What should you pain level be before getting ADR?

[longroadahead]

The surgeon's office called me yesterday and said the Dr. didn't do 3 disc at one time and then called me today and said he would. This put me on alert.

Yesterday, I called another surgeon and his office said he wouldn't do 2 lumbar and 1 cervical ADR at the same time. Plus, he isn't doing any right now because wasn't satisfied with the Prodisc-L and was waiting for the Maverick (this could be financially motivated though).

There are great technologies in the works (3 - 5 years) that it might be worth it too wait if the pain is not too great.

Typically, my pain hovers (honestly) around 3-5 on a scale of 0 - 10 sometimes spiking up to 7-8 and it hasn't been a year yet since the pain started.

[painstinks]

Long road;

The reason to have surgery is different for everyone. My pre-op pain lasted for nearly 4 years. I baselined around a 4 with spikes of 10+. I had severe migraines 3-4 times a week that left me contemplating suicide at times because the pain was unbearable. I too was in my thirties and the "long road ahead" was making me depressed. Add to that the mix of narcotics to manage the pain and the snowball began to get bigger and bigger. Therefore surgery to me was a last ditch effort to have a chance at an enjoyable life. I am not perfect or even normal but am much better now than I was. Not all people have the same outcome. Some are worse after surgery. I knew all of that going in and was ready for whatever outcome I got.

Some people go into ADR surgery thinking that they will be back to "normal" after it is over. Please remember that ADR is not a miracle cure and you may still experience pain and or other symptoms post-op. You may even question sometimes as to if you made the right decision. For me, I answer that question by asking myself if I am better now than I was.

So, do your research, make a decision that you can live with and follow through with as much of a positive attitude as you can. Be prepared for the good and the bad and take life one day at a time. "Live in day tight compartments" Dale Carnegie..

[Jack]

As the old saying goes "Been there done that". Couple years back, when I started with the back pain thing, I researched all the available options. Years later, the carrot of better stuff in the future is still dangling out there. I'm now at the stage where I don't care what is out there. It is kind of like that old Jerry Clower joke where he is in a fight with a bear. A partner says he can't shoot the bear without hitting Jerry. Jerry says it don't matter, just shot in amongst us as one of us has to get some relief.

Various drugs, injections, etc. are options. Waiting may be an option. You will know when surgery is your option. Knowledge is the key thing. Learn all you can and don't give your decision to someone else. The worst thing you can say is "Well, your the doctor. Do what you think is best".

Instead of using numbers, I try to quantify by things those without pain can understand. I tell them mine is like a 12 year old standing on my toes 24 hours a day, 7 days a week and every once in a while he jumps up and down.

[rhatzy]

Have to say that I have the maverick at L4-5 and L3-4 and I am very satisfied. The newest technolgy for cervical, I believe, is the M6. Where I went, they are using both and have had very good results. They will do both cervical and lumbar at the same time.

The problem with waiting, I believe, is that as your disc deteriorate, the start to take out the rest of spine, the facets and then arthritis. How long to wait for surgery is up to you, but keep in mind what else could be deteriorating. They dont call it Degenerative Disc Disease for nothing.

Mark

[DeniseT]

My pain didn't last very long (4 mths) before I went to the Neurosurgeon. After looking at my MRI and X-rays he told me that the best option would be surgery as it wasn't going to fix itself. I had been seeing my Chiro since rupturing my disc and she herself said she had done all that she could do. My spinal cord was completely compressed and the pain and numbness wasn't getting any better. I had my surgery on July 10 and the pain is less but the numbness seems to be worse with alot of prickly feeling as well. I am hoping this is just the healing process and I am sure there must still be some inflamation and swelling inside. I will be going back for my 3 week check up on Monday so hopefully I will know more then.

[cathydownunder]

I can see what a dilemma you have....unfortunately no-one has a crystal ball and can predict what will happen to our discs if we don't act now.

I do agree though that the best outcomes seem to be for those whos injuries/deterioration/bulges are relatively recent.

I saw my doc for 10 years complaining about my lumbar pain and kept getting told it was "just" my scoliosis and to live with it. Xrays every few years showed nothing remarkable.
Finally after moving interstate I saw a specialist who after doing MRI's and CT's was aghast at the extent of the DDD/ bulges and bone on bone L3/4.

What Im trying to say is....don't get accustomed to pain. Your threshold will increase without you realising and before you know it you've missed the boat..so to speak.
Cathy

[sahuaro]

I "only" have cervical issues but I struggled with the question of how much pain one should be experiencing before having surgery as well. What precipitated the decision to go ahead after 7 years of physical therapy and supervised exercise, was deterioration in functioning rather than the pain level: my dominant arm was subtly but noticeably weaker than the other, I was having increasing difficulty writing, and my EMG results changed, showing nerve damage. While my surgeon had previously advised I could wait, once the changes became evident, he indicated that it was now time to go ahead.

I feel incredibly fortunate. And the day my physical therapist discharged me was an unbelievable thrill!

[Cirobi]

I think the tolerable pain level for each individual is different. I spent a good decade at maybe a 2-3 on a 0-10 scale with a lot of varying levels between depending on what I did to irritate my spine. At the time, I didn't know any better since it seemed like my initial spinal injury was mostly muscular. Though I likely didn't describe it well. My pain tolerance is fairly high though, so my 2-3 could have been a 5-6 to someone else.

What became my deciding factor was not so much pain level but quality of life which invariably tied into pain level. My quality of life was decreased in the fact that certain activities were a big no-no and if I stubbornly did them anyway, I paid for it dearly with increased pain. Being the stubborn person that I am, this was the norm. The ultimate thing that lead me to investigate my spinal problems further was how my back finally gave out. When you stand up after using the restroom and don't feel right in your spine, or you spit out toothpaste and nearly can't stand up straight, it can be a pretty frightening thing if you've never had it happen before.

If I had the opportunity to rerun the spine problems from the beginning, I would have gone to the doctor after the initial injury during track season rather than insisting to my mom that I was fine at the time. I was given the option of some form of surgery (fusion or ADR) or wait it out. I received a Prodisc at L5/S1 and I haven't had a single regret in making that choice just over a year ago.

In any case, it comes down to how you feel rather than some pain level rule of thumb. If the pain you're enduring on a regular basis hasn't decreased your quality of life and you think you can wait for a different disc technology, go for it. If your current pain levels make you feel like a complete mess and are limited in many ways because of that pain, then I'd probably suggest using a solution that is already available.

That's just my 2 cents US. Hopefully it helps.

~Sara

[JasonR]

I struggled with that decision myself. In 1997 a Navy doc diagnosed me with tension headaches and the Navy discharged me in Jan 99. In 05 I finally let my GP know that I was experiencing wrist pain in my dominant hand since 01/02. We both assumed carpal tunnel since I do IT work. By summer 07 I had pain in both wrists and I was sent to an orthopedist. Only then did I get the correct diagnosis of DDD at C5/6.

My pain level throughout all of this was 2-4 daily with spikes to 8/9 on a regular basis. When I learned the correct diagnosis I was scared to death because I had not heard good reviews of fusion. I discovered that ADR's were around the corner and decided to wait. After fighting insurance companies and finding a new employer I finally got approval for the Bryan disc.

Personally, I'm grateful that the delays allowed time for the Bryan disc to be approved before my surgery. My opinion is that the Bryan disc is the best cervical disc available in the US at this time by a good margin. But that's just my opinion.

With the options available now I don't see the purpose to waiting unless there's a technology that you think will be available within the next year or two but that's me. My pain has come to the point where it significantly affects my quality of life and the quality of my work. Neither is acceptable to me and I think the risk/reward ratio is favorable at this time for getting the ADR.

In the end, it's your call as there is no magic answer. What I'd be wary of though is thinking that when the pain level reaches the tipping point that you can get it taken care of at will. It took two years and I had to change employers. You may have to factor in time to get the approval so keep that in mind.

Best of luck,

Jason

[tucsonmikenc]

I am preparing to write an appeal for denial of cervical ADR with the Bryan Disc. In the book I bought on medical appeals it says to cite specific cases where there were approvals. Do you know of anyone who knows how the heck you find those ? I would appreciate advise or cases I can cite. Thank you in advance.