C6-C7 Prodisc-C, Scheduled June 6, 2011

[winecaptain]

After much contemplation, I am going ahead with my Prodisc-C surgery on June 6th. I had another meeting/office visit with my surgeon, Dr. Jim Billys, in Tampa, FL (Florida Orthopaedic Institute) and we discussed the whole thing in great detail. I have decided to move forward with the Prodisc-C, as opposed to the Discover study, or an overseas M6-C. My physician also told me about another new Disc vs Disc study that their group has just received (where Prodisc-C is the Control arm), but after much contemplation, we decided to move forward with the Prodisc-C in a commercial setting. Having been through all of the conservative options (and failed miserably), Chiropractic, PT, ESI, etc, coupled with having a EMG study, as well as MRI confirmation of my issue, I think having this fixed will be the best option. I will post how I am doing afterwards. My symptoms are worse than ever, Classic Cervical Radiculopathy impacting the ulnar nerve in my lower arm (elbow to little finger). Loss of range of motion and on and off neck pain, with weakness in my left arm and now radiating back pain (new in the last month). The Epidural Steroid Injections help with the ROM, but did nothing for the nerve issue (constant pins and needles feeling for over 8 months). I am looking forward to the surgery (as much as one can, kind of like looking forward to a root canal with a severe tooth pain) and hope that I am one of the "lucky ones" that feel better before they leave the hospital. We discussed a cervical fusion and he offered it as well, but at my age, 40, I do not want to look forward to at least a couple more adjacent level issues/surgeries in my lifetime. I genuinely like the fact that my doctor took the time to explain the whole thing and didn't pressure me into something, but offered several logical solutions over a period of time. It has taken me several months to get to this point (I began this process in September 2010), but am really getting comfortable with my decision.

I went back and forth with this and my only wish that I could get into the M6-C study here in the US. Unfortunately, there is no more enrollment in this study from what I have found out from several former physician enrolllers. If someone knows different, please let me know (it might change my mind)... Given the fact that my insurance, BCBS of Illinois, will cover my disc replacement with an FDA approved product (given my failed history of more conservative therapy), I can not see the reason to travel overseas to get an M6-C. I do understand the technology, and really think that it is promising and the best out there so far. However, to go overseas, I am not sure that the juice is worth the squeeze (for me personally). My other concern was that if I had a complication, I wanted my doctor to be close to home to help me manage it. This was just my thought process, and I understand why someone may choose differently. Having looked at both the Medtronic Prestige and the Synthes Prodisc-C (my physician offered me either one and has a good working history with both products), I just think that the design of the Prodisc makes more sense to me. I understand the keel concerns, however the fixation appears to more more anatomically natural than screws from one side (like MDT Prestige). I am not an engineer, nor am I a physician, it is just my general opinion as someone who has worked in sales in the medical device industry (although never in the spine business).

I type this not to generate conflict of opinions, but to hopefully help someone else that may be reading it and going through the painful decision process. I think that this is truly a process and those who embrace it, will be better set up for success, both mentally and emotionally, regardless of the outcome.

Only time will tell if I am doing the right thing, but regardless, I feel like I have made the most educated decision (for me, personally) with the information available...

[spinches]

I am going through the same decision process that you have just completed. I can't get insurance coverage for a 2-level disc replacement (C 5-7), so I am headed for surgery overseas. I decided to choose the surgeon and go with his recommendations about the type of disc. I have opinions from Bertagnoli and Boeree, and am waiting on Pimenta. Depending on the surgeon's schedule, I am planning on surgery this September.

The decision process is indeed difficult, but it feels pretty good now that I have at least decided on the ADR rather than fusion, the 2 levels, and the trip overseas.

Best of luck with your surgery.

Sandra

[winecaptain]

I wanted to write a quick follow up to my procedure last week. I went in on Monday and am now a week post procedure. To begin with my cervcal radiculopothy symptoms are 100% relieved. I have no more pain, weakness, numbness, or tingling in my left arm. I noticed this in the recovery room and have been wthout any radiculopothy symptoms since! The only slight symptom that I have now is a slight numbness in the palm of my right hand and index finger. My doctor thinks that it could be related to the swelling and I will have to wait and see how it improves.

Regardless, it is much better than the problems in my left arm (and if I have to trade one for the other, it will be worth it). As far as the procedure went, all went as planned and my total procedure was about 1 1/2 hours long. The recovery was much more painful than I had expected, and I did not sleep well for the first few nights (hardly at all). I could not get comfortable and was just sitting up watching lots of TV re-runs. My dr changed up my pain meds (from vicoden to Percoset) and it made all of the difference in the world. I am now sleeping great and am completely able to lay flat and sleep on one pillow (when I started I could not lay down at all). From a pain prospective, I can only say that the first two days are not that bad (still lingering effects from anesthesia). The next two days are VERY painful! Be prepared it is miserable... This is when the swelling is at it's peak and nothing is remotely comfortable. I wish that I had been better prepared for this part... By Saturday (again my surgery was on Monday), I was feeling much better. By Monday (one week out), I would say that I am feeling even better.

I am still taking pain pills (Percoset, Valium, Celebrex, and some Ambien to help me sleep). I had x-rays at my first follow up visit (Thursday) and the implant appears to be in exactly the same position that it was upon implantation ( I was able to see both side by side). It still feels wierd to look at x-rays of my neck and see the Prodisc-C implanted in it and that I will have this the rest of my life. Right now my biggest regret is that I did not have this done sooner. I went on for almost a year with neck pain, and cervical radiculopothy radiating down my left arm. Not that surgery is for everyone, but for me, I wish that I hadn't put it off for so long. If I am to have these pains again, I know that I will act much sooner.

I hope that my story helps other who may take the time to read it. I am looking forward to starting physical therapy in the very near future and working in increasing my range of motion. For now I am very happy that I finally got my neck fixed!

[winecaptain]

Had a follow up visit with my Dr early today. More X-rays and my disc continues to look exactly like the day it was implanted (the side by side xrays are cool to see) (no movement at all). I am starting on physical therapy next week and expect that I will be going through PT for about a month, trying to restore complete range of motion, which is still somewhat limited, although getting better every day.

We spent about 15 minutes together today in the office reviewing all of my details and questions of real life do's and don'ts. My biggest limitations are really pain med related (driving, flying, etc), not surgical. I told him that my biggest regret was not doing this sooner. He has kept me on my Percoset, Valium, and Celebrex for now (the celebrex will be for two months to try to avoid any HO issues). He says that I can begin to come off of the meds during the day as I am able, but suggests that I stay on them at night to make sure that I sleep well.

It is really hard to believe that this is all almost over and within a short time, I will have the ROM back in my neck without any pain, or arm numbness. I still have a small quarter size spot in my right palm where it is slightly numb, but everything else is virtually normal. If anyone has questions, please don't hesitate to send me a PM. For me, this process was really worth it!

[Harrison]

Winecaptain, thank you for your thoughtful posts, which will help many people. I am glad you are getting better and better. Hey, how much walking are you doing? And are you eating more healthy these days too -- whatever that means to you?

[winecaptain]

Harrison, To answer both questions in a nutshell, probably not enough. I have been outside walking every day for the past few days. It is about 1/2 mile around my block which my wife and I walk the dog around together each evening. I start PT and will be discussing getting back in the gym as soon as I can. I have an elliptical in my home office, which I had to quit using about 6 months ago, as the pain was getting quite bad in my left arm every time I got on it. I am hoping that after a couple of weeks of PT, I will be able to return to the elliptical every day (which I did religiously before for 30-45 minutes, whether I was home or on the road in a hotel gym). This provided me good cardiovascular fitness without the impact of running.

As far as my diet goes, let's just say that this is not my strength... I am not sure that I I have never met a duck liver that I didn't love, nor have I been known to pass on a great bottle of Bordeaux. I would love to say that I am going to do better here, but the reality is that I don't see this really changing. I do however, carefully monitor my cholesterol and bloodwork. So far, the only medication that I have needed has been a statin for cholesterol.

[winecaptain]

Looking for some help here from anyone on the board who may have expereinced something like this... I'll start with the fact that I was feeling really good about my recovery (basically felt 100% recovered) and then...

I initially took a week off of work and then slowly went back to work 7-8 hours per day from home, while taking breaks to get out of bed and go for short walks around the house (actually bought a tray table for my bed to house my laptop, I-pad (to receive simultanious emails), and a bluetooth headset for my cell phone and a plug in headset for my office line. During the second week post surgery I began to reduce my pain pills and add in physical therapy (at this point I was going full steam ahead!). Three weeks post surgery, at the end of June I resumed work full force (12-15 hour days mostly on my laptop). I am a sales and have been working mostly from home and only taking local meetings with no travel (20-30 minute rides only). In late June while trying to close several large sales before quarter's end, I was working 12-16 hour days (albeit in my house) on my laptop and phones (blue tooth dying every couple of hours of use, so resting cell phone to ear/shoulder to type while I was talking and re-charging the bluetooth (by the way the new Bose Bluetooth is awesome for sound quality!). I woke up on Saturday July 2nd with a neck thickness that rivaled that of Hulk Hogan (I am a 17" dress shirt). Since then, lots of inflamation in my C2-C4 area. Good news is that my disc is at C6-C7, and I still have good range of motion and am able to move my head in all directions without any additional pain. I am just still sore to the touch at the base of my skull and to quote my physical therapist (full of inflamation) (my Physical Therapist) has changed my program around to include heat (10 minutes), gentle (I mean very gentle, as I am sore when she touches me) massage of my neck (10-15 minutes), electrical stimulation, and then ice. I also have a home electrical stimulation unit (IF, not TENS). I ice and use the home IF unit 4 times each day for 15 minutes (IF) and 30 minutes Ice. I also am in PT 3 times per week...

By June 26, I was off all of my meds (surgery June 6th), except 400mg of Celebrex daily (read the studies on Hererotopic Ossification with Prodisc-C). After this episode, I am now back on pain meds (Norco 5-325) 2-3 per day, Celebrex 400 mg, & Valium 5mg 2x per day... I know that I spent several days overworking myself, but never imagined that it would set me back this far. Pain is controlled to a 2-3/10 on meds, but when I wake up in the AM it is back to 7-8/10. I have spoken with the nurse practitioner for my spine doc and she suggests adding Chiropractic as a solution, as I am maxed out on anti-inflammitory dose, taking a significant pain dose, and muscle relaxers (though she says that I can up that to 3-4 times per day if need be). This has been on-going for just over a week, although the swelling is down, I am still sore to the touch in my C2-C4 area.

I am simply frustrated! I was doing really well and felt back to my old self. I know that I did this to myself for doing too much too soon, but am looking for opinions or ideas here. I am sure that I am not the first person to do too much too soon and pay for it. How long does it take to recover from this? It seems that I am taking longer from this than I did from my initial surgery? Am I simply missing something? Just looking for some thoughts... Thanks in advance for any advice!

[jss]

winecaptain, whatever this is I sure hope it passes soon. I don't know what the problem might be, but as you described it I was thinking infection. Please keep us posted.

Good luck, Jeff

[DAnn]

Winecaptain,
I am so sorry to hear this. I am 12 weeks to the day out from a hybrid cervical procedure. I did have a setback when I started working and driving, and my physicial therapist said that the adr/fusion site could swell, creating symptoms much like prior to surgery. But mine only swelled inside, not on the outside of my neck.
Please take it easy.
I too do more than I should, but I am doing great. I'm a bit disappointed in that I have muscle pain in between my shoulder blades still, but I'm off meds and pretty much living my life normally.
Afraid to start taking Aleve just yet (want to) but even though the doctor said I could, I want to make sure the fusion part is done. Weighing the HO vs the fusion....I think if I had it all to do over I'd have done a double ADR (but don't think they could have given the bottom level, so it worked out for the best).
Get up and move every 30 minutes and do stretching that your therapist recommends. Maybe slow down a bit?
Good luck.
D'Ann

[DAnn]

Oh, and I forgot,
My doctor and PT therapist say NO chiropractor. That is their opinion, and I don't think I'd want anyone moving my neck around except my therapist.
Be careful.
D'Ann