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New Member Introductions If you just joined, please introduce yourself here. Please add a signature describing your spinal history (use the "User CP) and ask us how we can help you get started. |
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#1
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Hi Everyone!
Thank you for sharing your information. This forum has been very helpful as I am navigating the Lumber ADR process. I’ve outlined my information in the signature. I am currently experiencing back and leg pain. Cortisone shot helped a little so I am able to control the pain with diclofenac and gabapentin. Not able to do most things I like to do so I need to find some type of solution. I have had 3 different opinions and am waiting on 1-2 more. I’m more confused than ever in terms of direction. I am leaning towards Dr. Blumenthal's approach but would love to hear any feedback from those that got the muli level disk replacement vs ALIF/ADR. 1. Illerhaus (ONZ/Spineconnection) - Recommended 3 disks (L3-S1) with either prodisk or ESP. Some of the recent bad results have me a little worried about this place. It is also the most aggressive approach. I do like the idea of getting it all done so I don’t have the possibility of needing more ADR surgeries in the future. 2. Paul Schwaegler (Seattle Spine Institute) - Recommends another microdiscectomy with mesh insert and remove disk protrusion that is affecting my L5 nerve and causing leg/foot pain. Does not think he can get the piece from the anterior approach and thinks I should wait on any more aggressive approaches. Don’t know if I am up for another microdiscectomy. 3. Blumenthal (TBI) - Flew to Texas for an evaluation. Recommends ADR L4/L5 and ALIF L5/S1 due to minor instability (Grade 1 anterolisthesis). He doesn't think I have a disk protrusion. But said if I do have a protrusion he can get it from the front. He didn't think I needed disk replacement at L3/L4 because it isn’t giving me symptoms and looks like normal wear and tear. I would hate to do the surgery and then need another one in a few years though. Bertagnoli - Sent all of the information to the liaison but have not heard back. Clavel - Submitted the online form but have not heard back. Current (January 2023) MRI Notes: L3-L4: Mild disc height loss with disc desiccation. Mild diffuse disc bulge without significant spinal canal stenosis. Mild bilateral neural foraminal stenoses. L4-L5: Mild disc height loss as well as disc desiccation. Compared to 1/11/2023 exam, there is marked decrease in size of right subarticular zone disc extrusion. There appears to be a 6 mm focus of extruded disc, possibly sequestered, in the right subarticular zone (7/14, 4/67) with impingement of the traversing right L5 nerve root, as well as similar mild diffuse disc bulge with mild central and right extraforaminal disc protrusion. Mild bilateral neural foraminal stenoses. L5-S1: Moderate disc loss as well as disc desiccation. Mild diffuse disc bulge without significant spinal stenosis. Mild bilateral neural foraminal stenosis. Any recomendations on other directions to look at is much aprecated. Thanks, Carl
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________________ Born 1975 (Currently 48) 5'11'' 160lbs Microdiscectomy l4/5 Left Side 2007 Microdiscectomy l4/5 Right Side Jan 2022 Reherniation l4/l5 RightSide Oct 2022 Chronic back problems with multiple episodes per year of back pain since 2007 MRI show significant DDD L3-S1 4/20/23 - Hybrid 4/5 Active-l 5/1 ALIF |
#2
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Carl, thanks for posting. Any updates? How is your pain management going?
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"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate |
#3
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Hi Harrison! Thanks for the reply. The cortisone shot seemed to calm the nerve down enough to function without opioids. I hate taking those meds so I'm very glad for that. I have constant pain in my back and down my right leg that seems to get worse in the evenings and mornings (putting socks is definitely rough) but can manage with gabapentin and diclofenac.
It is strange how some days are better than others. I am fearful of overdoing it because it seems to ramp the pain up the next day. I hope to have a decision made soon. Tim from Dr Bertagnoli got back to me and said most likely he will recommend a 3 level. Thanks for this website. It is a great source of information! Carl
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________________ Born 1975 (Currently 48) 5'11'' 160lbs Microdiscectomy l4/5 Left Side 2007 Microdiscectomy l4/5 Right Side Jan 2022 Reherniation l4/l5 RightSide Oct 2022 Chronic back problems with multiple episodes per year of back pain since 2007 MRI show significant DDD L3-S1 4/20/23 - Hybrid 4/5 Active-l 5/1 ALIF |
#4
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Carl, have you already cycled through various NSAIDs for pain management? Also, can you elaborate on causes of the condition of your lower spine?
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"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate |
#5
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Dr Bertagnoli is recommending a 3 level. The disk preference was not mentioned so I have asked. I am starting to lean this way because it will be a longer term solution than leaving one marginal disk in place.
Dr. Clavel’s opinion was to replace L4/L5 but did not indicate any action on the other disks. I have followed up with them to see if that means he doesn't think they should be worked on or if he was only looking at the disk that is causing me pain right now. I have cycled through all the over the counter medicine (advil, tylenol). They world ok but my Dr. thought diclofenac would be better and not as harmful to my stomach. Right now the pain is manageable without meds. I have opted for another epidural to see if I can get through the summer. I am still very limited in what I can do and nowhere near as active as usual so I will most likely need to pick a long term solution and move forward. My DDD is most likely the result of a highly active life (School sports, 40 years skiing, 30 years weights and golf) and a genetic disposition. My mother has had two microdiscectomies and father has been plagued with back problems for 30 years. Many of those years he has not been able to do much at all and it really limited a lot in his life. I don’t want to go down that path of just being fearful that anything I do will set my back off and put me in crippling pain.
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________________ Born 1975 (Currently 48) 5'11'' 160lbs Microdiscectomy l4/5 Left Side 2007 Microdiscectomy l4/5 Right Side Jan 2022 Reherniation l4/l5 RightSide Oct 2022 Chronic back problems with multiple episodes per year of back pain since 2007 MRI show significant DDD L3-S1 4/20/23 - Hybrid 4/5 Active-l 5/1 ALIF |
#6
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Sounds like you are getting close to a plan. But please don't forget that surgery will not make you new or young again. My 3 level made my arm and hand better than before surgery, but worse in other ways. It developed HO and will likely have to be dealt with when I am done dealing with other medical issues of a 67 year old! I think I recall a PCP once telling me that diclofenac might be easier on stomach, but could cause heart issues longer term. I never researched the issue Good luck.
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Pre Surgery: C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis. C4-C5:Midline central disc protrusion, significant. Mild canal stenosis. C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis. C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis. June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona |
#7
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PhillyJoe
Thanks for the reply. I haven't done any research on diclofenac so can't speak the heart issues. I don't like taking any of the medicine so have pretty much stopped taking it. Obvioulsy I don't think any of this stuff is good long term and is another reason to support seriously considering surgery. I don't expect to be young again but living in chronic pain, giving up most of what you enjoy and waiting for the next bad episode seems to outweigh the risks at this point. Meeting with Dr. Clavel here shortly so we will see what he has to say. Thanks
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________________ Born 1975 (Currently 48) 5'11'' 160lbs Microdiscectomy l4/5 Left Side 2007 Microdiscectomy l4/5 Right Side Jan 2022 Reherniation l4/l5 RightSide Oct 2022 Chronic back problems with multiple episodes per year of back pain since 2007 MRI show significant DDD L3-S1 4/20/23 - Hybrid 4/5 Active-l 5/1 ALIF |
#8
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I am very curious to see what ADR he now uses at lumbar. Doubt it is M6. He was honest with me after my cervical, that due to spondy, he wouldn't do any ADR at L4-S1. I took it to heart, since he is an optimistic guy, maybe overly optimistic, so if he said no, then it is a no for me. Good luck.
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Pre Surgery: C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis. C4-C5:Midline central disc protrusion, significant. Mild canal stenosis. C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis. C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis. June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona |
#9
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Dr. Clavel at first recommended ADR at L4/L5 and no other treatments. After talking with him more about L5/S1 he came back with a recommended hybrid with ALIF at L5/S1. This was based on some inflammation he could see in the bone and lower back pain. Same as Dr. Blumenthal at TBI.
Dr. Clavel also said he would definitely not do L3/L4 like the German docs. He said he sees higher complication rates and if it is not causing pain not to deal with it. Blumenthal had the same opinion. Getting another epidural this week so hopefully that will buy some time. The primary pain I feel is a piece of disk material affecting my L5 nerve. Back is doing ok so maybe my body can deal with the piece of disk material.
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________________ Born 1975 (Currently 48) 5'11'' 160lbs Microdiscectomy l4/5 Left Side 2007 Microdiscectomy l4/5 Right Side Jan 2022 Reherniation l4/l5 RightSide Oct 2022 Chronic back problems with multiple episodes per year of back pain since 2007 MRI show significant DDD L3-S1 4/20/23 - Hybrid 4/5 Active-l 5/1 ALIF |
#10
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Hello carls ,Do you feel as confident with the drs at TBI as you do with Dr Clavel ? Dr Zigler is another spine doc at TBI maybe get his opinion as well . It would be nice to have surgery in the states if possible uh? Dr Bertagnoli has been a star on this forum for years probably has the most experience etc. You mentioned you will be meeting with Dr Clavel , are you going to have a sit down meeting with him or an internet meeting , Zoom call ? Take care and Good luck !
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