Really thinking hard about disc replacement

[Jack]

Had chronic LBP for last 6 years. After more steroid injections than I can count, Facet nerve blocks, S-I nerve blocks, nerve ablations, and an IDET, I finally ascessed my surgical options in later part of '06 and early '07 with 2 neurosurgeons and 1 orthopedic surgeon. Disc replacement was just getting accepted by insurance, and the surgical community at that time, at least around where I live in mid NC. Fusion was suggested by all but the outcome for pain relief for L5 on S1 varied greatly. Results were anywhere from a 20% chance of some significant relief to 80% chance of some relief and 0% chance of complete relief. I was told it was one of the hardest to fuse.

I have been on narcotics for three+ years. Four months ago I was on Fentanyl 75 mcg patches change every 48 hours with 3- 10/325 Percocet a day for breakthrough. I have wiened myself down to no Fentanyl and 2.5 tabs of the Percocets a day. Backpain is now significant and am having occasional right leg neuropathy.

CT, post disc-o-gram in March of 2006 showed L3-4 asymmetrical bulging annulus into the left foramen with minimal tearing of the annulus. L4-5 showed circumferential annular tearing with annular bulge in midline into left foraminal region. L5-S1 has Grade 1 spondylolisthesis secondary to bilat spondylolysis of L5. Circumferential radial tearing with bulging disc tissue into midline. There is stenosis of the foramen bilat secondary to the spondylolisthesis.

In '07 I was scared to death of fusion as I have yet to find anyone with a L5-S1 fusion with satisfactory results. Now pain is constant and dehabilitating. I really like the idea of disc replacement, maybe even on two levels. Fusion only would appear to force the disease up to the next level and mean another fusion in the future.

Any recommendations?

[Harrison]

Welcome Jack, to our global community. Sorry you are here, but I hope we can help you sort through some tough issues.

It looks like you have an unusually good command of the technical details of your spine – good for you! You have a head start that most of us work hard to acquire and this will surely help you. Where are you at in terms of getting opinions from spine doctors?

Three years on narcotics…wow. I am sorry about that, but it’s good you are thinking of ways to get off the stuff! Have you tried the usual list of alternative treatments for pain mgt.?

BTW, it’s interesting the way you describe the disease being “forced up” the spine. I think most folks here think of adjacent level degeneration as a mechanical phenomenon, rather than the migration of disease. This could prove to be an interesting immunological advantage for ADR – its “isolating” characteristics of certain disease pathologies. Time will tell…hopefully!

I am five years post-op and doing great....

[Jack]

Thanks for the response. Another problem is I'm a poor typist and tend to rearrange words to take a short cut metaphorically.

For years I was a PA-C. Worked in emergency medicine. I've worked as a general contractor building houses for several years now. I was last certified as a PA in 2002. Since my body won't stand the physical labor anymore (that is what pushed me onto narcotics) I'm working on getting caught up on CME's and re-certification and getting off all narcs as I can't be hired and be on drugs.

I had planed on retiring in 2011 and getting re-certified to do charity/missionary work. The housing bubble burst in my face so now I need the income. Had close to two M in inventory. By the time I paid everyone else, there was nothing left for me. I'm just over 60. Honor/honesty means a lot as you get older and closer to the reaper. Real estate around here was bringing $0.40 on the dollar of worth just two years prior.

[rhatzy]

Jack,

ADR is, by far the best option for a mulilevel procedure. I personally know four people with multilevel fusion and none of them are doing anygood, in fact three had to get it redone and all are still in pain and drugged out. I have L3-4 and L4-5 with the Maverick disc put in back in January of 08 and I am pain free and back doing my job as an airline captain. My choice was the ADR with about a 70% chance of success as compared to the multi level gusion with a totally dismal chance for relief.

Since they weren't doing the Maverick disc, made in Memphis, in the US, I went to Germany to do it. It's the best decision I made. I had to pay for it out of my own pocket, but what the heck.

Reading you post, if your L5-S1 is way out of wack, fusion at that level might be an option with ADR's above at L3-4 and L4-5, They do this "hybrid" mix in Germany all the time. One guy I know had ADR at L3-4 and L5-S1 and fused at L4-5 because his end plates at that level were pretty bad. He is doing fine.

Mark

[Jack]

Mark,

Your response sounds encouraging. Last time I checked on Germany about 2 years ago, the cost was $55,000.00-$65,000.00. Is that still close? Wish I had done this two years ago. It might have kept me from working and I would have missed the Bubble Burst but probably not. I tend to go at things wide open.

Which doctor there did you see? If it is considered advertising please e-mail or PM instead.

As a side note, years ago I wanted to do your job. I couldn't pass the color vision test for a first class medical. I could get a third so became an instrumented rated private pilot. I had to quit flying when I started with the narcotics. Not being able to fly kept me depressed for months. It was my only hobby.