Observed a cervical ADR procedure today and boy am I glad :)

[tmont]

I thought I'd share some of my 'non-medical' impressions as I watched--not experienced--an ADR procedure today done by my NS. I'm not even going to attempt to go into the purely medical side of things, as I'm not qualified in the least, and the procedures themselves have been extensively described and can be found in both article form and even video here and on the NET.

What I want to try and explain is the strange and unexpected sensation of calm and almost relief I felt after seeing this single-level ADR performed from beginning to end.

As all spine patients faced with the decison of ADR vs fusion vs waiting, I've had--and still have-- my share of mental torment and sleepless nights, considering all the unknowns and the risks of the surgery itself. Spine surgery is terrifying, and to me cervical surgery puts me face-to-face with one of my worst fears: paralysis.

Although I've had 2 cervical procedures done before--one of which was a fusion--I never managed to quell the terror I felt in my room the night before, or keep from inwardly panicking as I was rolled down to surgery, or quite restrain a few silent tears as the anesthesioligist put me out. My first hazy thoughts as I came out of both interventions were 'oh my God, can I move everything?'

I imagined my spinal nerves and veins and arteries all in a twisted mass like an overgrown forest that had to be picked through on the way to the Holy Grail to be worked on, and one small slip would mean more pain and suffering instead of healing. And the spinal cord, running through and behind it all, the key to mobility and as far as I'm concerned, quality of life itself.

I remember telling my husband a few months ago in a moment of frustration, that I would have preferred having cancer to this. He was genuinely shocked. I think that unless you're a spine patient (and maybe even if you ARE one, whaddoIknow???) it's impossible to understand that feeling. Most cancer I could fight; my spine I had to submit to --and so did every other aspect of my life. Or something like that.

I had some second thoughts last night about watching this procedure, wondering if it wouldn't make my own future ADR more stressful for me. In fact, it took a lot of stress about the surgery itself off my shoulders.

The patients was wheeled in and the atmosphere was relaxed and calm. Dr DH attached the weights to his head (to minimize distraction), prompting some questions from the Mobi-C 'engineer' present. Simple answer: I always do it this way because it usually makes things easier for both me and the patient later on, and off we went.

The operation was neither bloody, nor long, nor 'tense' for the medical team in the OR, who remained relaxed and synchronized. Hard to explain, I guess I imagined more 'library silence' and movie-style tension and concentration .

No foraging, grappling of instruments or 'pipline digging' going on in this guy's neck, lol--just a clean cut and some progressive sweeping, deepening, cleaning, down to C6-C7 where the disc fragments were quickly removed. DR DH was using a microscope and the radiographic control images were on the screen next to the TV screen.

Once the disc was cleaned out, a 'phantom' prosthesis was used to correctly size the implant and once that was decided, it was a matter of minutes before the implant was placed, and it looked easy enough to these eyes: no banging, drilling or cussing went on at least

More X-ray checks, some suction and irrigation of the area, and he was closing.

"That's it, now we'll see how he does when he wakes up, and over time". Out the door went the patient, and we changed out of our scrubs and went and got a coffee.

He asked what I was thinking and feeling, and I told him I'd imagined (and steeled myself) for a lot more gore and tension than what I'd seen, that it looked almost easy.

He grinned and said it wasn't easy--but that it wasn't all that difficult either. This was a clear-cut, single level case and with the experience in ACDF he's had, training for this particular scenario was a logical progression of skills.

Next week he's doing a double level, which I also hope to watch. Who knows where he'll be in a few months or years time with this--or any of the other good surgeons out there who are starting ADR now, but there's no reason not to believe that as time goes on and more is known about discs and technique, that more of us will have easier access to skilled ADR surgeons no matter where we live.

I realize lumbar is different and carries a whole different set of risks,so I'm not going there except to say the obvious: sooner of later we'll know what to do, and how to do it, so hang on.

For us cervies (fewer, so maybe we need to hear specific messages every now and then), all I can say is that today a lot--not all-- of the surgical stress I was feeling dissipated when I saw how cleanly it was done. The stress due to unanswered questions on long-term evolution is still there of course, but one less rock to carry is always a blessing.

Hope this comforts some of you out there at least a little.

Trace

[ans]

Trace,

Very cool that the doc let you (and will) watch which assuaged some fears. Nice reporting.

ans

[Alastair]

A good description of the surgery, I found that your image of all your nerves and arteries mixed up quite amusing. A good look in Gray's anatomy should put most people's minds at rest.

I find it really interesting that although you're not having the procedure at this time, it's great that this is so reassuring to other cervical cases
Best,
Alastair

[sahuaro]

Thanks so much, Trace. It is amazing that you were allowed to watch (were you actually in the OR or in an observation room?). I do think being able to visualize what is done makes it easier to deal with the thought of surgery. Now I need reassurance that this patient is doing well...guess my anxiety levels are high, too.

[tmont]

LOL Sir A,

I know that Gray's anatomy would have helped me out, but it was MY NECK and it was BOUND to be different from everyone else's!!

I've got an MRI set up for Sept 4th; as I'm practically asyptomatic (thank you, God) at the moment we'll see how i'm doing then, but will probably have to think about surgery this fall. DR DH told me he thought my facets were starting to be implicated. I was offered a ProDisc with Marnay himself two days ago, by the surgeon who did my nucleotomy in October. Funny--he called out of the blue 8 months post-op to 'see how I was doing' and offer to bring in Marnay for ADR....

Sahuaro--I was actually in the room and in scrubs, and got warned a few times as I leaned over to see (before he turned on the microscope)not to get too close to the operating field.

There's a guy from the UK coming for a two level soon--I may help with some interpreting if asked-- and another single level on Monday, to which I've been invited if I want. I'll ask then how today's case is doing, Sahuaro

Trace

[tmont]

One other thing I forgot to mention and which I found interesting, on the sizing of the implant:

There was some discussion between Dr DH and the Mobi-C guy on which disc height to use. The Mobi-C guy wanted to use a higher (taller) implant than Dr DH, and DR DH said no, he was going for the lower one because 'oversizing could put the facet joints at risk'.

I seem to remember an article here on that....

[Harrison]

Trace, what an interesting perspective and picture you've painted, thx for sharing. It seems like much of your fear has been quelled by this experience. But I hope that does not change your sense of rabid curiousity!

[Mariaa]

Trace,
You mentioned that you don't have a medical background, just wondering how you were invited into the operating room for viewing? However, so, sounds like a wonderful experience~ thanks very much for sharing what you saw and your impression, also how it actually eased your tension vs. increasing it!

While I've been in the OR for many types of surigcal procedures in the past, the one procedure I had and was glad I didn't even view a film on the surgery until afterwards was Lasik eye surgery~

Anyway thanks again, looking forward to reading more about whatever you view and are able to share!

[tmont]

Hi Mariaa,

I was probably invited because my NS, who operated on me in 2003, is an exceptional human being and knew I was both interested in ADR and terrified of it (see the 'another consulting option for cervies' subject).

I've also been working for him as a Research Assistant, translating documents for him and have been telling him about this Forum, passing him articles for his opinon and discussion, and 'feeling him out' on ADR for over a year now. I've found him to be both caring and open-minded despite extremely prudent on ADR and its indications.

Harrison,

emphasis on 'curiosity'--or 'rabid'??

[Larry D]

Hi Trace:

I have some more questions for you;

How long was the operation?

How is the Mobi-c attached to the bone?

What was the history of the patient i.e. age, sex, DDD, cord compression, symptoms etc.

How long will the patient remain in the hospital?

Thanks.