Fusion after ADR?

jasonwidup · #1 04-09-2011, 12:01 PM

So if an ADR is performed and doesn't end up working, how difficult is it for a surgeon to perform a fusion? Do they leave the artificial disc in and fuse around it or do they have to remove the artificial disc first before fusing? Obviously if there is rejection of the device it has to be removed, but assuming in my case I have the surgery done and then my facets are shot, would they be able to fuse around the artificial disc?

Thanks-
Jason

jss · #2 04-09-2011, 12:36 PM

Jason,

I've seen a lot of discussion on this topic. Explanting a lumbar ADR is often a life-threatening surgery. If the ADR surgeon did not separate the adjacent arteries and veins with a polymer sheath, they attach themselves to the surrounding anatomy after the surgery; making a revision surgery extremely dangerous. Even if that utility was put in place, often bone grows up around the top and bottom bases of the implant, requiring a small power hand grinder tool to remove bone from around the implant. I've read that that is very delicate and difficult to do; which is why so many lumbar revisions involve leaving the ADR in place.

However, fusions don't always take over an ADR, leaving the patient with the options of spending the rest of his days bedridden and popping narcotics; or undergoing life-threatening surgery - if he can find a surgeon that is willing to do it.

Explanting a lumber ADR is very dangerous business. Here's hoping that you don't have to undergo that procedure.

Good luck, Jeff

cathydownunder · #3 04-11-2011, 07:23 AM

Jason, I read your other post with your CT scan and it looks very much like mine pre-op, except mine was almost bone on bone at L4/5 not L5/S1.

Without wanting to appear bitter or disillusioned......I believe an incorrect decision was made with my Maverick disc replacement on such a degenerated disc, along with the thoracolumbar scoliosis I have and the widespread arthritic changes that go along with it.

A revision less than 2 years later to place a Dynesys Stabilisation (soft fusion) over the ADR and a further L5/S1 PLIF have done little to alleviate my ongoing pain. In hindsight I believe a 3 level fusion would have been a better option for me....after all, contraindicationa are there for a reason!

At this point in time....5 years post-op, I'm still in daily pain, my SIJ's appear shot, I've each surgeon I've consulted says my situation is "complicated" and nobody wants to touch it!

Please get a second opinion and go with your gut..it's usually right.

dustman9725 · #4 04-11-2011, 08:13 AM

My "new" neurosurgeon from John's Hopkins wants to perform a revision-fusion over top of my ProDisc C.

Hopking that this surgery (Should have initially been done instead of disc prosthesis) will stabilize my C5/6 Disc which has been a mess since my ADR surgery back in July, 2010.

I would never imagined that a failed ADR procedure would ache so bad, I am just glad that I found a surgeon who was willing to do revision surgery on the ADR.

Now all that is left is to decide on when to do the surgery and pray and hope that the revision takes away the pain <-- which has ruled my life for the past year!

Should be in good hands with John's Hopkins.

jss · #5 04-11-2011, 09:01 AM

dustman,

I've read that the success rate for cervical revisions is much higher than that of lumbar. When is your revision? Please keep us posted.

Good luck, Jeff

dustman9725 · #6 04-11-2011, 09:29 PM

Jeff,

Thanks for the reply. I just emailed my Hopkin's surgeon this morning. I guess I will follow his schedule relative to surgical timeframe.

I am thinking that I would like to have the surgery in May.

Really scared, but hopefull. Revision surgery can make things worse, but I have no procedure or arena to turn to beside this option. Got to take a chance at this point. Not quite russian roulette but this whole situation has really forced me to make tough decisions.

dustman9725 · #7 06-15-2011, 04:08 PM

Last years initial pro-disc surgery was July 6th. The revision surgery is July 1st, almost a year. A year that has been hell!!!

He is going to do a posterior fusion over the pro disc.

Scared but have no other option. Praying for it to work.

He said it was too dangerous to remove the prodisc because of the bone growth and the large keels.

Surgeon said that if this doesn't take care of my pain, then it is a life of pain management. WONDERFUL

Terese64 · #8 06-15-2011, 09:07 PM

Dustin,
I just had two prodiscs removed at C5-6 and C6-7. My neurosurgeon used bone from my hip to fill in where the keels were and cadaver bone in between. He said I had bone growing over them, but that they came out fairly easy. I now have a fusion from C4-C7. I have been in a lot of pain and was in the hospital for a week for pain control! Last night he prescribed a different pain medication(I've been taking Oxycontin, Oxycodone, Fioricet, and Dilaudid) and a muscle relaxer, which have helped. I'm keeping my fingers crossed that long-term it'll all be worth it! Good luck!

beaverc · #9 07-17-2011, 05:05 PM

Jason did you have the ADR surgery with Delamarter ? How are you doing? Hope you are doing well. Let us know. Take care.

JKDE302 · #10 07-25-2011, 01:46 PM

Quote:

Originally Posted by Terese64

Dustin,
I just had two prodiscs removed at C5-6 and C6-7. My neurosurgeon used bone from my hip to fill in where the keels were and cadaver bone in between. He said I had bone growing over them, but that they came out fairly easy.

Really how are you doing now?