ADR revision, Remove disc or Leave

[mark-perth]

Hi everyone,

I would be extremely grateful for any advice from anyone thats had a revision or contemplating a revison of an ADR. I had a Maverick disc put in nov 2008 and it was placed way off centre. In the last 5 months my spine has developed scholiosis which is getting worse and more painful quickly. My facets in the lumber spine are all inflammed and hurting quite bad and were perfect before.

I had 10 radio frequency denervations done to the lumber facets in january 2009 which helped a little for a few weeks only. My surgeon didnt want to admit there was a problem and kept reassuring me that it didnt matter that the disc was crooked as he didnt think it would move anyway. Im actaully not annoyed with my surgeon and even know i have suffered with depression for years due to being in back pain for over 12 years im not that upset that the ADR didnt work.

I went into it only after years of research and knowing my only other option was a fusion. I had tried every possible thing to delay surgery and lasted 11 years before having no choice as the pain was unbearable. I knew that every doctor has failures and with my vertebra touching he had some job being able to get a disc in. He spent 7hrs on it and had to cancel all his other surgeries that day so I know he gave it 100% and I know that he proceeded with the ADR knowing that I was opposed to a fusion.

I had many opinions and had 3 say ADR, 1 say ALIF and one say he was unsure but prefered a PLIF due to the safety of it but did say he would attempt an ADR if I insisted but would also have a fusion cage there and if he felt that a fusion would be better then that was what he would do.

My biggest concern now is how much pain I will be in after the next op as my doc has said it may not help and I then know there isnt anything else that can be done. I knew that if the ADR didnt work that it would be fused and took the view that I was better to try an ADR first and if that didnt work have the fusion as it couldnt be done the other way round.

The biggest problem now is that a fusion now wouldnt be anywhere as good a result as if it had just been fused. I never realised that at all even know I researched it for years, I just thought that I would end up the same in the end with a fusion being a fusion. There is also a good chance Ive done something to the discs below as my physio thinks I have, my pain is over a much larger area than before and im still on huge doses of medicataions. Its a horrible feeling and I know exactly how others like Linda and Liz on here feel. Its such a big decision especially as im only 33 yrs old. I cant imagine being able to live like this for another 12 years let alone the rest of my life. Any advice would be greatly appreciated.

Thanks,
Mark,

1997 motorbike crash L3/4 DDD,
lots of rhizotomies from 1997-2009,
L3/4 Diam -November 2007 - no relief,
L3/4 Maverick ADR - nov 2008 - placed crooked causing scholiosis,
2009 10 facet joint injections minor relief

[CharlesinCharge]

Mark,

I am sorry to see you in such a bad spot, and being an honest person I am not going to lie to you---you are in a tough situation. Before I had my two level ADR surgery I wondered what would happen to me if it did not work, because it was the "end of the road" in that everything else we had tried for my pain had failed. I could not live with my pain, and I TOTALLY understand how you feel now---if you cannot get some relief, life is not worth living in the condition you are in. I have been there and it is not a good place, but please do not give up just yet.

From the many studies I have read, removing the artificial disc and then fusing has much higher success rates that just fusing the disc in place. I am not sure exactly why this is true (and the studies were not either), but it is what it is. The problem is that removing the artificial disc is a very complicated and risky surgery, as I am sure you already know. Even though the Maverick disc is keeled (I have two of them in my body), it can and has been removed. Google "ADR revision surgery Maverick" or something like that and you will find some examples.

I cannot tell you what to do, but if it were me I would probably take the risks involved with revision surgery and remove the Maverick disc before fusing, to give me the best chance of being pain free after the procedure. I know that this sounds terrible to say and I will probably get some flack for it from others on this board, but considering the pain that I was once in (and you are now in), I would rather be dead than live the rest of my life like that. As such, if it were me I would take the risks involved with the revision surgery and get the Maverick disc taken out before fusing that level. However, obviously you need to decide for yourself what is best for you and your family.

Best of luck,

[steve55]

I've read several patient stories exactly like yours. This kind of thing happens when the doctor screws up and recommends ADR with patients who aren't proper candidates. One case I know of occurred with the best and most experienced ADR surgeon in the world, dr bertagnoli in Germany. The patient says that all the American doctors said dr b put in a oversized disc and so her verterbrae space was in constant hyperextension causing severe pain and that her MRI clearly showed severely arthritic facets prior to surgery. She searched a long time for a surgeon who was willing to take on her revision surgery. No one wanted to touch her due to risks involved redoing a lumbar with a fusion. She was in constant severe pain, in pure hell. Her persistence paid off and she found a world renowned surgeon who had some experience with removing lumbar discs and fusing. I forget the surgeon's name, I think it was dr delamarter in los angeles or maybe it was dr regan. Anyways, her risky revision was a great success! So, with a top surgeon, it can be successfully done. You need to do it , what kind of life will you have living in this much pain?

[Virginia]

Dear Steve55,

I am a British woman living in Dubai, enduring excrutiating nerve pain for the last 2 month in my neck and left arm. I am new to this site.

The 2 neurosurgeons I consulted in Dubai favoured fusion, whereas Dr Fenk-Mayer at ProSpine analysed my MRI and X-rays and said a fusion was not necessaary in my case, as my case is "very straightforward".

I have been scheduled in for a 2 level ADR pro disc nova (C56 & C67) with Dr Bertagnoli on May 7. I chose ProSpine due to Dr Bertagnoli's reputation. ProSpine have quoted me 26,000 Euros, which I have to pay for myself as my insurance have refused to. They want me to wire the money to a firm in Cyprus.

ProSpine appear to want email communication only, with no phone numbers given so I can speak to a doctor before I fly over. I am in great pain but quite concerned at the service they are offering for such a large chunk of my personal savings. Once the surgery is over and I return to Dubai, what level of follow up can I expect if I need help, the impression I get is none, you pay for your operation and that is it, apart from sending an email and waiting for a reply.

I would have to find a surgeon over here who is willing to do follow up on a surgey s/he did not do?

If you can give me any details of your experience over there, I would be most grateful.

Thanks!

Virginia

1999 C5/6 disc bulge, neck pain, not much arm pain physio traction etc for one year
2009 C/6 disc bulge, C6/7 disc herniation, bony protusions on C5/6 and C6/7, intense nerve pain left arm and neck. Significant left arm triceps weakness.
Anti-inflammatory and painkillers not working, 6 weeks of conservative therapy, pain is worse now. Cannot sleep.

[phylly]

Mark,
I think I understand how you feel. I had a huge revision surgery 2 month ago and removed the prodiscs and then fused with a cage and bmp. the prodiscs were removed from the anterior position and the fusion was done with percutaneous incisions to save the muscle. I still have pain at this point and I am on a little more medication than prior to surgery. I may have started to be more active and that is why I am getting more pain but I hope it is temporary. If I can answer any questions, please ask.

I always thought would try the ADR and then if it didn't work, I could fuse. I didn't realize that fuse meant fuse over the discs to most DRs. as the surgery is very dangerous. I found a Dr. who believed the best result was taking out the discs to avoid micro-movement from fusing over a problem. I hope that you can find answers to your dilemma. It was huge for me and I was not sure which Dr. to believe. I think I made the right decision. Again please let me know if I can help.
Phylly

[mark-perth]

I spent alot of time before my surgery looking at the consequences if the ADR failed at I too thought that it would be the same fusion afterwards as if I went straight 2 a fusion. If only I had know that first. I have spoken to nearly every surgeon in AUS and they all want 2 leave the disc as it is. I have read alot of papers on revision surgery and they all say its alot more dangerous doing another anterior operation but better results.
Who did the revision surgery for u Phylly?
Im so glad they were willing to do the best for you and not just try 2 cover up the problem probably making it worse.
I was actually more scared for the first op than this 1. I think im at the stage where I dont care whether I live or die but would rather die trying than live in more pain.
Ive only found Dr Bertagnoli that is so far prepared 2 do a revision but he wants 2 remove the maverick and put in a Prodisc L, maybe the oblique one they said as it may work better as the keel is cut different. I myself R worried about the curve in my back as well and R probably favouring removal and fusion. What R your thoughts?
Thnaks for your advice
Mark

[mark-perth]

Thanks for you reply
I to feel exactly as you said. I would prefer to die trying than suffer in pain for the rest of my life. I 2 have read alot of reports in full regarding the revision and know the best results have been with removal and fusion and not just fuse and leave in place. I feel ive suffered enough and couldnt imagine living forever like this. Im already on over 300mg of morphine as well as a topical Ketamine, muscle relaxants, anti inflammitorys plus other medication and still in pain. Some people may say that I couldnt think clearly on that medication and wouldnt be capable of making such a big decision but I dont get effected by the medication and are still able to study at university. I also am not depressed. I have suffered in the past but since the last op I have been of pretty good spirits although in alot of pain. I dont have any kids yet and would not bring any into the world if I was in the state im in now and I wouldnt either if I have a fusion as it is so I dont see alot 2 loose.
I see that U had a XLIF at the level above the ADR's, was this pre-existing or was it brang on thru the extra strain the ADRs provided?
What was the XLIF like compared to a standard anterior operation?
Thanks for your advice and best of luck in your recovery

Cheers
Mark

[mark-perth]

thanks for the reply Steve
your advice has helped alot, Dr Bertagnoli is the only person so far 2 be prepared 2 revise is, every1 else just wants 2 do a PLIF. I dont agree that this is the best thing to do either. I havent heard 2 many people that R happy with the results from that. U said that there was some1 that Dr B stuffed up, was she on here? do u remember her name? Did u no that before u went 2 Dr B? U said that your surgery was 100% success, Im so happy that it was, U R very lucky, would U recommend Dr B for a revision?
Thanks for the advice, I feel alot more comfortable proceeding with everyone else agreeing that it provides a better result.
Best of luck in your recovery
Mark

[steve55]

Mark-Perth, all I remember is the lady's board handle, it was job13 or something like that. And yes, I knew that before I went to Dr B. It was the only story I ever found out in cyberspace that was a negative on Dr B which says alot given I have found hundredes of Dr B's patient stories. I am not yet in the clear as I have sufferred a setback a few weeks ago and still havent cleared it. Im 2 months post Op and still in some pain, but its not any of the old pain, its a different type of pain and I sure hope that it will go away in time , if it doesnt , I have to change my board signature section to say "semi success".

And yes, I would reccommend Dr B for any surgery based on what Ive read, he is one of the best and his success rate is extremely high. If I were to need a revision , Id also prefer to remove the discs and just fuse. Id feel safer going to a top surgeon who had done the most of these cervical revisions, maybe even over Dr B. Im not sure how Dr B's reputation is with revisions.

[steve55]

My experience there with Dr B and prospine was great. He has done over 3500 ADR's which is more than any doctor in the world, and he is considered the best ADR surgeon by many in the medical community.

About after care, I also considered that but for me, I thought it was more important to get it done right the first time by thebest, so that my need for a follow up surgeon would be less likely. Make sense? IN my book, there's not much a follow up surgeon can do anyways. He cant go inside your back and change what has been done right? He can talk to you about what might be going on and thats about all a follow up surgeon can do. Heck, I can do the same and talk to Dr Fenk Meyer who will talk to Dr B in turn, and get a email reply. To me, Dr B is my follow up surgeon by email, and if necessary, I can get any xray, MRI etc type testing over here in the states and just send it to them. Lastly, Ill fly over there for a follow up if it was necessary to be there in person. I just dont see much value in having a follow up physician locally. There's absolutely nothing he can do that Dr B cant do by email discussions or ordering tests and sending them over there. I think having a follow up physician offers a more psychological benefit or comfort to the patient more than anything else. So try not to focus on that, focus on going to the best ADR surgeon in the world so you can get increase your odds of getting it done right the first time.

Im 2 months post op and while my oldpain is 100% gone-thus success, IM still in post op physical type pains on my left side muscle and general inflamation where my discs went in. Ive heard 3 months to 9 months are the most common healing periods to where you can know if it really worked for good or not. One person here claims it took 2 years to be all healed with no pain. SO, I continue in some pain but yet, still better than I was before I had surgery. Ive heard 2 months isnt enough time to make any decisions on surgical outcome success or failure, so I am not concluding anything yet.