ADR Risks, Complications, Disqualifications

[Harrison]

Steve and others, sorry to ask this question, but I think it is important. When TBI (or others) notify a patient that they are not qualified for ADR because of "psychological" reasons, what is the exact wording or phrasing that is used? And is that put in writing?

[CindyLou]

Good question Rich. Yes, I'd like to see the exact wording too.

[KBear]

A bit of a correction to Steve's post. I was told I could not have surgery due to pysch reasons. I was able to do bio-feedback and then got through (it had nothing to do with me switching doctors). I was supposed to do 5 sessions. I did 2 sessions (in which I was actually extremely relaxed when I got there, according to their testing). The man who did the bio-feedback switched jobs, so they didn't have someone to finish mine. I refused to do hypnosis because of religious beliefs (nothing against anyone who has done it or has had benefits from it, I just did not feel comfortable letting someone have 'control' or at the minimum 'strong power of suggestion' over my mind). I then had to go in and talk to the counselor and she 'released me' for care. I will look through my records and see if I have the stuff from her. I don't think I do, I didn't request it, not exactly something I wanted to send in for my case for my appeal.
Kathy

[Harrison]

Just wanted to let the new folks know that I updated the orginal topic, a very important one for understanding the risks, complications and contraindications for artificial disc replacement.

[cavalier]

couple of quik points - someone asked if they had a discectomey if that is a deal breaker for ADR. The answer is no. Someone else stated that a ADR at L4L5 may not work & a fusion would be better. Honestly out of all of the lumbar places that NEEDS to be able to bend & still move it would be hands down as number one would be L4L5 in the lumbar closely followed by L3 L4.

I have a single ADr at L4 L5 for 5 yr's now - it has so far kept L3L4 from having to be replaced as it was ALREADY herniated when we did the ADR & had been for some time - otherwise I would have had to have had a 2 level fusion as L3 L4 was already blown. Dr Bertangoli did my surgery & it helped me considerably. Now I am having stenosis in my neck at a few levels & so once again am having issues but I am glad I did what I did for my lumbar. Revisions have been done in replacing a ADR - they have moved the arota twice in some patients they dont want too but they have. those revisions sometimes have had a 2nd ADR & sometimes a fusion but each case will be depending on the skills of the surgeon & what they lean towards for that patient. What their level of confidence is in the products they use & their time in using them.

Sorry I just saw alot of confusion on here & some ?'s that were still not answered. Jill

[Harrison]

Jill, these are general guidelines for us patients. They are in no way meant to convey any notion of "standards." Some surgeons are more nit-picky than others; these are for furthering the dialogue between the patients and their doctor(s)...

[ans]

I don't understand why this could be an exclusion:

"Objective evidence of nerve root compression"

Thanks for this information!

[tigerpaw75]

Is a "hemilaminectomy" a contraindication for ADR at that level? This hemilaminectomy was done in conjunction with a discectomy to excise the ruptured portion of the L5-S1 disc that was pressing on the sciatic nerve.

This was not in the list of contraindications...but wondering if there greater risk of movement of an ADR on a level where this surgery has been done. This is theoretically do the potential weakness of the facet joint on the side where the discectomy was done.

Thanks,

Tom

[hey_look_its_dave]

Hi,

This was the question I had when I joined the board. After having now asked the opinion of a number of surgeons I can tell you the answer is, it may or may not be.

When they do the hemilaminectomy/discectomy, they need to remove a bit of the lamina (upper and lower) on one side (not the whole side, mind you) and perhaps a bit of the facet.

As you've mentioned, when you get an ADR, there is a bit more floppiness to the joint since, unless you get an M6 disc, it doesn't have a tendency to return the spine straight as a regular disc does. As a result, the facets take a bit of a beating. The facets are the hard limit stops of the spine to prevent over-extension (overbending backwards). You'd want to start with good facets.

One place in Germany said I was disqualified because of it without even seeing MRIs or CTs. Others have said it depends and they find with the MRI and CT. I'm still waiting for more opinions to come in.

Be aware though, if one guy says he won't do it because of the previous operation and another says he'll do it no problem, you might want to ask yourself whether the latter is a cowboy or whether the former is overly-conservative.

Let me put it another way: If one guys says he won't do it, is he protecting his reputation (and your interests too, we hope) because he knows your outcome won't be as good as a fusion? If all the top dudes say "no", I'd be worried.

How's that for a non-answer? heh...ugh

Dave

[tigerpaw75]

Thanks for the response Dave...the doc had not yet looked at my wife's films, so I don't know how much of the lamina they removed...but, a hybrid fusion at S1-L5 and an ADR at L4-L5 may be what we end up doing. Apparently data suggests that this surgery is just as effective and may have a slightly lower risk of complications.

Tom