Seriously considering 2 level Lumbar ADR in Germany
 

Hi, I'm a 37 year old active mother, wife, and occupational therapist. My husband is a physical therapist. We have been researching relentlessly (mainly me and passing on info. to my husband) since my spine surgery (2 level ADR at L3/L4, L4/L5 or hybrid (ADR and fusion) was cancelled on Jan. 15, 2015 when the very final nurse caught that I had a possible nickel allergy (b/c I break out to cheap jewelry and rivets on waist of jeans) to the fact that the ProDisc might have nickel in it (0.03% as an alloy). I was NOT screened for metal allergies at the surgeon's office.

I had formal metal implant patch allergy testing 2 weeks ago and I have confirmed allergies to: Nickel (2+), Pallidium Chloride, Tungsten, & Silvre Nitrate (1+). The ProDisc is automatically out and so is the MobyDisc, even thought my surgeon said he could use it "off-label" possibly (it also has nickel). The only lumbar ADR I have found compatible with my allergies is the M6 made by spinal kinetics which is not fda approved yet in the U.S. & I can't find any clinical trials in the U.S. for the Lumbar spine. Dr. Bierstedt at the ONZ spine surgical group in Germany has reviewed my case & says I'm an excellent candidate for the 2 level ADR procedure. Dr. Bertagnoli primarily uses the Prodisc as far as I know so I have ruled him out.

Any feedback/advice for me? Thanks so much, this is an amazing online community to be a part of. I have already ordered the ADR video. The spine surgeon in the U.S. has told me my only option now is a 2 level spinal fusion given the level of degeneration I have going on. My pain is considered to be discogenic and mechanical/axial and I have minimal (if any) nerve impingement.

Hate to sound like a broken record but take the time to rule out facet joint pain before going the ADR route.
I also was told I was an excellent candidate by Bierstadt and company for multi-level ADR and that according to my MRI my facets were fine....
Decided to go for facet nerve block and found out my facets were a major pain generator on my right side.

Adr
 

Pete it sounds like her discs are in pretty bad shape! Did Bierstedt give an explanation as to why he feels your discs are to blame? Loss of height? Past surgeries compromising disc function? Maybe your facets are in decent shape but have become loaded due to malfunctioning discs?

AK, see Codger's post just a few down from yours:

http://www.adrsupport.org/forums/f58...t-metal-13020/

AK, please delete your email from your signature! The SPAMBOTs will collect your email and share with hundreds of spammers!

Shape of my facet joints
 

I've had at least three Dr.'s (two spine surgeons) and a non-surgical spine specialist tell me my facet joints are in great shape. I'm not a candidate for the steroid facet injections I was told b/c of this factor. I grew up on a small farm riding horses all over and have been thrown at least 5 times if not more, I've commercial fished for 12 years as a deckhand starting at age 15 and my parents raised hay so I've always worked hard. My local spine surgeon feels I must have had significant trauma to L3/L4 many years ago b/c it has moderate height loss its says on the MRI but when you look at it with the naked eye, it looks like a flattened pancake and it bulges out to the front and back with significant reactive marrow endplate changes seen on the MRI T2 weighted imaging, which is most consistent with edema (Modic Type I changes). My provocative discography on 9-19-14 was positive at both L3/L4 and L4/L5 for those discs causing me pain, with of course the L3/L4 causing the most but the L4/5 not far behind. The report says my L3/4 is chemically sensitive (to so many leaks and it doesn't hold any pressure any longer) and my L4/5 is mechanically sensitive which both make sense. I don't know if this helps, but following the discography I had a inter-discal steroid shot into both discs (more into L3/4) and it was nothing short of a miracle (no pain, I could even run, bouncing out of bed, no meds, no NSAIDs, no muscle tightness) until 3 weeks later when it started to slowly fade. I appreciate your feedback though (about the facets) but the DR.'s seem to think my discs and the Modic Type I/II reactive endplate changes (edema) actively are my pain generators. Thoughts?

So, facet nerve block is a good test to determine if they are a source of pain? What if both, discs and facets, are pain sourses? Should one pursue ADR?

Arthritic facets are a contradiction for ADR.
In my case my facets on my right side were a major source of my pain.
I still have manageable pain at L4-L5 and L5-S1 because I've had a discectomy at each level..According to my latest CT scan I have moderate central canal stenosis and moderate right foramenal stenosis due to facet hypertrophy at L4-L5..If I were to get an ADR at L4-L5, disc pain could/would be eliminated and facet loading would be lessened but id still have arthritis at that facet level.What Boxer said makes sense if you havn't been dealing with damaged,thin degenerated discs for many years..
Once extra bone is created at the facets and the lining and joint has been compromised, reducing the load will not magically fix the joints..Motion at the damaged joint will only continue to degenerate it further..Removing spurring and bone from the joint will only compromise it and then stability becomes a problem..
IMO, ADR is for people that don't wait until their disc injuries cause a more rapid degeneration then the natural aging process.
Look how many people on this board continue to experience some type of pains after ADR...How would you like to spend $50,000 to fly to Europe and have a surgeon you never met before tell you you're a perfect candidate with the possibility that you might be told to go have a facet nerve block done down the road...Anyone considering ADR overseas needs to be proactive in diagnosing their own pains and symptoms...Do your due diligence, do your research and get as many opinions from reputable US surgeons as you can..
My 2 cents

Adr
 

Pete I see where your coming from. Not to high jack the thread but what's the end game for someone like yourself?? I feel like the damaged discs are the root of the problem which are causing the facets to build bone because of abnormal loading and sheering over time. Is it possible the unloading the facets could create more foraminal space and possibly stop bone growth in the facets? If I remember correctly you had some successful blocks or ablations? What's the long term outlook on those treatments? Tough spot to be in hopefully your best option isn't fusion.

I don't think the OP would mind because id say I'm probably lumped into the same boat as the majority of the people on this site..
Yes, the damaged discs have definitely accelerated the degenerative process...Problem is I had a disco at L4-L5 in 1996...Even though I kept myself in pretty good shape, guess which facet is the worst? L4-L5 on the right side...
Of course, but in my case the damage has been done at L4-L5..My gnarled up, overused facet joint cant remove the bone that's already been created..
An ADR at that level would increase the disc height but how would my body adjust?...IMO, common sense tells me no to an ADR at L4/5 and a surgeon looking at an MRI cant diagnose that...
Yes, I needed to find out if my facets were problematic before I continued down the ADR path..I know my body and know that my facets on my right side were always getting caught or locked up...I constantly needed to self adjust and open up my right side to pop them..I had constant sharp pinching and a dull aching on my right side...Shots to the 2 bottom right facets took away the pinching..Second set confirmed and I had the rhizotomy in July for right side facets..
In a nutshell my hunch was correct in that my facets were a major pain generator but not the only source..I continue to have episodic muscle spasms that have prevented me from standing up straight since July..
I believe that im working and stressing my facets more than ever now because I havnt been protecting them since the rhizotomy..Im having spasms on my left side also which I never had before...
.
Well, im not going overseas to get cut in a strange country with absolutely no recourse if anything goes wrong..
I have a steep sacral slope and don't believe after much research on the subject that ADR at L5-S1 is an option for me..
I'm looking at accepting a 2 level fusion in the very near future..While some may frown on this decision or even argue it, I feel this is my best option to give this 44 year old after 20 years of this back pain sh*t a chance at a normal life..
Im not looking to run a marathon, nor lift a ton of weights at the gym or play fullcourt basketball...
If L3-L4 goes because of the fusion ill deal with it then when the Activ L is FDA approved...I got it all planned out:wiggle::wiggle:

true
 

I has test blocks and rhizotomy of facet joints and no help, so it wasn't facets!