Update: ADR post Foraminotomy, Dr. Regan?, PLL?, M6 vs Pro Disc?
 

I originally met with Dr. Etminan back in March for a disc herniation at c6-c7 causing weakness numbness and tingling in my right arm. I had a posterior approach foraminotomy which was successful in ridding me of my rt arm symptoms but not the back pain. I have since asked Dr. Etminan why he did not suggest ADR at the time, he stated because ADR is only good for healthy discs with an acute rupture (what he calls a soft disc) not discs that have degenerated - it seems he needs to read up on his literature because that opinion is his alone. None of the ADR surgeons, nor the clinical trails done, nor the medical literature agree with his opinion. In fact the overall majority of ADR's performed are performed on those with DDD.

I have now met with several surgeons Dr. Zigler @ TBI, Dr. Bitan, Dr. Lauryssen, and Dr. Regan - They all had some what different points of view but none said that my posterior foraminotomy is a contarindication for ADR and all stated I am a very good candidate for ADR.
As for my impressions of the surgeons (take with a grain of salt - only met once and only one man's opinion - I am in the medical field which possibly means something).

I was most impressed with Dr. Regan - anyone else have experience with him?

Dr. Bitan suggested a fusion at C6-C7 not because I'm not a candidate for ADR but rather because he rarely places ADR in C6-C7 due to technical difficulty. He said he only places ADR in C6-C7 when someone has a very long neck for greater accessibility - none of the other surgeons seem to find any problem with placing ADR's at that level - nor does the medical literature seem to have a problem. He also stated that C6-C7 disc has little to do with Neck ROM and therefore fusion is almost the same as my current state.

Dr. Zigler is a very nice man - He suggested I do a discogram first in order to determine if surgery will be affective and if fusion may be a better option - none of the other surgeons suggested this or think that was needed.

Dr. Lauryssen seems to be a very capable surgeon - although seem to be very eager to operate. He also stated he would like to retain the PLL (posterior longitudinal ligament) and if not recommended possible fusion at C5-C6 - Does anyone have any opinion on retaining vs cutting the PLL? It seems most surgeons remove the PLL, otherwise very difficult to smooth out the vertebral bodies for proper placement of ADR and also retained osteophyte may lead to greater inflammation.

Another very important question I had for the surgeons was what is the risk of doing nothing - How will that effect my chances to have an ADR at a later date? and if by not having the ADR how is that effecting my other healthy discs. In short all said somewhat different things - the consensus seems to be If I do wait to long placing an ADR may be difficult. As for causing DDD in other discs - some surgeons felt my adjacent discs were already starting to show very early signs of disease others felt they looked healthy and the current DDD is not effecting the healthy discs.

I have not explored the European option yet, I will, mainly because of the M6 disc, Dr Lauryssen is a big fan - and also read some of the other favorable posts on M6. Does anyone have negative opinions on Prodisc? I understand M6 probably has the best biomechanics of all the discs however from my understanding how this translates clinically is still undetermined?

In addition it seems my insurance will cover one disk replacement which will reduce a large portion of the cost :).

Hey Tman, thx for the introduction. I've been traveling for a few weeks, sorry for the delay. Perhaps others will chime in offer questions & comments.

In the meantime, all of the docs you mentioned are docs that patients have visited for consults or surgeries, so pls do use the search function to find these topics...which works well.

And to touch on one of your points:

"...Another very important question I had for the surgeons was what is the risk of doing nothing - How will that effect my chances to have an ADR at a later date? "

It really depends on the etiology of your undiagnosed disease. What is the rate of your DDD in accordance to your:

- imaging studies, as read by the radiologist between your imaging studies (XRay, MRI, Discogram);
- progression of symptoms (pain);
- degradation of quality of life;
- immunological health;
- mechanical stresses and joint chemistry, that could lead to autofusion;
- attitude regarding "just-fix-me-itis."

Perhaps we can talk next week. I really hope we can help.

Many others here are in your shoes too, so feel free to communicate with them by email, PM or phone. Use all your resources here to support your difficult decisions.

tman,

Welcome! I have a couple of cervical fusions and a couple more M6's, so I can address a few of your questions.

I have seen people that suffered with disc problems for many years without undergoing surgery. Sometimes there's no problem (other than years of pain), sometimes the vertebrae autofuse, and sometimes permanent loss of sensory and/or motor occurs. In hopes of avoiding those issues many people elect to have surgery sooner than later. I don't believe there's a one size fits all answer.

I didn't know that retaining the PLL was possible after the disc was removed. Because stenosis is sometimes caused by hypertrophy of that ligament, I'd want to query the surgeon asking if manipulating during fusion/adr surgery and then retaining it increases the probability of that problem in the future. I don't know the answer, but it sounds like a reasonable question.

I have two M6's, courtesy of Dr Pablo Clavel in Barcelona, Spain. I am nearing the first anniversary of their implantation. I have no physical limitations and can't say enough for my M6's (C3/4 and C6/7).

Good luck!

Jeff

tman,

I am a HUGE fan of Dr. Lauryssen ( So are Paula Abdul and many others). Please read my post here: http://www.adrsupport.org/forums/f51...uryssen-10813/ . Just had a Prodisc C at C 5-6 and a fusion at C 6-7 (I am positive I could have found someone to put in an ADR at C6-7, but it would the wrong move). I am also a RN and have spent 28 years of my life working with physicians and around hospitals the world over. I can tell you categorically Dr. Lauryssen is a class act with rare knowledge and judgment. I trust him implicitly and he has my utmost respect and admiration. Bob

Hey tman -

I met with Dr. Lauryssen after the Chair of Orthopedics at our local University of California medical school and others strongly recommended him. I also appreciated his input and experience from having led the U.S. clinical trial of M6 and having worked with many other discs so he was definitely instrumental in helping me make my decision.

I hope you're making progress - if I can help in any way don't hesitate to ask!

Best,
Tyler

Tman,

Like Tyler , I am having 2 m6's maybe 3 with Dr. Boeree Next Wed. cervicle. There is a possibility of a fusion at 6-7 and adr the 2 above. The problem I have with that is, is it not important to keep the adr's moving post-op but how can you when you have to let the fusion harden? He will be answering all my questions and I will trust that he will make the best decision for me. He said he has done 3 but they are more rare. Take care and I will be posting after I get back to Milwaukee on Thanksgiving Day. Have a good one and "go Packers ."

Hey wgnmn - how did it go? Hope all's well!