[JinSong]

Hi there! I'm excited to have found this forum. I suppose this is probably the spot to put my long-winded intro. I've had chronic neck/shoulder issues since a significant roll-over car accident in 2011--did plenty of PT, etc, no real help there. Spring 2015 I started having severe muscle spasms, and by May 2015, I got that horrible tell-tale pain down in my right forearm, along with numbness/tingling in my thumb, index, and part of my middle finger.

After months and months of running around between orthopedic doctors and physical therapists, I finally forced the medical director to authorize an MRI, and low and behold! Disc problems. Here's my MRI summary, in case anyone's curious:

C4-5: Mild posterior osseous ridging which is eccentric to the left. Mild left-sided canal narrowing. No cord compression. Neural foramina patent.

C5-6: Disc-osteophyte complex with element of left paracentral disc protrusion. Moderate canal stenosis. Mild left ventral cord contouring without cord compression or cord edema. No significant foraminal stenosis.

C6-7: Shallow central disc protrusion without significant canal stenosis or cord compression. Neural foramina patent.

I got referred to a pain specialist, and after months of waiting, got in to see a neurosurgeon as well. The pain specialist I saw first wanted to try some cortisone injections in C6-7, just based on reading the MRI report. I was going to do that, but I lucked out and got in to see a neurosurgeon early before that appointment. The Neurosurgeon looked at my actual MRI films, and thinks my issues are mostly from the C5-6 level, and said that he thinks I should have an ADR surgery to fix that issue. Especially because of the bone spur at that level, he said there’s little chance that disc will ever stop being a problem on its own, and I’m young (32 year old female). Seemed reasonable to me, since I’ve been ready to just cut my own arm off.

He also said that a disc replacement would decrease the chance of speeding degeneration at other levels, so long as insurance will pay for it. I am still a little concerned that the disc below it, C6-7 is already bulging—he obviously didn’t think it should be dealt with surgically yet, but I’m still worried about it, since the pain specialist actually thought that disc was the problem. That’s making me nervous.

After having my pain disregarded for so many months, I was taken by surprise when the neurosurgeon suggested ADR, and I knew absolutely nothing about that surgery. I was unprepared to ask questions. I called back later and asked what type of disc they were going to use, and the staff told me it would be a Prodisc-C. I wanted to ask more questions directly, but unfortunately they would not let me speak to the surgeon over the phone. I scheduled an appointment to speak with him in person, but they're so booked up, that appointment is only three days before the surgery itself!

In the meantime, I'm concerned about the type of disc he's using. As I understand it, the Mobi-C is the only disc that's approved for use at two levels. My concern is that although it's not surgical now, I already have a disc that's herniating beneath the one that they're replacing. I'm concerned that in the future I'll need that one done as well, so I'm worried about having that older Prodisc in there.

I work in academia, and I spend a bunch of time combing through journal articles--so naturally I spent some time reading through the literature on various types of ADR models. The issue seems to be that most of the studies are comparing different types to traditional ACDF surgeries, not to each other, so there's not a lot of robust research to really say oh, well, Mobi-c is definitely better than the Prodisc-c etc. I found a few that compared them, but they were in a lab setting, not actually in human bodies. This is probably too much for one post, but here were some of the things I dug up:

Overall, across several studies I found, the Prodisc has good results over a 5-7 year period, with little risk of implant failures so long as it was placed properly. It may have a slightly higher risk of heterotrophic ossification, but most of the implants seem to have that same problem, and it's not totally clear if the Prodisc's design has anything to do with that higher risk. Furthermore, heterotrophic ossification didn't seem to cause adverse patient outcomes anyway--it's like the devices just slowly convert into a fused disc, as I understand it, and fusion in general also has high success rates.

In lab tests, it appears that the Prodisc does a better job of protecting against extreme forces/excess movement, because it has a more constrained design than the Mobi-C. However, the polyurethane core wears down and starts shedding plastic particles more quickly than the Mobic-C (not proven in a body, just in a lab setting).

The only thing I found about the Prodisc that was worrisome is that there is a potential risk of a vertebral body fracture, due to the way they cut the bone to insert the big keels. But, this risk should be mitigated by them implanting it correctly, and not putting it in people who are not good candidates (small vertebrae, significant osteoporosis, etc). This risk does increase if you have a fusion OR another Prodisc implanted in an adjacent vertebrae. Interestingly, there are studies of Prodiscs being used at multiple levels, so it IS a possibility (although not FDA approved). It just carries that added risk. And that added risk concerns me. It was unclear about if they could put a different type of disc in the second level, and what the consequences of that might be.

Sorry about that long, long introduction, but basically I'm hoping for some other perspectives on my issue, and about the Prodisc-C itself as a device. There's only one surgeon in my area that does the Mobi-C that's on my insurance, and for practical reasons, waiting until summer to sort out another long chain of referrals is going to be difficult for me. As it stands, I'm scheduled for the ADR with the Prodisc on February 29th, and that's the most trouble-free option, but I don't want to make a mistake letting someone put this thing in me!

Is there another forum I should put a more condensed issue of my question in? Thanks for your help!