my intro & is ADR worth the risk if not in bad pain?
 

Hi, I'm Rick & have had back problems for 20 years. Fortunately I don't have much pain as long as I'm not going thru a flare-up (my heart goes out to those of you who do have pain). However, my back is very sensitive & will easily go into spasm, so i have to baby it. Here's a few examples:

- I can't play sports, except I can hike & bike a little. Im 50 now & interested in gardening, but leaning forward with my knees on the ground is asking for it.
- To pick something off the floor, I have go down on 1 knee & keep my back perfectly straight.
- Before lifting a grocery bag, I have to make sure my glutes & abs are engaged first.

I was considering ADR back in 2001, but at the time my doc said he didn't like any of the designs. But now they look great, I'm considering a 2 level L3-5 ESP in Europe. I've lived in Germany for years & speak the language well, so going there is not an issue.

I'm curious if any of yous have untergone an ADR operation to improve your quality of life, even if you didn't have significant pain? thanks

Hello Bokes, sorry for the late reply. Thousands of patients have had ADR and posted here since 2004. Most people are in deep, complicated pain before they have surgery. Some, less so.

Where are you at in your decision process? And in what state do you reside?

Hi Harrison, I'm in the SF Bay area & I'm in research mode. I appreciate this site as there's lots to read & learn. So far in my reading it seems like most of the complications have been from subsidence or misaligned ADRs. I started a thread in the Arthroplasty Forum about the Mazor Robot, which I suspect might help avoid the misalignment risk, but afaik it's not in use yet for ADRs. Since my pain is low, I could wait if there was a killer technology around the corner.
The other option i'm considering is a Transforaminal Discectomy. But since I've already had an IDET on my bad discs, I don't know if they can handle more trauma. I think my doc will order another discogram later this week. yippee

If youre not in pain Id wait as long as possible. I have pain every single hour of every day. I had lumbar fusion L4-5(2006), lumbar surgery to remove bone spurs(2007), and ADR cervical C5-6(2009). Been dealing with countless syptoms from numbness tingling pain in groin, thigh, hip pelvic, abdomen, ribs, diaphragm the list goes on. I now know that Ive developed adult scoliosis, kyphosis and spodylolthesis since the surgeries. See my pics and youll see screw is coming out of the hardware thats in my neck(i have trouble swallowing and breathing at times). Im now desperate to find a Dr who is trained in removing ADR. If i could go back I would not have done either surgery, just my opinion

star7 I'm deeply sorry about your pain, I really hope you can find someone who can get you some relief.

You are definitely not a candidate for surgery. Only the vulture clinics will offer you surgery. It may be difficult for you to see, because maybe your friends are more active, but you are already living a life many would dream of post-op. Once you replace your biological discs there's no going back. Anything happens your ADRs it's more surgery as your body doesn't know what to do with them.

I feel that this is overly simplistic bad advice. Surgery has risks and can make a problem worse or leave you in pain with no recourse. Obviously, because we're talking about getting surgery to fix things, it can also fix problems and leave you in less pain.


There have been posters here who sought surgery due to a quality of life question when their pain wasn't serious. They didn't all regret it. Personally, I'd suggest investigating surgery now, while your pain is manageable, and learning what you need to know to balance how you see risks and how you'd make your decision.


Don't rush off to get surgery once you've learned enough to make that decision but make use of the time while you're not clouded with pain or pain medication to learn enough so you'll be confident of making the right decision. Waiting until you're driven by pain means you'll feel rushed and pressured, which might leave you making a decision before you've learned all you should know.

Bokes
 

Glad you found this site. Most people here that had ADR or any surgery for that matter, were in a lot of pain, but moreover, a level if disability. I for one on both counts. Only you and your trusted surgeon can make that decision.
Keep something in mind, we are here to share each others spine history, surgery, and successes as well as struggles.
Unless someone here is actually a doctor of neuroscience or orthopedics and has seen you as a patient, they cannot tell you that you are or are not a candidate for surgery.

I'm in a similiar boat to you. My pain is manageable, but my overall wellness is suffering because of my limitations. I am a 26 year old, former athlete, and have a completely collapsed L5-S1.

Advice that one should wait until the pain is unbearable seems like a major philisophical difference in ones view of life. Being active is major part of my identity, and being physically limited reduces the joy of life for me. Additionally, If you take really good care of yourself right now, that is likely contributing to why your symptoms aren't as bad as others in similiar situations.

With only one life to live, i'm strongly considering the surgery. I'm living the best case scenario without surgery right now, and I personally want more from life. If there are things you're unable to do that you and your surgeon think could be restored with the operation, I would say go for it.

My biggest hesitency at the moment is my age (an artificial disc will have to last me a long time if i live as long as i plan to). Still, I'm exploring all the options and think you should too!

Mri
 

Here's my MRI, if you have any feedback, please feel free to share, thanks
https://i.imgur.com/V5l7YmK.jpg

Bokes
 

I am not a doctor, but the midline and anterior part of your disc still look fairly good, I would consider a partial micro discectomy. My husband had one and a coworker and they are both doing great!

Cheryl I believe a micro discectomy is done when one has nerve compression from a herniation or bulge. I dont have that, instead I have annular tears which cause discogenic pain & frequent back spasms.
I did find a youtube clip about 'Transforaminal Discectomy' that is used for disc tears, but my doc said he thinks it's way too dangerous using lasers around nerves.
I'm fed up with how poorly natural discs heal, if I'm going to take any risks, it will be for an ADR.

True
 

That is how I feel about radio frequency ablation. The risk of permanent nerve damage and scar tissue

Quality of Life
 

bokes; Your already going in the right direction looking at Euro doctors. Regardless of pain levels do you want to live the rest of your life with the quality of life you have now or take and chance (any surgery involves some risk) with a Euro who has done probably a few thousand ADR implants not only vastly improving your quality of life and actually getting your LIFE BACK , research it and GO FOR IT!

disc
 

bokes ;
"The other option i'm considering is a Transforaminal Discectomy" , you mean a microdiscetomy? Thanks .

@beaverc:
Above I should have called it 'Transforaminal Endoscopy'.
Im not an expert but I think T.E. is like a swiss-army tool for surgeons. It's a hollow needle with a bunch of gizmos at the tip, like a camera (so the surgeon can watch on TV), a light, a laser, a vacuum, and a rinse feature.
I believe when the surgeon uses the laser on this tool to remove herniated disc material, it's called 'Transforaminal Discectomy'. That's my understanding, feel free anyone to correct me on this.
I think a microdiscectomy is the old-school method of treating herniations, using more traditional tools.
My reason for mentioning this above, I saw one surgeon on youtube using the laser to cauterize the nerves on an annular tear, which is similar to the IDET I had done 20 years ago, which was partially successful.
But I'm no longer considering this tho, as my doc said it's too risky for too little benefit, & I trust his judgment.

Adr?
 

bokes ; I agree with annapurna's comment 100%

"There have been posters here who sought surgery due to a quality of life question when their pain wasn't serious. They didn't all regret it. Personally, I'd suggest investigating surgery now, while your pain is manageable, and learning what you need to know to balance how you see risks and how you'd make your decision".

I have seen spectacular results here with Lumbar ADR done in Europe. Actually I think the answer is quite simple start consulting / research (euro) and DO IT. Unfortunately I don't believe I would be confident with any US doctors to do a 2-level ADR no matter what ANYBODY says. Good luck with the research / consults.......................

I'm doing what annapurna suggested, researching surgeons, complications other people have had, and if there any safeguards or technologies around the corner to help prevent the same from happening to me.
I'm quite certain I will have it done in Europe in a year or 2.

Discs
 

bokes
"My reason for mentioning this above, I saw one surgeon on youtube using the laser to cauterize the nerves on an annular tear, which is similar to the IDET I had done 20 years ago, which was partially successful.
But I'm no longer considering this tho, as my doc said it's too risky for too little benefit, & I trust his judgment".
Has anyone mentioned a procedure to you called "radio frequency ablation" , it's for pain reduction. It uses radio waves (you could probably say heat) to I guess you would say to "burn" specific nerves causing pain. Efficacy / duration of pain relief / side effects I don't know. I haven't heard it used much on this forum.

What discs have you considered , have you researched the LP-ESP?

beaverc: thanks for the suggestion about RFA, I'll keep it in mind, but for now i'd rather get ADR or just leave my back alone. My bad discs have already had one 'burning' related procedure (IDET). I feel like "been there, tried that". Plus natural discs heal glacially slow, and I've already lost an enormous amount of life due to back pain, I'm excited about the prospect of having a brand new back.
Given the technology we're at now, Im only interested in the ESP & perhaps the Axiomed Freedom, but who knows when they'll be available again.

It's also worth remembering that the nerves heal from the RF ablation. If you don't have a plan to fix the area, you'll be back in the same position in 2-3 years, more or less, when the nerves shut down by ablation heal. Laura did use RF ablation but it was to buy time while she pursued other structural repairs so that she was net-improved when the nerves came back online, so to speak.

thanks for the heads-up, yeah I'm looking for a more permanent solution.