In need of advice
 

Hello fellow back sufferers,
I am the mother of two that is desperate to get back a normal life. I have a herniated disc at the L4-5 that I have been putting on bandades for the last 5 years with epidurals, PT, accupunture, drugs and lots of yoga.
I had a discectomy/laminectomy a year ago. After PT i was able to work out 45 mins of cardio and even added weights back in. It only lasted 6 weeks. I once again started suffering from intense lower back pain, sciatica and leg weakness on the same side. I was lucky if i could get a half hour walk in. I have now graduated to very intense pain on both sides of my lower back with very intense sciatic nerve pain now down my Right side.
the MRI shows an 8mm bulge on the right and some scarring from the previous surgery.
My dr. at Kerlin Jobe recommended spinal fusion. when i asked about disc replacement he said they rarely do it and that it was not covered by my insurance. he also said that i was not a candidate because i have retrolithesis.
Today I saw a dr. at the Watkins institute who said it looks like i need to have another discectomy on the right side. I told him that i was reluctant because the last one didnt work very well. I asked him about the retrolithesis and he said it was so slight that he didnt even mention it on the report, nor did the radiologist that did the MRI.
I have submitted my MRI and Xray to Ritter-Lang, Bertagnoli and the XL Nuvasive TDR study. Got any advice for a desperate mom that taking way too much medication???
thanks!!

Yes, submit to Zeegers too, and I've been reading a lot on here about Boeree and Clavel. Get as many opinions as you can afford. I am preferential to Zeegers but that's just me, I haven't have surgery yet. Good luck and welcome!

update
 

thanks for the advice. I got a recommendation from Bertagnoli, who says a discectomy would help the pain in the leg but probably not the discongenic back pain as the bulge is significant and is likely to continue coming out. He recommended single level ADR as long as my bone density test checks out. I am seeing a Dr. Spayde tmo that specializes in ADR has been involved with studies and articles
. He is participating in the NuVasive XL study so I would appreciate any advice from anyone that has already had this disc implanted. I've read a few that sound promising. He goes in thru the side so he doesnt have to cut the abdonminal muscles.
All I know is that I've been in excruciating pain and am flat on my back and just want to fix this disc.

Victoria,

What a terrible story! Condolences on your condition, and welcome! There is a lot of lumbar experience here for you and great bunch of people that are happy to share their experiences.

Retrolisthesis is a contra-indication for ADR. I believe that many ADR manufacturers publish a limit of retrolisthesis for which their device can be safely used. I want to say that most are in the 2-3mm range? Before having ADR I would strongly encourage you to thoroughly vet the implant you use for its performance in patients with retrolisthesis. As you are interviewing potential ADR surgeons, I would encourage you to quiz them thoroughly on their knowledge/observations/experience of ADR in those with retrolisthesis. A failed ADR can be a life altering and life-long debilitating condition.

As you are willing to go overseas for surgery, there are three surgeons overseas surgeons that I would highly recommend that you consider (with special attention to their experience with ADR/retrolisthesis)...

• Pablo Clavel, Barcelona, Spain - Highly experienced in practice and research, turns out a steady stream of successful outcomes, and gave me my life back on Nov 25, 2009.
• Nick Boeree, Hampshire, England - Highly experienced, turns out a steady stream of successful outcomes, and I've never seen an ill word posted about him.
• Luiz Pimenta, Sao Paulo, Brazil - Highly experienced, turns out a steady stream of successful outcomes, and is profusely cited by his peers in scientific literature. A bonus for you, (consider this a rumor), I have heard that he periodically practices in southern California. (so potentially no trans-continental flights required)

Nan has mentioned Dr Zeegers. He also turns out a steady stream of successful outcomes, and it is very unusual to come across a bad outcome had at his hands. He would be worth your consideration as well.

Be aware that surgery overseas is replete with risks that you don't have in the US.

• No protection by the US legal system is there is a problem
• You are required to pay at the time of service if there are complications
• Getting back home if you come out of surgery worse than when you went in could be problematic and expen$ive
• It can be difficult to find followup care from US ADR surgeons once you've returned home

You have a long road of research ahead of you. I would encourage you to take no one's word for anything; research for yourself everything that you are told. Possibly the most useful research tool at your disposal is the surgical outcomes posted in various spine forums.

Good luck!

Jeff

NuVasive XL TDR
 

Thanks for chiming in Jeff. I appreciate the info. I went to see Dr. Eric Spayde who is participating in the Nuvasive clinical trial. He also does a few ADR's a month using the prodisc. His practice is called the conejo spine institute in thousand oaks, CA.
He did an in depth eval and looked at both my MRI and Xray and said he would recommend ADR. I asked him about the retrolithesis and he said he wanted to take a new xray. he said there was no evidence of retrolithesis and that the vert was lined perfectly. It was also not noted by the radiologist from the MRI or from my second opinion at the Watkins Institute, so at this point i am not worried about that. After reviewing my info and filling out the extensive packet it looks as tho I am an ideal candidate for the study. I am awaiting final approval now. this surgery is new in that they go in from the side and most patients go home the same day or spend one night in the hospital. i have been reading results from other patients in the study and they are all raving except one.
So right now I am weighing my options. I did get an eval from Dr. Bertagnoli and he also recommended a single level adr.
Right now I am feeling optomistic and excited as I have been suffering from a bit of depression.

Victoria,

The retroperitoneal approach for lumbar ADR is used by some European surgeons because they don't have to manipulate as many organs. I just assumed that some surgeons used it here also; perhaps not. I've never spoken with anyone about that approach that's actually had it; but have wondered if it eliminates the problem of constipation incurred with an anterior approach. Did Dr Spayde mention if that particular problem was eliminated (no pun intended) by the retroperitoneal approach?

Please keep us posted, and good luck!

Jeff

You had a good dialogue with the surgeon, thumbs up.

Stay optimistic. I think from earlier reading the results post-surgery are tied to physical and mental/psychological well-being pre-surgery. Realistic expectations about outcomes help also (recovery time, etc.). The co-existing medical conditions are a powerful preopertative prognostic factor for clinical outcomes with surgical treatment. I am glad you are on a good path, thumbs up.


ref: transperitoneal or a retroperitoneal, see Archives of Surgery AMA
The Open Anterior Paramedian Retroperitoneal Approach for Spine Procedures - LINK

"Conclusion

Open retroperitoneal exposure to the lumbar and lumbosacral vertebral bodies can be performed safely with a multidisciplinary approach that maximizes the various surgical skills of the orthopedic and vascular or general surgeon, reducing complication rates in anterior spinal surgery."

Dr. Yue Yale University is one of the authors. I believe all authors of the above are from Yale. Dr. Yue is a researcher (?) or listed with Dr. Garcia of Florida on many Aesculap Activ-L FDA clinical trial documents.



Ideally the surgeon moves the great vessels around as little as possible. Some vessel movement must be made and I think many surgeons use adhesion barriers (clinicaltrials.gov etc).

see also, TMI (too much information)
http://www.orthobullets.com/approaches/12004/retroperitoneal-anterolateral-approach-to-the-lumbar-spine

Thank you!
 

I really appreciate the advice and comments. I will check out the link provided!
I certainly hope it helps with const. As I had a c section with my daughter and remember how tough the recovery was.
Dr. spayed did talk about how much easier it had been to recover for the patients in the study as opposed to the ADR he does with the prodisc and that those patients had to stay in the hospital at least 4 days.
I also got a call from the stenum hospital and the recommendation is for ADR.
So I do feel as though it is the right surgery for me and that gives me releif (mentally).

exposure of L4/5 requires more manipulation of the vessels than L5/S1 - just a educational comment, not saying anything "bad". it's something you can't change, so not anything to be stressed about ;) an experienced surgeon has exposed L4/5 many many times...

Happy Camper!
 

I am now 2 weeks post op and have changed my post to the post surgical page.
I am thrilled to be inrecovery, off the drugs and out of pain!!