Cervical ADR vs Fusion

[hotoru]

Will the ADRs stand the test of time?

Probably a frequently argued issue. Looking for input from those who have had cervical ADR to compare.

I am 39 with DDD C4/C5. I had a microscopic partial disc removal a few years ago with some temporary relief. It was known to be a temporizing measure at the time. My biggest complaint is numbness and weakness of the right arm. Pain with repetitive use. I am considering ADR if I can get approved.

I am leaning towards fusion. My concern is the limited devices available in the US. I am also not aware of any implanted articulating joint hardware that has lasted more than 20 years. No one seems to have a plan on what to do with these artificial discs if they need replacement in 20 years. Fusion carrys known risk of altered joint mechanics. But, it is tried and tested with known results.

Any input appreciated,
Thanks,
Hotoru

[annapurna]

No cervical ADR has existed for 20 years. Lumbar ADRs have been in existence for something like 30 years with reasonable success, given the inevitable design changes that come with experience.

[hotoru]

I did not realize they had been putting in lumbar discs for 30 years. Yet, lumbar fusion remains the procedure of choice for most. I believe that cervical disc replacement has a better chance as it carries less weight (but more motion).

Some challenges still exist. Most of the newer devices are not yet approved in the US. Other artificial joints such as knees and hips wear out and have to be replaced when placed in persons under fifty. I am just surprised that know one seems to know a replacement strategy. I guess you could just remove the artifical disc and fuse later. Anyone on the forums heard of such an experience?

Hotoru

[Harrison]

Sure, we've talked about revision surgeries a zillion times! If you use the search function (above link), you'll find over 300 past discussion topics that include this term...

It's not quite 30 years now for ADR, but pretty close. In 2007, I met the first patient to ever receive an artificial disc in Germany. He received his Charite' in September of 1984 and was still doing well with the original implant. BTW, one year later it was named the "SB Charite' Modular Type Disc Prosthesis." There's a few tidbits in this article about revision procedures relative to design differences (cleat vs keel).

Hope this helps.

[hotoru]

Thank you for the search information about cervical revisions. I mistaking was searching under "replacement". I am not sure if all the posts about revisions makes be feel better or worse about cervical ADRs. At least options exist for those who need.

That may be another disadvantage about having the surgery done out of country. If device is not FDA approved here than revision might not be covered either. I would suspect reluctance on surgeons to remove devices they do not place.

Hotoru

[steve55]

Looks like I'll be having surgury soon to remove my c6/7 prodisc ADR and fuse. You can follow my story in the surgical outcome section. It is my understanding that fusing after ADR is not a big deal as cervical revisions are not complicated to do.

[JasonR]

Hotoru, welcome to the club!
I'm 36 and am scheduled to have the Bryan disc in August. I know how you feel as I am concerned about long term use as well. But, I am conviced that a combination of an ADR now and whatever else 5-20+ years from now is better than a fusion now and whatever else on my other discs down the road. I'm admittedly enticed by the likelyhood of a shorter recovery time and being able to maintain motion.

I think we'll be seeing significant changes in treatment over the next 10-15 years. Traditional artificial discs will get better designs I'm sure but I'm thinking we'll see more "natural" designs that don't necessarily include metal frames like we see now. Maybe even a true artificial disc that acts exactly like a healthy disc but attaches to the vertebrae without the need for channels, screws, or other fixation. Then again, maybe I'm dreaming .

[hotoru]

Originally Posted by steve55

Looks like I'll be having surgery soon to remove my c6/7 prodisc ADR and fuse.....

Thanks for the welcome. Steve, sorry to hear about need for more surgery. Let me know how it goes. Sounds like your are going back to Germany to get it fused? Is that because you want to use surgeon who placed or could not get done in states? Is insurance covering any of the costs?