Artificial disc replacement- a dream for chronic backpain sufferers or bonanza for su

[mikezoe]

Following my unsuccessful trip to Alphaklinik, Munich (turned down for ADR),I have written a piece (see my blog link below) which addresses some of the issues around clinics offering ADR to unsuitable patients. I would welcome comments and discussion on the points made.

[Harrison]

Mike, thanks for posting and helping others with your story. Patients here in the US see that Dr. Z is kind to personally call them and adress their spine questions. Most people I speak with are surprised with this and not expecting that kind of TLC. Yet another difference between the US and Europe...

Can you elaborate a little:

- why did Dr Z think your spine would collapse? Are you qualified for any spinal procedure? Fusion or active stablization? XStop?

- what kind of bone density tests did you have? How was the bone density of you spine (and various segments) assessed?

- did you have any thorough blood tests in the past year that might have indicated any outliers in any of your blood components?

- did you get tested for any of these other things at the Alpha Clinic? I ask because their docs are more "hip" to some of the diseases which are obfuscated or even ignored by the U.S. hospitals and surgeons?

- Sorry about the finding of the 5mm soft tissue neuroma. Is that what contributed to the instability? What's the latest on this?

Hope we can help you in some way. You are across the pond, but you'll make new friends here!

[Harrison]

Mike, I skimmed your blog and found this interesting:

"...Dr Zeegers left me drawing the conclusion that a different surgeon- perhaps less concerned with statistics and more concerned with profits might have decided to complete the operation. He commented that there are clinics which welcome older ADR candidates as there is a good chance they will pass away before the surgery fails!

Revision surgery for unsuccessful ADR operations is notoriously difficult and potentially dangerous. Worldwide there are a significant number of post-ADR patients who in the months following their operation run into a variety of subsequent spinal problems whose quality of life has not been restored (some with much-increased pain) and whose bank balance has been hugely depleted..."
_______________________

I am not sure agree about the "significant" number, as NO ONE is tracking post-op patients; it pissing me off to no end for many different reasons. On top of this, some docs are using statistical recovery rates of 90% or better for patient improvement. How the heck are they coming up with this number!? If doctors are giving you numbers like this, just say "cool" and ask for the data.

There is one solution -- better data gathering in the form of a registry. I am convinced the Swedes are way smarter than everyone else -- they figured this out more than 20 years ago! Another rant, another time...

Any way, Dr Zeegers raises some excellent points of caution that all patients should heed, especially ones with multi-level disc disease. I recall last year in Berlin when he politely raised the issue of bone cement making ADR revisions almost impossible -- as it makes vertebral bodies very brittle. Of course it does, as chemical cement is injected into a porous, diseased bone!?

Just my 2 cents here as a patient and researcher. Thanks for getting me back into the groove...

[mikezoe]

- why did Dr Z think your spine would collapse? Are you qualified for any spinal procedure? Fusion or active stablization? XStop?
I suspect that it was a late-formed realisation informed by his vast experience of failed ADR operations (both his own and knowledge of other's) that here was a tragedy about to happen. Not enough has been written about the critical issue of the quality of life of the candidate presenting- in my case I was not writhing on the floor in agony and apart from having had to stop playing tennis was generally still very active. In such as case the surgeon has to weigh perhaps even more carefully than with a desperate candidate, the probability that the patient will end up significantly worse-off. He could sense that following a 1 or 2-level ADR I would soon be back on the golf course hitting the ball 300 yards and it was this image of my possible implant collapse which haunted him that morning. In detail one problem related to the trapezoidal shape of the possible ADR evacuated space due to scoliosis (20 degrees) and how this can lead to the prothesis suffering excessive forces which may cause a shearing effect. Another concerned dye leakage in 2 discs during the discography and the inference that the surrounding tissue remaining after an ADR would not assist restraint of the shearing tendency during golfplay.

- what kind of bone density tests did you have? How was the bone density of you spine (and various segments) assessed?
I had a full X-Ray bone density which showed no raised tendency for breakage (see blog)

- did you have any thorough blood tests in the past year that might have indicated any outliers in any of your blood components?
Yes several recent blood tests all of which were reported as normal.

- did you get tested for any of these other things at the Alpha Clinic? I ask because their docs are more "hip" to some of the diseases which are obfuscated or even ignored by the U.S. hospitals and surgeons?
I had a full neuro test which showed some interesting left/right side deteriorations.(Reflexes/hearing/eyesight etc). Before going to Munich I thought I was pretty healthy except for a bad back. After Munich and these tests I realise I am a crock who happens to have a bad back!

- Sorry about the finding of the 5mm soft tissue neuroma. Is that what contributed to the instability? What's the latest on this?
I had a follow-up MRI with dye contrast B4 going to Munich which showed the neuroma had not grown since Dec 07 and showed no signs of being an issue for my health. They also did a cervical MRI which showed no other neuromas higher up my back but suggested I should have a full brain MRI to check for them in my skull. This I may pursue in the UK.

Hope this answers some of your questions. Dr Z did suggest fusion might be the best option but was not sure how many levels might be best as apart from the 3 adjacent discs in terrible state the others are all in a degenerated state.

[JulieA]

Mike- Thanks for sharing. It was a very interesting read and gave me more things to think about.

Julie

[mikezoe]

In a long discussion with Zr Z one interesting area concerned backs generally. In his research he has been allowed to carry out MRI scans on thousands of deceased individuals of all ages, nationalities and backgrounds. The major finding which surprised the medics was the generally poor state of spines. A significant proportion had severe disc degeneration and almost none had had nack surgery. It is tempting to conclude that our backbone is barely able to last our lifespan- that evolution has failed to compensate by strengthening its design for our decision to stand on two legs 10,000 years ago! It is interesting that Alphaklinic is full of slim, sporty ADR candidates- not as you might have supposed obese, couch potatoes. Have you ever seen a cat with a bad back?

[Harrison]

Mike,

I think some guys go to the AlphaClinic just to see the nurses!

Any way, my belief is that the "modern" diseases afflicting people today are caused by very different pathogens than the ones that ailed our parents and grandparents. Some of this had been documented and studied carefully (see the big bucket topic on spinal diseases).

[annapurna]

Even the caregivers who aren't getting surgery like the assistants and nurses at the Alpha Klinik. One of Laura's fellow inmates who was locked in for the weekend following ADR surgery on Friday was bemoaning the fact that he was stuck in the clinic for the whole weekend and all the "fashion models" were gone until Monday.

[Don]

Originally posted by mikezoe:
In a long discussion with Zr Z one interesting area concerned backs generally. In his research he has been allowed to carry out MRI scans on thousands of deceased individuals of all ages, nationalities and backgrounds. The major finding which surprised the medics was the generally poor state of spines. A significant proportion had severe disc degeneration and almost none had had nack surgery. It is tempting to conclude that our backbone is barely able to last our lifespan- that evolution has failed to compensate by strengthening its design for our decision to stand on two legs 10,000 years ago!

Mike,

That matches what my rheumatologist says, that after years in the practice, he has come to the realization that the body was only designed to last 50 years.

Thanks for the info and good luck.

Don

[ERvet]

Originally posted by mikezoe:
Have you ever seen a cat with a bad back?

Mike: I speak from my veterinary background.....yep, we see cats and dogs with bad backs!! Beyond the dogs that have acute disc hernations (think Dachshunds, other small breed dogs with short legs and long backs), we see a significant number of mostly medium to larger dogs with chronic lumbosacral degenerative disease that ultimately benefit from decompressive surgery. As for cats, we never really though it happened to them. But the more we take radiographs of middle-aged and older cats, we find they also are developing LS degeneration, and their owners just thought they were getting too old to jump up on the bed anymore.....So, the four-legged creatures are not escaping the bad backs!!! Our surgeons perform back surgery rather regularly at my practice. Just an interesting FYI

Susan/ERvet