Discogram today

[bmills]

Well, had my discogram today. L3/L4 no leak/tears, but the pressure still hurt. L4/L5 has a tear and leaked. However, it only hurt like the healthy L3/l4. L5/S1 as expected hurt badly and appears to be the real pain generator. It clearly was much worse than the other two.

So far the Doctor is recommending Maverick ADR now in L5/S1 and he does not feel L4/L5 is a problem. Or wait and get into the upcoming Maverick/Charite study.

Thoughts?

Brady
Considering L5/S1 ADR

[JeffreyD]

Brady,
Nice to have THAT over with, isn't it?
I'm a little curious about the 2 levels above your L5/S1 causing pain, even though as you said it wasn't as bad as the L5/S1. Was it "concordant" at all at those levels, that is, did the higher 2 levels reproduce any similar pain to what you experience on a daily basis?

Jeff

[bmills]

Jeff, no the two levels above L5/S1 did not seem to produce pain like my daily pain. They produced more of a pressure that was different. And that pressure seemed to be in a different location than where my daily pain comes from.

L5/S1 seemed to produce a very severe pressure, very acute, and in the same area as my daily pain. Not the exact same pain but similar.

Did you have a discogram, what did you learn?

BTW: In your case, did the IDET w/Nucleoplasty resolve your issues? Can you give me your story?

Thanks.

Brady
Possible ADR

Brady,

Do you have leg pain in conjunction with your back pain? And if so, did teh discogram reproduce your leg pain?

Paul

[Harrison]

Brady, the specific results (and terms that the doc use, like "concordant") are critical factors that weigh into your options. It sounds like your L5-S1 pain is concordant -- or that disc is "bad" and may be worthy of replacement. But this is an issue where your doctor will advise you.

Discography results can be tricky, that's why we asked some TBI docs for some guidance in this area. See the recent Q & A columnthat touches on these gray areas.

[bmills]

Paul, I do not have leg pain and had none with the discogram.

Brady

[Alastair]

Hi Brady,
That sounds a good result. I would try and get a Charitee if its not too long a wait. Did you read what Mark said about it in a different posting?
Best
Alastair

[bmills]

Alastair, thanks. No I did not read the other post. Which one?

Brady

[JeffreyD]

Brady,
I sent you a pdf file outlining the medical "highlights" of my long battle with back problems.
Regarding my 2 level IDET with Nucleoplasty, no, it didn't help my problems at all. I knew going in that it most definitely wasn't a "sure thing", but chose to do it because It had few long-term risks, so I was told.
I have been in contact with an ADR surgeon (Zeegers) for almost five years now, but I put off the trip to Germnay for as long as I possibly could.......now the time has come.

Jeff

[Alastair]

Mark said about the Charitee.

Steve, here is something I wrote elsewhere regarding Charite vs. ProDisc and facet loads. Someone quoted a paper....

"Is this what we are hearing in some papers?"

Yes it is. There was a paper about facet loading on unconstrained vs. semi-constrainied devices that got a lot of attention that was presented at SAS-4. (Read this as Charite' vs. ProDisc)

Dr. Moumene made a very detailed presentation about the testing that he did. 2 cadaver spines, one with ProDisc, one with Charite. There was a very intricate sensor system designed to measure loads on facets as the test configurations were moved through range of motion testing. He went into great detail about sensor design... all very scientific stuff and his testing did show higher facet loads in certain ranges of motion for Charite, but higher facet loads for other ranges of motion with ProDisc. However, it was not equal... the testing was clearly showing higher facet loads for Charite'. During the panel discussion, the first and last question were the same. I don't know if the last questioner didn't hear the first one, or if he just wanted to rub it in. In any case, it seem that every Charite' surgeon in the audience noted something interesting when the pictures were shown. Both of the surgeons I was sitting with mentioned it as soon as the pictures were up. Here is the question:


quote:
--------------------------------------------------------------------------------
Dr. Moumene, do you think it had any impact on data generated by your testing, the fact that the Charite' was implanted, not only upside-down, but backwards?
--------------------------------------------------------------------------------

He was obviously very embarassed. Even if the Charite was not bass-ackwards, how reliable is testing done on one spine each with these custom sensors? If there were 15 spines each, maybe I'd listen more. What if the rumors are true that the Charite was implanted by a ProDisc surgeon? It certainly wasn't implanted by a Charite' surgeon. What does this tell you about the test set-up? What was it designed to show?

Many Charite patients I know are getting way anterior placements. Many ProDisc patients I know are also getting inappropriate placements that are equally problematic. Some of the patients are assuming facet problems because they've been lead into that line of thinking by the hype that's been generated... they really don't know what their pain generators are.

Surgeons are now pushing the envelope on how much facet degeneration is allowed with ADR. Neither disc is magic and many patients with either disc will continue to have facet problems. There are also reasons for the facets to degenerate in spite of the other spine elements being perfect... ADR is not magic.

The big difference related to facet loading between Charite and ProDisc is the fact that with Charite' the center of rotation of the joint changes in a manner similar to a normal disc. The ProDisc does not allow the center of rotation to change. In some cases the more natural movement of the Charite' will be an advantage. In some cases, the constant center of rotation of the ProDisc will be an advantage. I doubt it will be possible to predict which device may have an advantage for any given patient.

Fortunately, the bottom line is that both devices are excellent. Proper implantation and proper patient selection will be huge factors in success, whereas ProDisc vs Charite will matter very little. If you've got contra-indications going in, your odds of success are substantially reduced... even more so if your surgeon doesn't have much experience dealing with your type of special case. If the other elements of your spine are in trouble, you've got problems no matter which prosthesis you got.

Mark

PS... we won't know for years if there is a huge difference. There are some modes in which ProDisc is worse than Charite. We should not be talking about which device is harder on the facets... They will both relieve facet loads in an unhealthy system.