Request Info/Insights on 2 and 3 Level ADRs

[mattbrand]

Hello All!

I just had a Prodisc L put in at the L5-S1 level (Dr. Bertagnoli, Pro-Spine, Bogen Germany) and after 4 months post-op I still have pretty much the same symptoms that I had before the surgery. Mostly severe numbness in the legs, particularly in the left and concentrating in the foot region. It is getting worse daily and I can barely walk and get around and I have been told by 3 surgeons that the two discs above are bad and should be replaced (L4/5 and L3/4). This diagnosis of the discs being bad were solely from MRI and X-Ray images…NO tests (like a discography) have been done yet. I have had no other procedure or surgery done except the L5-S1 ADR. So thinking of trying epidural steroid injections on these two discs.

If anyone can answer or address the following questions or concerns I have it would be greatly appreciated.

1. I am concerned about facet joint pain if I do have 3 levels of ADR in a row. Anybody have any experience they can share or thoughts on this?

2. I understand the newer discs (e.g. the M6) do not risk facet joint pain as much as the older technology "ball and joint" discs, like the Prodisc. But I am reluctant to use the M6 since it is not FDA approved and I am concerned my insurance providers will not pay for a non-FDA approved device/procedure. Also, I understand the FDA has only approved ADR at the L4/5 and L5-S1 levels. Anyone have any info on insurance providers NOT paying for ADR since a non-FDA approved device was used or a non-FDA approved level was done?

3. I am concerned that the cause of my continuing problems could still be at the L5-S1 level. I had osteophytes/bone spurs and narrowing of the foraminal openings, etc at that level. Supposedly Dr. B cleared this all away--but the new MRI I had done cannot see ANYTHING at this level due to a signal void caused by the metal device. I heard now I must do a CT or some other imaging procedure to see what is going on at this level. Anyone have any words of wisdom or experience dealing with this problem?

4. I was thinking to minimize the excessive unnatural motion and potential facet joint pain I can have with a 3 level ADR to have a fusion in the middle...Prodisc at L5-S1 (which I already have in place) fusion at L4/5 and another Prodisc at L3/L4. Anyone have any experience or thoughts on this type of hybrid solution? One reason I would be reluctant to do this is that would equate to two surgeries I believe, since the fusion would be done from the rear and the ADR from the front. Or maybe I could have them done at the same time with the same frontal approach? But the fusion recommended to me was a rear approach using a plastic spacer in between the vertebrae and the stabilizers screwed into the back of the vertebrae (no cage or bone growing around the cage). So that may not be feasible with the type of fusion recommended to me. Any experience or thoughts on this type of hybrid approach?

5. If I do have facet joint pain in the future, anyone have any experience on how best to remedy it? I heard they have facet joint movement stabilizers out there now to limit movement and the resulting pain. Anyone have any personal knowledge on remedies for facet joint pain that WORKS?

6. Finally, no one has been able to adequately explain to me why some experience mostly pain, or some mostly numbness (like myself). My discs are bulging out and pressing against not only the nerves as they exit through the foraminal openings, but also bulging against the spinal canal sheath (or thecal sac they also call it?). I am assuming the pressing against the sheath/thecal sac is what causes the numbness and pain is the symptom from the nerve as it passes through the foraminal opening. Anyone have any insight on this issue?

Thanks in advance to all who respond and please feel free to e-mail or call me if you wish.

Matthew

[annapurna]

I only have partial answers but for those I do:

2) No only do most insurance companies refuse to pay for non-approved devices, they often find ways to declare items that are recently approved "investigational" and refuse to pay for them.

3) A very careful MRI can image the facets but a clumsy CT will have the same problems that a clumsy MRI has imaging an ADR level. You might be forced into a CT with contrast to get a good image.

5) They have lumbar devices to help with facet motion and lumbar facet replacements that are new but have been in use for a few years. Pimenta in Brazil was heavily involved in the studies.

[Hooch]

1. You're risk for facet degeneration goes up with a 3 level replacement, it also depends on the state of your facets presently.

4. You can be fused from the front. Another hybrid consideration could be posterior stabilisation (like an x-stop), although I expect they would simply do the 3 level replacement and see how you go.

6. Impingement of the thecal sac doesn't necessarily generate pain, the nerve has to impinged or irritated. I had thecal sac impingment, and had no nerve or stenotic symptoms whatsoever.

[mattbrand]

Laura/Jim and Hooch,

Thanks for taking the time to reply! I appreciate it immensely.

Matthew