Adjacent segment degeneration question

[berry]

Hi there

Does anyone know anything about adjacent segment degeneration?

I had 2-level ProDisc in Feb 2004, L4/5 & L5/S1, and have been delighted with the outcome. My two year follow-up x-ray showed further degeneration at L3/4, I, at that time, had no back pain although I had developed some urinary urgency and incontinence; I was referred to the gynaecologists who say this may be neurogenic and may or may not improve. I've aslo had repeat MRI's. In 2005 I was diagnosed with cervical DDD and prolapsed C6/7; I was offered a fusion and given 6 months to decide about that surgery. In 2006 I had a begnign frontal lobe brain tumour which was surgically removed. (This surgery took priority over my spine and I have not had a cervical fusion)

Recently I have had some intermittent back and leg pain and worry that I may be on a progressive decline. I would like to know if it is possible, after already having a double ADR, to have another should I worsen in the future or would fusion be the only option?

I see the surgeon soon to discuss the results of my MRI but thought I'd try to get some food for thought from this great forum.

Many thanks

Lynda

[Alastair]

Hi Lynda,
I know we have spoken before, but I can't remember who your surgeon is, off the top of my head. Usually ADR should help prevent any further Adjacent segment degeneration. Do you think that these problems that you're having could maybe coming from your cervical problem?

We have a member across in Germany at the moment who has two cervical implants last week and has three lumbar implants from two years ago and is doing extremely well.

I wonder if you're just having general degeneration of the spine as a complete item? I think that's a question to ask your surgeon next time you see him.

Fusions do tend to cause problems with adjacent levels, that is why disc replacement is so good.
Best,
Alastair

[annapurna]

With a sufficiently skilled surgeon, you can get another ADR lined up with the double ADR you have in the future. It takes some artistry but it is possible.

[Alastair]

I think I have remembered who Lynda`s Surgeon is, it's Mr Shackleford, there could be financial restraints if she's having this is done under the NHS (the UK health system).

A large number of PCTs (the organisation who fund the treatment) are either in great debt or broke until the new financial year begins. I'm afraid this is the UK health system folks. I'm sure Lynda will be a long and straight on me out if I'm wrong
best,
Alastair

[tmont]

Hi Linda,

On adjacent-segment disease (or degeneration), you'll find many conflicting opinions and statistics (via studies) on the topic, whether it is subsequent to a fusion or linked to other 'untreated' and diseased levels.

However, it merits reminding that while ADR logically should reduce adjacent-level degeneration (as it is supposed to preserve natural motion and loading), this has yet to be proven by any significant,long-term study to date.

Unless I'm mistaken, ADR in this aspect so far 'looks good and hopes are high', but concrete comparisons to fusion and even lack of treatment are still in the works....

Trace

[Harrison]

Please see the abstract of the long-term study I posted:

http://adrsupport.org/eve/forums/a/t...1/m/1491009412

I can send you the original article too, just email me.

[berry]

Annapurna, Alastair and Trace, thanks for the replies.

Annapurna it is reassuring to know that it is possible to have another lumbar disc although I am hoping it does not come to that.

Alastair, you are right, Mr Shackleford is my orthopaedic surgeon. When I last saw him he told me he was planning to begin cervical disc replacements using Mobi-C at the end of 2006 and said I was a suitable candidate. I do not know if he has in fact done any yet. It may be that, with the deficits in the NHS, he has had to postpone until the new financial year. I see him in March so will have more info then. (I had to postpone my January appointment because it coincided with the funeral of someone very dear to me - my Dad; A sad sad time.)
I agree that I have general spinal degeneration and will ask when I next see my consultant. I hope my discs don't continue to degenerate from either end and meet in the middle!! Seriously though, there are genetic origins as there is a history of sciatica and back pain in my family. Brain tumours too.
My dysfunctional bladder may perhaps have something to do with the cervical DDD. It did however, get worse after the neurosurgery and, from what I have researched, frontal lobe tumours can affect the bladder. Although, by my simple logic, having the tumour surgically removed should have improved things rather than make them worse.That's my uneducated guess. My neurosurgeon (who is anti ADR) thinks it is gynae related. The gynaecologist thinks it may be neurogenic! Perhaps it could also be caused by the further lumbar degeneration. Whatever the cause, the good news is that it has got slightly better recently.

Trace, I have found very litle data about ASD following ADR but understand that I am in the minority 2% of cases in whom it occurs. Longer term studies, as you say, may alter these statistics. Despite my ASD, which in my opinion is due to the natural progression of my DDD, I have no regrets about having ADR. Having the surgery massively reduced my pain and improved my flexibility and mobility and I am extremely grateful that I had the opportunity to have the surgery. Will be in touch.

Regards

Lynda

ProDisc L4/5 & L5/S1 Feb 2004

[tmont]

On the Charité report: a reassuring beginning, even if one device-specific report doesn't yet allow us to put the question of 'Does ADR prevent adjacent-level disease?' to bed. I'd like to read the whole article, as a few points in the abstract left me wondering:


"196 (patients) returned to work and were still working at follow-up"

Good news. I assume by 'at follow-up' they mean 10 years and beyond. But have the other 30 patients stopped working due to age (retirement seems unlikely for most given the mean age at time of surgery) or additional problems? If the latter, what were they? and

" Adjacent-level disease requiring re-operation was 2.7% or 6 patients"

This is the important one. What was the time frame for this? How can it then be compared to time frame and performance of other lumbar and cervical devices, fusion, and lack of surgical treatment?

These last two questions are the ones the jury is still out on, and are likely part of the reason that ADR is not at this time performed by certain physicians and in certain countries. A cervical patient in Australia told me his neurosurgeon said flat-out 'there is no concrete evidence that ADR prevents adjacent-level disease, and until there is, we won't consider it'.

Lynda, having no regrets about ADR is already a huge achievement and I'm really glad for you. And 'future adjacent-level risk' versus 'living in unmanageable pain and limited mobility', was a no-brainer for me too and I took the surgery and got my life back. To this day, no regrets even if I now need another level fixed.

The only question I really have is whether these relatively new devices with moving parts and hi-tech cores and keels and teeth, etc etc will over time DISTINCTLY prove themselves clinically superior to the so-called 'gold standard' of fusion-- or whatever 'bio' solution might come along in the next few years. As a future Mobi-C recipient myself (without a lot of time to wait), I'm betting on it and looking for proof--and hoping that it will hold up next to the added stress of being adjacent to a fusion. I hate not being sure, but that is ADR reality in 2007...

Good luck on your consult; will be waiting to hear how things go and hope your feeling of improvement holds. But on your doc's take: I'm a bit confused as to what your NS said on 'gynae-related' issues? What exactly is he saying might be related?

Trace

[berry]

Hi Trace

I found the abstract interesting and have asked Rich to forward the full article to me to study in detail. I will forward it on to you once received.

Sorry if I wasn't clear about my NS, (he did my craniotomy and resection, my ADR was done by an orthopaedic surgeon) the NS thought my urinary frequency, urgency and incontinence were not neuro but gynae. Interestingly, the urology nurse after urodynamics thought I ought to be referred to a neuro-urologist. The NS dismissed this and referred me to gynae team (I think he just jumped to gynae because I've had six children). Also, his opinion was my C spine wasn't bad enough for surgery yet and suggested traction and physio. I decided to stick with the orthopod who did the lumbar ADR and initially wanted to do the cervical fusion (but hopefully will have by now begun cervical ADR). He ordered the repeat MRI's. Is that as clear as mud? Anyway, I still see all three and no matter what the cause things in that area have improved somewhat.
I am looking forward to seeing the consultant and will let you know how things go.

Off to bed

Night night

Lynda

[Adam]

Hi Lynda,
Hope you are doing better. I was wondering if you can update us on your condition.

Thanks,
Adam