adhesion barrier
 

Dear Harrison,

Thank you so much for replying. So according to your observation, adhesion barrier is not necessarily beneficial due to the fact that it might cause more troubles? I wonder what kind of adhesion barrier Dr. Bertagnoli uses. Do you happen to know? Is it a certain instrument or a technique?

Now I understand there are truly some technique differences between European and American doctors. When i read on the "superior surgery" page on Dr. Bertagnoli's website, I was unconsciously taking his ways as the "Golden Standard" without knowing that there might be some downside to the approaches too. Thanks for pointing out.

I struggle between the two options a lot. (Dr. B or Dr Guyer at TBI). At this moment, I don't know what to choose. I wish there are more public information about the surgical outcomes and techniques employed by US doctors. But I do find out a paper written by Dr. Guyer and Dr. Zigler that says "In the series of 1,707 patients, there were 17 patients who underwent TDR removal (0.99%) and 3 additional patients underwent TDR revision (0.17%). The rates based on the total number of 2,023 TDR devices implanted in the 1,707 patients, were 0.89% removals and 0.15% revisions. " These are the patients from last 17 years.


The link is below if anyone is interested.


http://www.isass.org/abstracts/isass...-during-a.html



Thank you! I would love to hear what you think and your perspective!

question about metal sensitivity test
 

update: I saw Dr Guyer yesterday and asked him a bunch of questions. He will use Activ-L for me based on my specific bone shape. He says it is a really good disc. He also said that he does not use adhesion barrier, bone cement, bone wax etc. He also does not preserve the anterior longitudinal ligament. Their revision rate is 1%. 90 precent of the people have 50 percent improvement of pain level. I asked him a bone density scan and prescribe a metal sensitivity test with Orthopedic Analysis.

He thinks it Orthopedic Panel one is sufficient for the test. However, i believe there is a titanium coating on the activ-L as I recall. I called the manufacture of Activ-L and asked for a list of metals in activ-L.

Does anyone have a metal sensitivity test with Activ-L at all? which panel do you use?



The panel one include: aluminum, cobalt, chromium, iron, molybdenum, nickel,vanadium, zirconlum
panel two include the above plus: Titanium alloy particles, cobalt alloy particles, bone cement particles, bone cement liquid

thank you!

metal sensitivity
 

I called the manufacture of Activ-L and was told that there is a 1/4 mm coating made from pure titanium power on the end plate. I called the Orthopedic Analysis and asked which panel is better. They just won't tell me. She kept saying that whichever the doctor orders. I am not sure whether Dr Guyer is actually awared of the fact that there is actually pure titanium power on the device.

It is funny that Orthopedic analysis people just does not want to help with simple stuff like that. I asked who else I can talk to but she refuses to tell me.

Can anyone help on this matter?

Lei

It might be that Orthopedic Analysis doesn't have a doctor on staff and thus can't give medical advice. Or, they've been ordered by their lawyer(s) to not offer such advice.

I didn't research the Activ-L so this is likely to be 90% my opinion with 10% fact but often the pure titanium powder is added to produce a hydroxyapatite surface which bonds well to bone. That said, there's a potential for titanium ions to go into your system from it. I'd suggest panel #2 would be a wiser choice. It's very rare to react to titanium but there have been other posters who did.

panel two
 

Thank you so much for your help! I think it would be safer to go with Panel 2. Also there is one more element that that is in Activ-L, but not in any of those panels . It is tantalum. Do you know anything about tantalum? unfortunately it is not even in panel two either. I will try to upload the pdf file in the next message. I don't know whether I should worry about it or not.

Activ-l
 

Attached is the metal info about activ- l I got from aesculap . It shows the element of tantalum

draw blood
 

I have trouble finding places willing to draw blood for me for my metal allergy test or charge high price for the simple drawing( $200). Is this a normal price for blood drawing?

I can't see the alloy breakdown that you posted well enough to know how much tantalum is present. It's typically a minor alloy addition. It's relatively inert and corrosion resistant so my guess is that the likelihood of allergic reactions to it is relatively small. If you were going to roll the dice and hope you don't have an allergic reaction to any given element, tantalum's a good one to risk.

tantalum
 

Dear Annapurna, thank you so much for your help. I really appreciate it. I tried to upload the excel file on this site so that it is more readable but failed multiple times. I wonder whether the file size is too big? (The picture is quite bad after being loaded)

But you are right. Tantalum is a minor addition in this case. I decide to "roll the dice" and keep my fingers crossed that I am not allergic to those other major elements in the implant. I will order the panel two and hope to find somewhere to draw my blood for the test.

Hopefully, Dr. Guyer's office can help me with the blood draw.

thank you again. I truly appreciate you helping me out the entire time ever since I got in the forum.

Lei

bone scan result
 

Finally, I got my discogram done yesterday and it shows my L5-S1 causes 10/10 pain and L4-L5 causes 7/10 pain. That is good news. But bad news is that my bone scan T number is only -1.9 for spine and -2.1 for hip. Based on my understanding, this number will disqualify me for adr. But I am not for sure yet until I meet with Dr Guyer next week.

I am very disappointed with my bone result and decide to do everything I can to improve. I know it is not a overnight fix and I don't know how long I can stand the pain... Maybe I can consider some docs overseas with the bone cement technology?

Any advice?