getting Maverick disc...questions..concerns

[ouch2]

Hi everyone, I have had my back injury for almost two years.My main problem is at the L5/S1 level, but have bulges and moderate facet hypertrophy at L3/L4 L4/L5.

I had a discectomy/laminectomy about 5 months ago. I didn't have any improvement, not even a little bit for one day. Things have actually gotten alot worse since then.Pain is unrelenting, mobility is poor.

I have had a few opinions from local doctors. I am scheduled to have a Maverick ADR at the L5/S1 level. My main concerns are my facet joints which have moderate facet hypertrophy. The surgeon still says that I am a candidate. I am also concerned as to whether or not I have instability issues. What is the best way to test for this ? Positional xrays? I have had regular xrays, but not positional.

Also looking for others experience with the Maverick disc.

Thanks everyone, hope you are having a painfree/reduced day!

Karen

[jss]

Karen,

As my surgeries were all cervical, I can't answer any of your questions, but do have a few thoughts.

More than a few patients have come out of ADR surgery with perfectly placed prosthetics, but were in the exact same pain as before surgery; because even though a diseased disc was replaced, it was not the pain generator. As your discectomy and laminotomy were unsuccessful, are the doctors certain that L5/S1 is the level of your pain?

Were flexion and extension xrays taken? Can you tolerate them? I have been told by one surgeon that that is one tool that is used to look for instability.

Many surgeons will perform ADR on a level with moderate facet degeneration. I've never read that facet degeneration at an adjacent level was any kind of contraindication.

Good luck, Jeff

[ouch2]

Hi Jeff, Thank you for your response. When I saw the surgeon, they asked about flexion/extension xrays and I told them that have not had them done. I have an appointment later this month and am going to ask to have them done to make sure that I don't have instability issues.

I also had facet injections, as I was worried that this may be my pain generator. I didn't have any relief with it, so hope that this is a good sign that it is the disc itself that is causing the pain. I am worried though, as you said, since I didn't get any relief from the discectomy/laminectomy. The surgeon was unconcerned about my other levels at this time though,even with the bulges and hypertrophy.

I truly hope that this will be the answer to my pain. Although I don't expect a miracle, a good amount of pain reduction would be so welcomed, as I cannot continue with the pain that I am dealing with daily.

Thanks again Jeff!

Karen

[jss]

Karen,

I would dare say that most of use do experience what we'd call a "miracle" after ADR surgery. Here's hoping that you'll be using that term in February!

Good luck, Jeff

[Slackwater]

Originally Posted by ouch2

Hi everyone, I have had my back injury for almost two years.My main problem is at the L5/S1 level, but have bulges and moderate facet hypertrophy at L3/L4 L4/L5.

I had a discectomy/laminectomy about 5 months ago. I didn't have any improvement, not even a little bit for one day. Things have actually gotten alot worse since then.Pain is unrelenting, mobility is poor.

I have had a few opinions from local doctors. I am scheduled to have a Maverick ADR at the L5/S1 level. My main concerns are my facet joints which have moderate facet hypertrophy. The surgeon still says that I am a candidate. I am also concerned as to whether or not I have instability issues. What is the best way to test for this ? Positional xrays? I have had regular xrays, but not positional.

Also looking for others experience with the Maverick disc.

Thanks everyone, hope you are having a painfree/reduced day!

Karen

1st pass: please get your adr/tdr surgeon to comment on the prior surgery vs. contraindications.

2nd pass: facet items are not at the index level, so a red flag is not raised immediately.

3rd pass: possibly seek an alternate opinon from a surgeon that has successfully done ADR / TDR in your region with full disclosure regarding first surgeon, with all MRI's in hand with radiologists and surgical reports.

You wrote the surgeon said you are a candidate for a Maverick artificial disc at L5/S1.
You wrote moderate facet hypertrophy L3/4 L4/5 and laminectomy discectomy L5/S1.

Severe pathology of the facet joints at the involved surgery level is a contraindication (ref.Clinical Trial NCT00635843 ).

The surgeon may want to avoid ADR/TDR surgery at a level with facet issues; this might be a contraindication to ADR/TDR surgery depending on several issues and interpreting the MRI correctly. The "Moderate" hypertrophy was not at the planned surgery (index) level. The term needs to be used in context with the MRI.

You wrote about a prior laminectomy / discectomy without a positive result. Prior posterior lumbar surgery resulting in significant muscle/ligament morbidity is a contraindication. Did your meetings with the surgeon(s) about the discectomy/Lami include any words close to this, or wording on the recovery process? Is this the same surgeon that did the discectomy/Lami ?

The Maverick vs. Anterior Lumbar Fusion (ALIF) write-up in Spine gave an OK+ result to Maverick. The write-up is on adrsupport.org/forums.LINK. I am not a surgeon, medical doctor, Phy.Ther. or ..., just a patient that reads (doctors reports, radiologist comments, ...).

[jss]

Slackwater, all great points you've raised.

[ouch2]

I too hope that I can say that it is a miracle Jeff! Reading posts of others who have gone through it is encouraging.

Slackwater, thanks for your post. After reading I need to clarify my error in the original post. I also have moderate hypertrophy at L5/S1. My surgeon stated when I asked him about the facets that he was confident that "moderate" would be okay, but that if they were "severe" he would not do an ADR.

This is a different surgeon than the one that did the disc/lami. He said that the previous surgeon did a good job and that he had removed the part of the disc that was impinging my nerve. The new MRI after the previous surgery shows scar tissue and that the disc has further collapsed.

I am going to have flexion/extension xrays this month to rule out
(hopefully) instability. It has been a few weeks since my facet injections without any relief.

There are so few surgeons that perform ADR in my area that I am thankfull that I was able to get in to see one. 99% only do fusion.

I bounce back and forth between being soo excited, and very scared.

Karen

[ouch2]

I had my pre-op for my ADR surgery last week. I met with the nurse, physio, doctor and had blood tests done. Just before it was time to

leave, I was told by the doctor that my white blood cell count was elevated (I believe it was 14) After doing a urine test (which was fine) the doctor looked in my mouth and thought that I had an abscess on a back molar.

I was so worried that they were going to cancell/postpone my surgery. The doctor said that I needed to have the tooth taken care of and then have repeat bloodwork done this Friday. I had the tooth looked after on Friday and started antibiotics. I HOPE that this takes care of the WBC and that when I have the test done again on Friday, the count is back down to a normal range.

Has anyone else had any experience with anything similiar? Can the count go back down in that amount of time? Fingers crossed that the tooth was the problem and that it will be okay.

Karen

[Harrison]

Karen,

You have a good doctor! Glad he was paying attention to this problem. This is an issue that I explore in detail in my film to be released in March; from my film blog, pls see:

Oral Bacteria in Bloodstream: Common Knowledge? | WhyAmIStillSick.com

And from the FAQs within this community:

How does dental health relate to spine health & surgery??

I am not clear about the dental work you had done – you absolutely should have it properly fixed before any major surgery.

[laid up doc]

Karen,

I see dental issues a fair amount in my practice, and I had a tooth issue exactly 2 weeks prior to my ADR surgery date. In my case - pain around a previously known failed root canal.

I saw a dentist right away - there was a lucency under the tooth, indicating the possibility of infection - and started antibiotics. The dentist I saw was otherwise fairly clueless, so I then called a dentist friend who sees the referrals from Duke's ortho/joint replacement/spine people, to ask him if I'd need to reschedule my surgery - since my surgery involved an international plane ticket, apt reservation, etc... i was VERY anxious about this, but knew the importance of eradicating the infection due to getting a prosthesis

His answer was that if the tooth is removed properly and antibiotics started, then 3-4 days later one would be ok for surgery. that's a big IF though - things that will play into whether this scenario would apply:

1. do you have an abscess? if so - having it drained and the tooth either root canaled or pulled is imperative
2. do you have any other medical conditions that would hinder resolution of an infection?
3. is there ANY other source for that WBC count? the reason i ask: in my experience, only an dental ABSCESS would create that kind of elevated WBC count - not just a bad broken down/cavitied tooth. and as i stated in #1, an ABSCESS has to be DRAINED. if you have facial/jaw swelling, that is evidence of an abscess. if not, you'd need an xray to evaluate for an abscess under the tooth (called a periapical abscess)
4. did they start you on antibiotics for the tooth?

hope that is helpful and not scary. as Harrison stated, you really have to make sure that whatever is going on is addressed before you have an implant put in!!