Hello Everyone!
 

Thanks for the forum Harrison!
Thanks for all the posts I'm getting overwhelmed by the huge amount of content.

History:
I am a 53 year old male, pole vaulted and landed on my head a good bit as a kid. Lots of chiropractic over the years to deal with a periodic nerve pinching at C-6/7. Then had herniations and searing pain in Dec 2012 from C-3/4-C-6/7. The worst were the two bottom discs. Inspired by the golfer Davis Love III, that led to a two level ACDF in March of 2013. Two separate docs recommended that and leaving the two not so healthy discs above alone. Lots of relief, got much of my feeling and strength back to my triceps and left side. No more pain!

Then woke up with a stiff neck in November 2013 which led to a new MRI showing a new herniation at C-4/5 and barely being able to raise my left arm. Since then I have seen Dr. Theofilos in Palm Beach Gardens who has been part of an FDA trial for ADR. He seemed the most likely surgeon in my area. He said I was probably not a candidate for ADR at that level. I asked why and he said it would relieve my pain to my left arm but I would then have neck pain because the disc had already collapsed. Huh?

So after initially suggesting another fusion at C-4/5 he would probably also want to fuse C-3/4 as well (making 4 levels of fusion). He said there was to many bone spurs at C-3/4 with too much bone work taking them off making that level not a candidate for ADR. After talking he volunteered that he might fuse C-3/4 and ask his other disc guys their opinion on my level C-4/5 for ADR.

I go see the doc who did my fusion on 12/23 and it will be interesting to see what he says. I trust him a lot. I originally got two separate recommendations for him from a friend who has known him since he was in grade school and a colleague who was turned on to him by a nerve monitoring sales manager who said he was the best surgeon in FL. Anyway - wondering which way to go and who to talk to further, knowing I have a time bomb in my neck and shoulder not wanting to wait too long with this weakness before I decide what to do.

Any suggestions would be welcome - thanks for this forum - it is a godsend!

Saw the surgeon
 

He said an ADR adjacent to the fusion would produce additional wear and tear on the artificial disk, risking wear debris, etc. which could produce infection etc. He said we don't know enough yet to go this route so the tried and true approach would be fusion. i asked about wear and tear to the next adjacent disc and he admitted that, yes the reason to avoid the ADR was the same concern I had for the next adjacent disc. But that even with my less than healthy next adjacent disc it was the better option.

Anyone ever heard of this argument against ADR?

Time for a third opinion?

Welcome to the United States, where fusion is our business!! Sounds to me like your doctor is not well-versed in ADR technology, or he would rather just trade what risks there are in ADR for the risks associated with fusion. I"m assuming your looking at a Prodisc? You're 53 with 2 fusions already, what risk of wear and tear to the ADR is there really at your age ? People in their 30's are getting ADR's. Even 20's. How stiff would your neck be with 4 levels? Seems like alot of levels for such a short length of spine.

For my lumbar, my doc recommended a fusion/hybrid ADR procedure. Fusion for Spondy at l5/s1, and ADR at l4/l5 for DDD and to help protect the discs above. That was his words. Your doc says to forget the ADR because it would put extra stress on the ADR?? REALLY?? If i had MY choice, i would rather stress the ADR than my own natural discs, wouldn't you? Fusion has been known to do that, while ADR can potentially overstress facets(which fusion can as well)

I would get some opinions from a couple overseas docs who have more extensive experience with ADR's before proceeding. You're talking 4-level fusion here. If for some reason the ADR surgery is botched, a cervical ADR is a doable revision to fusion.

Thanks bwink23
Yeah, sounds very strange. His colleague, an did a clinical study which identified lumbar ADR wear debris as a source of infection and inflammation. He's pretty conservative obviously. But what is interesting is that the ADR doc who was part of an ADR FDA trial said I was not really a candidate for the level on top of my fusion. But as I was finishing up the office visit he said he'd do two more fusions (making 4 in a row) and talk to his Disc doc colleagues to advise on my case for C-4/5. I said, let me see if I have this right, "I have a small chance to still get an ADR at that level and you would check with your disc doc colleagues for their input?" Right? Right. At least my original doc only wants to fuse one more level.

This is really the wild west for spine treatments. Are we getting clinically correct answers? Are they gaming us for business? Do they know? I like my original doc and based upon the current level of clinical evidence (never mind the FDA) at least he is giving me his honest opinion - I believe. I just know though that there are other opinions out there. But I also know I am a paycheck for a second opinion (one doc who has vast experience in ADR's wants between 250-650 just for the second opinion office visit) and for the surgery (we don't take insurance - so check your out of network benefits and call us back). I'm gonna call them back tomorrow when they are open and go from there.

Wow.
Thanks again bwink23 - fusion should be spelled f-USA-n here.

I'm interested to know why the doc would say you're not a candidate...could it be facet degeneration at that level ?? U.S docs are very strict about where they put ADR's. If your facets have moderate degeneration, they will not do it, as far as i know. Most U.S. docs will be very conservative with this "new" technology, and issues to cover it are abound. Are you tried Texas Back Institute ?? They seem to be the major players for ADR here in the States at the moment.

Get the recommedations of Dr. Pablo Clavel of Spain and Dr. Bierstadt of Germany before continuing further, even if you don't have the funds or ever plan on going overseas for surgery. Or some other names if you like. We are so far behind the times here, as the FDA puts it's vice grip on our capabilities to advance medicine in the States.

Check out Dr. Zigler or Dr. Guyer at Texas Back Institute as well and see what they say. Decisions, Decisions.

Thanks Bwink23
Yeah, I was able to get an appointment with a guy locally (Roush) who did a fellowship at Texas Back and I'm eager to see what he says and run these arguments against ADR in my case past him if he recommends ADR. I am also interested in what device he uses /prefers to use as well. So we'll see what he says in my case. He is a top 100 surgeon so with him and the other two guys I would think that is a pretty good attempt at due diligence. Will keep you in the loop. Thanks!

Dear Sgress,

I am also in the process of doing a lot of due diligence and what I found is that a lot of the doctors are willing to review your MRIs, X-Ray, etc via e-mail and at least say what if they would do ADR, fusion or Hybrid at no charge. I share my info through LifeImage and it has worked very well. I also know that time is of essence and since October I have contacted a tremendous amount of doctors all over.

Best,
Lucelia

Saw Roush from Lake Worth FL today at his Plantation office. Very nice guy - his PA said disc replacement with the pro disc (and said Roush has done thousands - probably exaggerated) but the doctor has the final answer. The doctor came in and said that in my case I could try a nerve block but it was probably not a solution. A fusion would be the best solution and a disc replacement was a distant option. He said don't get me wrong, I'm the biggest advocate for disc replacements. In your case the disc is compressed, there is a lot of arthritis and the disc would solve one problem but the facet joints would still rub and cause neck pain (seemed to be what Theofilos was saying too). He intimated that it would probably also be prone to wear and tear and probably eventually need fusion in 2-5 years because of its proximity to the fusion. Said I've done this before in rare cases and they need to resurgery. He also said that C-3/4 rarely blows out, has more height and this would be the last surgery you would probably ever have. (Sounded encouraging). So in the end I think I have my answer - two ADR guys said I'm not a candidate for ADR and my own surgeon said the same thing. I don't need to keep searching. Scheduled for the 16th of Jan for fusion with my original doc whom I really like and trust.

Take away? Wish I knew about ADR a year ago!!!
If you need an ADR surgeon in the USA - Roush is the guy. But he doesn't seem to take insurance and out of network is the only way he rolls as far as I know. Really liked this guy, appreciated his candor, his patience in explaining things to me. Lots of confidence and eager to keep up with the times and do what can be done to keep your movement. Unfortunately not for me.

sgress,

Congratulations, as you've done more research than most spine patients will ever do. Good luck on the 16th. I hope you'll keep us posted.

Good luck, Jeff

21 days post op
 

Just a quick update. Fusion of C-4/5 on January 16 above my two prior fusions. The doc used the LDR-ROI-C cervical cage LDR Spine > Products > Cervical
Lot's more swelling in my neck and throat than the last time. But now 21 days post op, wearing a cervical collar and trying to walk and keep productive. Both my surgeon and one of my other opinion docs (Roush) said my range of motion may in fact be better one year post op. The rationale is that the muscles will relax and not impede motion once the nerve is decompressed etc. Neurological monitoring equipment showed normal nerve activity after the surgery as well.
I am just trying to stay positive that the next adjacent disc will be fine long term. Same two docs said I had a better than (statistical average of 1 in 5) chance it would be fine. Roush even said it would probably be my last surgery.
Best to all of you in the ADR support community.