Adjacent segment degeneration question

[berry]

Hi Adam

I really am so much better, thanks. I had two Activ C's three months ago with great success. You can read about my progress in the surgical outcome forum. I am much improved since the op, no futher vertigo or unsteadiness and no arm and hand pain..its great. My walking has improved, my legs no longer feel like lead and I don't bump into walls as if drunk anymore. I get occassional tingles in some fingers now and again but I'm hopeful that those feelings will resolve too.

Regarding the brain tumour, I feel very well... I recently had another MRI to check for recurrence and get the results later this week.

Re the adjacent segment degeneration which is what my original question referred to, I am 4 years and 3 months post lumbar ProDiscs and now have some symptoms from my facets - moderate to mild lumbar pain and intermittent pain in my right lower leg. (So not too much deterioration over the last year when I posted this thread.) I am having facet joint injections in two days time to see if they will help. I have had them before, about five years ago; they were not very effective then but the discs were the pain generators then so perhaps these post-op ones will make a difference. I'll have to wait and see. Time will tell whether I am on a decline here. Despite the return of lumbar and leg pain I am still significantly better... greatly improved mobility and reduced pain... than I was before the lumbar TDR's and have no regrets about either surgeries.

The following abstract and quote from an article in Spine, one of the medical journals, may be of interest although Adam as you have Activ L, a newer design which we are told are kinder on the facets, you should not have this problem.

CHARITE versus ProDisc: a comparative study of a minimum 3-year follow-up.
Author(s): Shim CS, Lee SH, Shin HD, Kang HS, Choi WC, Jung B, Choi G, Ahn Y, Lee S, Lee HY

Publication: Spine, 20 April 2007, vol./is. 32/9(1012-8), 0362-2436

Publication Date: 20 April 2007



Abstract
Study Design. A retrospective study.

Objectives. To evaluate and compare clinical and radiologic outcomes of the CHARITÉ and ProDisc.

Summary of Background Data. There is no clinical report comparing CHARITÉ and ProDisc.

Methods. Among a total of 61 patients who underwent total disc replacement, 57 patients followed more than 3 years were enrolled. The CHARITÉ was used in 33 patients and ProDisc in 24. MRI follow-up was possible in 52 patients. Clinical and radiologic data including range of motion (ROM) and facet degeneration of the replaced segment, and degeneration of the disc at the adjacent level were evaluated.

Results. Mean percentage improvement of Oswestry Disability Index (ODI) score was 78.9% in the CHARITÉ group and 75.8% in ProDisc group. The mean improvement of the Visual Analogue Scale (VAS) pain score was 72% in the CHARITÉ and 74.2% in ProDisc. There was no statistical difference between 2 groups in improvement rates either of the ODI scores and VAS scores. Degradation of the facets was seen in 36.4% of the CHARITÉ and 32% of the ProDisc. Degradation of disc degeneration at the adjacent level above the index level was seen in 19.4% in the CHARITÉ and 28.6% in the ProDisc. The degradation rates of facet joints and disc at adjacent segment between the 2 groups were not significantly different. Segmental ROM of the replaced segments was well preserved, but ROM of L5–S1 of the ProDisc was significantly less than that of the CHARITÉ.

Conclusions. While clinical outcomes of both CHARITÉ and ProDisc groups were fairly good, the facet joint of the index level and the disc at the adjacent level showed an aggravation of the degenerative process in a significant number of patients, regardless of the device used, raising concerns of possible late consequences of total disc replacement, especially regarding facet arthrosis and adjacent segment disease.


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Quote from the above paper

"Clinically, our data support all the promising clinical results of the lumbar TDR in the literature that showed efficacy of TDR in the treatment of degenerative disc disease. We agree that lumbar TDR is one of the most rewarding procedures in terms of rapid pain reduction and early recuperation. But unexpectedly high incidences of degradation of facet degeneration at the replaced segment and disc degeneration at the adjacent segment alerted us for the late consequences of lumbar TDR, especially regarding facet arthrosis and adjacent segment disease.

Key Points
* Both the CHARITÉ and the ProDisc improved patients' back pain and disability effectively, and there was no statistical difference in improvement of ODI and VAS and clinical success rates between 2 prostheses.
* Range of motion at L5–S1 in the ProDisc group was significantly less than that in the CHARITÉ group.
* Unexpectedly high rates of degradation of facet degeneration of the level of replacement and disc degeneration at the adjacent segment were identified, raising questions about the long-term efficacy of lumbar TDR, as it relates to facet arthrosis and adjacent segment disease."


The short term results of my TDR's have been pleasing, only time will tell what my long term outcome will be.

Regards and good luck in you recovery Adam, take things easy.

Lynda

[berry]

Thought I'd just update this thread

Lumbar spine: 4 years 9 months post ProDiscs at L4/5 & L5/S1

The facet arthrosis at the index sites responded to the facet injections I had in May 2008, although the relief was only short lived. I have been offered radio frequency ablation, which I am undecided about as I have read that although it can provide relief this is only temporary, and, when the pain returns it could be worse.

An mri scan in September 2008 confirmed further degeneration at three levels above the artificial discs which is disappointing. I have some sacral pain and intermittent pins and needles in bottom and down the back of legs, right lower leg pain, which increases on walking and a reduced sitting tolerance. Recently there has been some right groin pain, which disturbs my sleep. X-ray shows some peri-prosthesis ossification- see attached file below for picture if interested:

I am disappointed that I have gone on to have progression of degeneration but still have no regrets about having the surgery. I do not know whether this is a natural progression or whether the movement permitted by the artifical disc has increased the stress on the facets and acelerated the process. I have read research that shows 1 in 3 women with multilevel disc replacements go on the develop symptomatic facet degereration.



Cervical spine: 9 months post Activ C at C5/6 & 6/7

My neck is great, almost as good as new, with my two Activ C discs, they have made an amazing difference. Very occasionally I get some tingling in the hands and fingers but range of movement is very good, no shooting electric shock-type pains or unsteadiness. Details of my post-op recovery is on the UK site http://z6.invisionfree.com/adrsuppor...?showtopic=303

The shoulder pain I had post-op has been confirmed by mri as tendonosis and I am having physiotherapy (rotator cuff strengthening) but an arthroscopic debridement is possibly on the cards.

All in all I am not as good as I was two years ago but still better than I was five or six years ago so I can't complain. Sometimes I feel as though there's no end to it, I no sooner get one problem sorted out and another one jumps in its place. Still I guess that's life, and I'll deal with whatever comes along as best I can.

Regards

Lynda

[Terry]

I am wondering if this is the bane of artificial disc replacements. I am also having some SI joint and facet issues a little over two years post op with Maverick disc replacements. I may be premature in my assessment as I have not gone to get injections at this point. I am seeing a P.A. Monday for an assessment prior to getting injections. The last ones lasted me almost a year. I am hopeful that this may only be a once a year occurrence.

I sure hope that the discs do not cause premature degeneration of facet joints. It will mean that the fusions still may be the better of the technology unless they replace the facet joints at the same time. The only problem with this is the newness of the technology. The other issue is that hardware is always a potential harbinger of bacteria that could cause Staph which is a huge problem that can result in needing to have the hardware removed.

Life is always challenging. I was sure hoping to win the lottery and go grazing in the pastures.

Terry Newton

[Justin]

Lynda,

Keep your head up. I'm sorry it's like musical chairs with your problems. It is frustrating.

Did you have a lumbar discogram prior to surgery?

[berry]

Thanks Justin and Terry for your replies.

I did have discography prior to my lumbar surgery and L3/4 was not thought to be a pain generator, but L4/5 L5/S1 cetainly were! As I was very well for the first few years I believe it wasn't a false negative at 3/4.

My surgeon has offered nerve ablation for the facet related pain but I'm still undecided about undergoing the procedure. Tonight I'm struggling with shoulder impingment pain, the physio seems to be making the pain worse... its not great to be falling to pieces when I thought I was fixed.

I don't know about musical chairs...as a mother of six we've had fun at parties playing that game many times but this continual round of hospital appointments just isn't me....I do sit on lots of chairs though, does that make me a winner?

Lynda

[Justin]

Originally Posted by berry

I don't know about musical chairs...as a mother of six we've had fun at parties playing that game many times but this continual round of hospital appointments just isn't me....I do sit on lots of chairs though, does that make me a winner?

Lynda

Being a mother of six puts you in your own league. Talk about having your hands full. Good luck with the shoulder and back. My wife wants to have at least four kids, and just the thought of it makes me tired.

[KBear]

Originally Posted by Justin

Being a mother of six puts you in your own league. Talk about having your hands full. Good luck with the shoulder and back. My wife wants to have at least four kids, and just the thought of it makes me tired.

Justin- I also wanted 4 kids, being that I was one of four, it just seemed
"normal". I actually had wanted 10 when I was younger. My husband wanted 2 (which seemed weird because he is one of eight) Anyway, we had 1, then I changed to maybe 2. I had the second, which was the second girl and my husband changed to 3 and it was a maybe for me. Three years later, we would both like another; but it is on hold because of my back. If I didn't have to do the pregnancy gig, I would have a lot of kids (and even as much as I don't enjoy pregnancy and labor, I do know that I can't fathom never holding a newborn of my own again) There are days where I think I am crazy for wanting another, days where I try to take my birth control 5 or 6 times in a day and just think I can't do it. But then, more often than not, they do something sweet, a look, a kiss, an expression, do something silly and you know that these are the best days of your life!