterior stabilization device still in place. That being the Diam which I do understand is not as good as a DSS system or a Corflex but surely that would help a little. I obvoiusly would like to have the symplist and safest operation, as long as it doesnt burn any bridges if it doesnt work. So if a posterior fusion doesnt remove the options of a disc removal at a later date then to me that would be the wisest option. But that being said I dont want to have 3 or 4 major operations if it can be done in 1 and from the medical papers I have regarding ADR revisions fusion while leaving the disc in often isnt as good as removing the disc. Also listening to Mark (MMGlobal) it obviously isnt something that has been perfected and there is obviously alot of debate about the correct procceedure to correct a failed ADR as there have been possitive and negative results from all attempted ways. I have heard of too many problems with a DSS system to consider that especially as my disc is so far misplaced and feel that way would definately mean an extra operation or 2. From what ive read the best option is usually removal with a 360 fusion to fully stabilize the area. Hopefully I can find a surgeon before problems occur to other areas. Please continue to give me your thoughts as your advice so far has been exremely benificial.
Thanks,
Mark

[Hucky :)]

Hi Mark,

I'm from Sydney and I saw a guy at Westmead Private. I haven't been operated on but saw him for a consult for ADR/fusion.

If you want his name I can give it to you, I don't know if he does ADR revisions though.

There is a neuro in South Australia that has a good reputation for taking on very difficult fusion revisions, but can't think of his name, if you would like, I can ring someone who was revised by him and get back to you.

The other thought I had is to ask your neurosurgeon who HE thinks is the best for revision surgery. As someone suggested, Matthew Scott-Young has a pretty good reputation, but he is in Queensland.

If it were me in this situation, I would be trying to see the guys in Germany. They are the best of the best. It would cost a lot more than being done here, but if you can afford it, it might be the safest and best outcome for you.

Take care

Hucky

[mark-perth]

Hey Hucky,

Thanks for the reply. That would be very much appreciated if you could get the name of the neuro in SA. I have contacted at least 50 surgeons in Aus so far and none are willing to look at removing the disc. I am happy to travel anywhere to get the best treatment as a life in pain is not my idea of fun. Hopefully I can have it in Aus and I still have a few surgeons to wait for a reply from but it doesnt look great. The problem is more to do with them having not done it before and I really dont wamt to be there first. I think it would be better to have someone experienced with it so I hopefully get a good result.
I hope you have a better experience than mine. Dont let mine put you off, just understand the dangers if it doesnt work. Have you seen my scans from earlier in the post? Failures can also happen with fusion as well which is the scary thing. Good luck with your choice.

Thanks,
Mark