I'm new here - need 3 disc fusion - looking at options
 

Hello,
I am 53 years old and was diagnosed with DDD back in 1988, along with cervical bulges. I have been handling that very well over the years.
On Oct 28, I was pulling vines out of trees in our back yard and felt like I'd overdone it. The next morning, I was really sore but got in my car to drive to a conference, I could not get comfortable all! X-rays showed Osteroarthritis (which I knew I had).. So Dr gave me steroid PAC and pain pills. 2 weeks later I went back and got an MRI. Results showed bulges pretty much everywhere, but moderate at L3, 4 and 5. L5-S1 was actually indenting the thecal sac.

She sent me to Ortho. Couldn't get in for weeks, so agreed to see his PA. She looked at everything and said she didn't think it was te disc bulges, but te facet joint arthritis causing my pain, and sent me to PT. 5 weeks of PT and I decided to see a neurosurgeon. He's done amazing work on my husband so we felt comfortable seeing him. He ordered a discgramn, which I had last week. Went to see te doc yesterday, and I have Level 5 Annular tears at All 3 of those discs! L3,4,5! He said 3 disc fusion was an option. We asked if there was anything else, and he mentioned the Autologous Stem Cell transplant. He is currently gathering more infirmation for us, trying to confirm if I would be a candidate. We are also researching... Which led me to this forum. He did not mention ADR... Not sure if its because he doesn't personally do that surgery or it wouldn't work for me.

So hear I am... Wearing my heart on my sleeve. I work at a computer (telecommuter employee, thank God!) for a college, and have a fairly heavy travel (conference) schedule coming up. Trying to make some decisions and wondered if any of you could assist.

1. Do you know if I would be a candidate for Autologous STM Cell transplant? Doesn't make sense, that if my tears go all the way through, how would injecting cells n there work? Wouldn't they just leak out too?

2. Would it be wise to ask my Dr. About ADR? it appears by many of your postings, that it would involve a trip to Germany? Clearly this also is a non-insurance covered procedure? sigh.

Thanks for letting me share. :)

Welcome Grover! I am sorry you need to be here, but I think you will find this forum a great resource. I know I did.

As for your questions, American doctors can fuse no more than one level unless it is a worker's comp case. Only European docs can do multi-level, both because of skill and because it is still not FDA approved. The reason your doc did not mention ADR is that he cannot do it. I would be wary of fusing three levels anywhere, especially your lumbar spine. The chances adjacent levels will go down the road and need to be fused as well is just too high for my taste.

Personally, I wouldn't even THINK about letting anyone other than Drs. Clavel, Dare, or Pimenta do a three level. There are some great stories coming out of Germany, but far, far, far too many horror stories, so there is no way I would go there.

Sadly, it is not a procedure covered by insurance. The upside of going to Europe is that instead of the 150k you would pay for a procedure here, you are looking at slightly over 40k for a three level, which is WAY more manageable.

My stateside doc straight up TOLD me to go to Europe!

Grover771,

Welcome and condolences for being here.

I think the facet joints could be an issue, but this can be checked with a facet joint injection which would temporary block the nerves coming out of the joints. If you feel relief - then culprit found. I am surprised no one suggested this. :/

Also were you awake for your discogram, i.e. did they ask you to rate the level and nature of the pain when they 'inflated' your discs? Some docs use it just for imaging purposes others do it for pain detection. Considering your pain could be from multiple locales or not be discogenic (from your discs) I would have thought they would do it awake - was this the case? If so what were the results?

To cover your questions (but there are FAR more qualified people to talk about stem cells - try the user slackwater)

1) Honestly the jury is VERY out on stem cells for reducing PAIN associated with mechanical lower back pain. Studies thus far show improvement for DDD but NOT when there are associated tears - these don't neatly seal up with an injection of stem cells, at least there is no study I know of where that is the case

2) Of course you can bring up ADR with your doc, but if he doesn't do the procedure the general experience of patients here is that he will disparage the procedure and try to disuade you from it. Just keep that it mind when he gives you that answer. Germany is just one locale where you can get ADR surgery, I got mine in Spain (Dr. Clavel) which I felt was a much better option for me. Others have gone to Brazil (Dr. Pimenta). Do your research, comb the boards to see who is going to whom and what there experiences are. Note with a potential three-level your choice of doctors that you should be looking at is narrower as you want someone with sufficient experience with that since it is obviously trickier. Now as far as insurance goes, it totally depends on your provider, there are people on the board who got their overseas surgery 100% paid for, but I would say the more common scenario is 0%. In the US you will have difficulty getting a 3-level covered as it is off-label for the available devices which are only FDA approved for 1 level DDD. You will also be limited to discs approved by the FDA which is significantly smaller than those in Europe, and many on this board would argue (including me) that the M6-L is currently the best available disc and it is only available outside the U.S.

Good luck,

-Jeff

Thanks
 

Thank you both for your comments.
Yes, I was certainly awake for the discogram, and my right arm shows it (bruising where I dug my nails in)
It was very painful when they injected L3-4, but I almost jumped off the table (they strapped me down) when he did L4-5. L5-S1, which showed indenting the thecal sac, didn't really hurt at all. And the MRI showed moderate bulging of L4-5, unremarkable... So the discogram was helpful in identifying the culprit.

This neurosurgeon, in the Florida area, is well respected throughout. He's the first to say, let's see if we can do anything else before resorting to 3 level fusion.

I continue to research,
Thanks again

Sorry you have to be here, but welcome aboard. I am also in a position of US surgeons recommending fusion but looking into ADR. Dr. Clavel has recommended 3 level ADR (S1-L3). I am waiting to hear back from Dr. Dare and Dr. Lauryssen regarding their recommendations. I wish you the best and hope this forum is as helpful to you as it has been to me thus far.

Waiting to hear back
 

Thanks all for your comments. I'm waiting to hear from the Dr., to see if I'm a candidate for the Autologous Disc Stem Cell transplant. I'm going to ask him about ADR.

In the meantime, I've been trying to find out:
1. Do Grade 5 Annular tears would ever heal on their own?
2. Will taking Vicodin twice a day for weeks be harmful?

No other pain Meds help me... And they don't even make me loopy, they just help me carry on my daily living activities. :-(

How many weeks? Are we talking two, six? Longer?

About 5 weeks. Looking into Fentanyl patch.

You might get a certain amount of healing but generally not enough that you'll never have problems with it again. Are you looking to avoid surgery or heal enough that some kind of stem cell treatment might work? There are things that are being discussed that might help with the latter but avoiding surgery would only work if you get lucky and find the Holy Grail of a technique that heals the tears, another technique that stimulates formation of more nucleus material, and a means to get them to work quickly enough that daily living doesn't stop the healing or squirt the newly grown material out.

Just to set the record straight, many US docs have performed multi-level surgery, up to 3 levels. Of course, it's not as common as the German docs, but it happens every day.