ADR size and placement vital,, access surgeons essential

[Fortitudine]

In my old age I forget a lot of things...

Another interesting observation at the Banff conference was that early procedures 'stuffed' ADRs into the disc spaces. In other words, it's possible that in their enthusiasm surgeons have used a larger than necessary prosthesis, possible leading to unnecessary distraction pain... Also, correct placement is essential and worth the extra time it may take.

Also, unless the NS/OSS is VERY experienced in lumbar ADR, it was recommended to have a vascular surgeon create the access, and to remain in the OR for the entire surgery. If nothing else, it's a spare pair of hands, but if there is any question regarding vascular bodies, the AS can look after that aspect.

[Alastair]

I was talking to one of our UK ADR surgeons today. From within our conversation, came the very strong message of the extreme skill and knowledge that successful ADR surgeons have.

I had always thought it was very similar to a fusion, and when you look at the physical procedure that might seem the case.

However, the placement, size of prosthesis, bone density, and many other factors, emphasised upon me the skill of these surgeons.

[letteski]

Fortitudine

it's possible that in their enthusiasm surgeons have used a larger than necessary prosthesis, possible leading to unnecessary distraction pain...

This is my biggest fear these days because I was told that even the smallest charite might not fit in me because I have small discs to begin with. This was told to me by a well trained ADR US doctor. It may not just be nerve distraction pain that can cause pain but it can tear the facet joint too. I will quote the doctors letter to me: (remember all this is me and not you!)

"It was not just disc space height but elevating the facet out of it's pocket placing them in an abnormal relationship and that distraction of the facet joints would tear the posterior facet capsule." Scary

Just something I can't get out of my head these days. This is my anatomical make up and I have to look to the medical profession to make the best recommendation for me. I am still searching. Dr B and Dr Z disagree with this doctor and recommend ADR. Experience is crucial!

Re: vascular surgeons and ADR do they do this surgery without one and who holds you open if the vascular leaves the room?

[Dano]

Due to the nature of the vascular structures and their importance to your life span (Abdominal Aorta to name one) complications can be reduced by the use of an experienced vascular surgeon. Not to mention that if an accident were to take place the vascular surgeon is there in the OR with his hands inside to fix the problem. Additionally, the ADR surgeon�s focus is on the ADR, the vascular surgeon�s expertise and concern is the entire vascular system and making sure it is not harmed! I would never have this type of surgery with out an access surgeon who is a trained, experienced and board certified vascular surgeon. Remember, blood colts, bleeding, occlusions ect. are all very real life threatening problems that are the area of the vascular surgeon. And who better to take care of these structures while they are ligated and distracted so the ADR surgeon can do his thing! This has nothing to do with the experience of the ADR surgeon; it is the standard of care that is recommended by Dupey/J.J. Take care, Dano

[Alastair]

I would think that no member would have this type of surgery without the knowledge that a vascular surgeon was in attendance.

I checked up on my bill from the Alphaklinik in 2002 and sure enough there was a charge of �2600 for the vascular surgeon and one or two other small extras.
Best,
Alastair

[ans]

Wonder how often the sudden sneeze hits surgeons?