I have to decide tomorrow wheter to reserve operation spot for 4-5 or not, and I am just getting crazy and very depressed.

- Dr. Clavel tells me that a fusion reverse should be made as soon as possible, maximum within 6 months counting by now in order to try to recover mobility on that level
- My pain level right now is tolerable, if i do a minimum physical activity.. but it depends on the day and it is fair to say I am not working since 6 months ago so my physical requirements are very low
- Everytime I seem to be decided I read a new thing that causes me 1000 new doubts. Today I talked with Dr. Clavel about HO and he told me in my case may not appear.. but when I was coming back at home I read about osteolysis in elastomeric replacements. Are these ADR really aimed to last more than a few years?? https://link.springer.com/article/10...86-021-07094-7
- I am pretty obsessed about adjacents disks damage due to fixation, but there a lot of studies that suggest that ADR does not prevent that either.. it pisses me out the perspective to have all my spine fused in a future.. really worried

I would appreciate any feedback, my mind is getting crazy already

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Elorpar

c5c6 fused in 2021
Thinking to replace fusion to cp-esp

Osteolysis was a hotly debated and much-monitored topic when the Charite and Prodisc were the only disks available. Basically, the theory that says it should be happening with ADRs but the practical experience (listening to this and earlier boards like it) is that it isn't or is happening so rarely that it's not a major factor. Rich/Harrison and Laura both have ADRs that are nearing 20 years old and Laura had hers checked with x-ray and MRI last year only to find that it was performing extremely well with no signs of degradation or adjacent level problems.

I think most everyone's convinced that ADRs decrease the chance of adjacent segment problems compared to surgical fusion or self-fusion. There are some who argue against that but the ones that I've seen are quoting results of theoretical biomechanical models. While I use similar models all of the time and like to use them, they're also a really efficient way to lie to yourself if you get caught up in the theories and the models and ignore the data. So far, there have been few posters complaining about adjacent segment problems next to well-placed ADRs.

Yes, you are driving yourself crazy, as we all have done in making the same choice.
Maybe this helps you? It came out a few days ago.
Spinal Tech

2-level data out on NuVasive's artificial disc: 4 details
Carly Behm - a day ago Print | Email
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TEXT
A study published in the Journal of Neurosurgery: Spine supports the effectiveness of NuVasive's Simplify cervical artificial disc at two levels compared to spinal fusion.

Four things to know:

1. The FDA investigational device exemption trial followed up with patients for two years and compared disc replacement patients with anterior cervical discectomy and fusion patients.

2. Researchers found the overall composite success rate was statistically significantly greater in the artificial disc group compared with the fusion group after 24 months. The mean neck disability index for both groups improved significantly in both groups, and the disc replacement group had lower scores at follow-up points.

3. Rates of subsequent intervention was 2.2 percent in the disc replacement group and 8.8 percent in the fusion group.

4. Data from this trial was used in the FDA pre-market application for two-level indication approval, according to an April 21 news release.

And attached here is a recent article. (If my meager tech skills did not fail) . Good luck in your decision. Only you can decide what is best for you, given the available info at this time. The future is always uncertain

Thanks Jim and Joe, I will answer to Doc on monday.. I need to meditate this weekend.. also my operation is a fusion reversal so this extra-panics me and Dr. Clavel does not assure me 100% he will be able to implant an ESP over an M6 (wit all respects to M6).

Anyway I feel grateful for finding this forum, you guys are super wise about back medicined and I feel very happy to find friends like you over the way. I do not like Facebook groups so far, so much noise..

If you come to Barcelona someday, I owe you a dinner.

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Elorpar

c5c6 fused in 2021
Thinking to replace fusion to cp-esp

I'm sorry that I haven't followed your whole thread. Have you made sure that whatever is causing the (neck/arm) pain from the fusion can be fixed with ADR/revision? Or are you suffering a fusion that failed to fully fuse? Have you had nerve conduction tests to identify the source of impingement?

In the fused level there are soft osteophytes -> Maybe to be solved by doing a revision

Fusion is completed, causing cronical stiffness and trap pain like a normal fusion does -> Maybe to be solved by ADR

Neuropatic pain is cronical, resiudal from the former herniatic impigment -> not to be solved by ADR

I am obsessed by adjacent disk damage in a future -> Not a current problem, but maybe to be prevented by ADR

These are the things are what are making me to consider a revision, are they enough? This is the decision I need to make

Not sure where the osteophytes are located, can Dr Clavel do some kind of anterior microforminotomy (assuming that is where the osteophytes are there) without disturbing the fusion? PT -intensely, can help the muscle stiffness and trap pain. Elastic band workouts. Fusion isn't always a terrible thing -adr at new levels can come later if needed

Osteophytes are located in c5c6 posterior, probably generated by cage position (a little bit displaced to the frontside), I assume the best way is to take out the cage and clen the area.

Stiffness is also causing like a really creepy sound when I move my neck.. maybe caused by extra pressure in adjacent levels/facets and really concerning when you have 36 years old and have to carry this all neck your life.

As you say in a future I could take ADR on other levels and fusion is not that bad compared with an herniated disk, but it is not good enough to ponderate if it is worth to try to prevent neck health and to have a maybe better functionality at this point.

I thing I will go on with operation next week, and also try PT after that operation if the outcome is still not good (maybe better PRP?).

If you do go forward with the operation, I'd strongly suggest a very careful rehab plan. Any muscle attached or working through the fused level that's being revised to an ADR will have spent a year idle and generally losing strength. You're then going to switch that level to an ADR that requires a degree of dynamic stability from strong muscles.

Take it slow and easy but plan on a long careful rehab with lots of strength-building. Of that sentence, the "slow and easy" part is definitely more important than meeting some pre-determine mark for strength at a given pace. Don't let the physical therapist push you too fast or too far. I don't know if you have the problem in your country but here in the US, there's a lot of poorly qualified therapists who are doing a lot more harm than good.