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  #21  
Old 10-07-2010, 03:25 PM
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scotto74 scotto74 is offline
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Hey everyone,

Just thought I would attach a quick snapshot from my last MRI in May. I am still contemplating what to do -- but am leaning toward the hybrid surgery (fusion at 6-7 and ProDisc at 5-6) with Dr. Bitan. My insurance company (CIGNA) has denied the ADR portion of the surgery, so I will likely be paying out of pocket and then trying to pursue reimbursement through the appeal process (ugh).

While I have some concerns about the ProDisc, I think it's probably a better choice than a two-level fusion given the deterioration of the discs above. I'm also not really sure about going overseas for a different device (like the M6) given the complexity of my neck and the likely need for additional surgeries in the future.

While the thought of potentially needing additional surgeries in the future is a little unsettling, most of the surgeons I've talked to are in agreement that 5-6 and 6-7 need to be decompressed relatively soon. So at some point I need to make a decision and get going I guess!

Thanks again for all the support, and I hope everyone is doing well.

Scott
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File Type: jpg sag t2 fs.0001.jpg (63.1 KB, 43 views)
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Diagnosed 6 years ago (at age 30) with multi-level DDD of the C-spine
Have had numerous epidurals, nerve root injections, PT, etc.
Now have severe stenosis and cord compression at C5-6 and C6-7 -- also have herniations and some stenosis at two levels above
Cord compression is starting to affect my legs and movement, nerve pain has increased
Need to find a surgeon soon, hopefully not a two-level fusion
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  #22  
Old 01-08-2011, 10:36 PM
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scotto74 scotto74 is offline
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Hey everyone,

It's been awhile since I last posted, so I just wanted to provide a quick update as I'm still agonizing over my final surgical decision (my hair is literally falling out as a result of all this stress LOL)... sometimes, just posting on here helps get some of the weight off of my shoulders and I always genuinely appreciate everyone's feedback and thoughts.

So I met with Dr. Yue up at Yale a number of weeks ago. Really nice guy, and I thoroughly enjoyed talking to him. Biggest take-aways were that he urged me to get a CT Myelogram before surgery (which I did right before the holidays), and he also is a pretty big fan of the Spinal Kinetics M-6 disc. He said something to the extent that if he could implant one device in all of his patients today, that would be it. He also confirmed that I've lost all reflexes in my left arm at this point. I followed up with him after I got the CT, and he recommended facet blocks at 2/3 (left) and C7 / T1 (right) before I got a two-level fusion or ADR. At this point, I think I need to move forward with surgery to alleviate the cord compression although I appreciate his conservative approach.

I also followed up with Dr. Bitan and Nick Boeree after the CT scan. Both are sticking to their original recommendations... a hybrid with Bitan (which he thinks is slightly preferable to a two level fusion), or a two-level ADR (M6) with Nick Boeree. Dr. Bitan said my facets appear to be in pretty good shape, and Nick Boeree said he didn't see anything in my CT that would be a contraindication for the two-level ADR. Nick also feels strongly that a two-level ADR is the best course of action for me.

My biggest concern, however, is that I was finally able to get TBI to review my CT Myelogram (which they suggested a while ago) and give me some feedback. I believe it was Dr. Zigler and Dr. Blumenthal who reviewed them. While I did not speak to the doctors directly, the feedback was that they did not think that I was a good candidate for ADR given (1) the severity of the stenosis, and (2) the amount of osteophytes or bone-spurring going on in my neck. In summary, they felt my neck was "too unstable" for ADR.

While I trust both Nick Boeree and Dr. Bitan when they say that I am a good candidate for ADR, I have a hard time getting past the feedback from TBI. I read something recently on one of these forums where someone who had a two-level M6 surgery is likely going to need to have them removed and fused as a result of osteophytes forming at those levels. If I already have some osteophytes, my concern is that I could be in this very same boat. However, on the other side of the coin, I worry that if I fuse these two levels now (5/6 and 6/7) I may end up with my whole neck fused at some point (which is keeping me awake at night)

Anyway, I'm sorry for the long post... but I'm just trying to sort through all of this info in my head As much as I really would prefer to have a two-level ADR with the M6, I think I am leaning toward a two-level fusion because I just worry that I might not be an ideal candidate given the amount of degeneration.

I'm curious... of those of you who have had cervical ADR's -- did you have any osteophyte formation prior to the surgery??

I also attached a recent X ray snapshot where you may be able to see what I'm talking about...

Thanks in advance for the feedback, and sorry I've been MIA for so long. Hope everyone had a great holiday and is doing well!!

Scott
Attached Images
File Type: jpg cervical x ray.jpg (92.9 KB, 38 views)
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Diagnosed 6 years ago (at age 30) with multi-level DDD of the C-spine
Have had numerous epidurals, nerve root injections, PT, etc.
Now have severe stenosis and cord compression at C5-6 and C6-7 -- also have herniations and some stenosis at two levels above
Cord compression is starting to affect my legs and movement, nerve pain has increased
Need to find a surgeon soon, hopefully not a two-level fusion
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  #23  
Old 01-09-2011, 12:32 AM
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jss jss is offline
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Scotto,

For my untrained eye the loss of disc height seems apparent at C6/7, but I'm don't know enough to see the osteophytes at C6/7 and C5/6.

I had a "very large" osteophyte on the right side of my uncinate process of C4 that had the spinal cord compressed over to the left side of the spinal canal. It looked really wicked on the MRI. It was removed before the placement of the ADR.

That was 13 months ago. Today I have no symptoms, but I haven't had a follow-up either. If it's grown back it is currently asymptomatic.

Good luck on making a decision.

Jeff
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #24  
Old 01-09-2011, 02:34 PM
Jarrod Jarrod is offline
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Scotto,

Just my two cents.... I had a three level ADR in Barcelona Spain with Dr. Clavel. He iplanted 3 m6 cervical discs at c5/6,c6/7,c7/t1 and I am 32 days post op and feel pretty darn good. Symptoms such as numbness, tingling and needles feeling is fading week by week, and I think over the course of another 4 months I willl be in pretty ggod shape. I had osteophytes at alll three levels that had to be removed also. It seems that bone spur formation is common in a normal aging spine and that surgeons will encounter this quite often, which leads me to believe that it is only a small percentage of patients who have this reoccurance after surgery. My surgeon had me take 600 mg of ibuprofen 3 times daily for the firest 6 weeks after surgery, this helps slow bone growth formation after surgery. I hope this info helps, also Jeff basically has a a hybrid configuration in his neck and seems to be doing great, he also had Dr. Clavel and the m6 disc.

Jarrod
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  #25  
Old 01-09-2011, 09:49 PM
CP7959 CP7959 is offline
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Scott,

I had (2) M6's almost 2 years ago. Before I had the surgery several Dr.'s told me that one of my levels would fuse (C6/C7) regardless. I didn't listen had the M6's. I had to have revision due to Stenum not removing osteophytes. Anyway when my surgeon did the C6/C7 revision, he did tell me the M6 was starting to have bone overgrowth and was fusing. I am not saying this will happen to you or anyone else, but it did to me. And I was informed this would happen.I was taken Ibuprofen, but that didn't slow things down.

I currently have (2)ADR (C3/C4, C5/C6) and (2) Fusion (C5/C6, C6/C7). I don't notice any range of motion issues. If I had to do it all over again, I would have fused 2 or 3 levels from the onset and top it off with an ADR. I say this based on my experience and my C3/C4 level was perfect from an osteophyte perspective, which made that level a good candidate.

Of course everyone is different. Good luck with your decision.
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CP

Fusion C6/C7 - 2/2002
Foramenotomy 1/2004 - C5/C6 right side
Stenum M6 - 4/2009 - C4/C5, C5/C6
US Prestige ST - 12/2009 - C3/C4
Revision to Fusion 4/2009 - C5/C6 M6
Auto fuse of M6 at C4/C5 - determined after Xray on 3/2011.
Current - Fused at 3 levels C4/5/6/7, ADR C3/C4
Lumbar L5/S1 Annular tear - pain started 8/2009. MRI Hiz on 3/2011
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  #26  
Old 01-10-2011, 12:23 PM
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Harrison Harrison is offline
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Scott, I am no expert by any means; but based on your explanations -- a hybrid or fusion sounds like the safer route.

The reasons for spurring are complicated, but can involved any combination of these factors:

- previous trauma;
- repetitive stresses;
- poor diet or health;
- autoimmune disease(s);
- localized disease in the spine (which is really what degenerative disc disease is!).

So, my question is perhaps more specific: what is the rate of changes that have been documented in your spine in the last few years? Is the spurring localized? What about the rate of change? Could this process continue AFTER disc replacement? If so, fusion is safer...

Spurring is said to be a biomechanical compensatory mechanism, but I can't untangle that from the mess of other variables or symptoms.

Dunno if this helps or hinders the process...
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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
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  #27  
Old 01-10-2011, 07:43 PM
Jarrod Jarrod is offline
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Harrison,

I have follow up x rays due at 3 months which would be march for me. How long does it take for heterotrophic ossification ( hope that's right) to start showing on X-rays, and if someone dosent show signs of it after a certain amount of time can they assume they won't get it.

Jarrod
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  #28  
Old 01-16-2011, 08:57 PM
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DAnn DAnn is offline
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Scott,
I'm so sorry you are so young and are in this situation.
I'm new to all this, but all the dr names all look good to me given my research.
I am sorry that you did not have luck with the doctors at TX Back. I wonder if there was some contraindication for ADR? You should definitely ask.
Harrison posted the contraindications for ADR in a post on this site. You can also just search ADR and find them. My worry is your diagnosis of stenosis. I believe that is one.

Good luck, and keep us posted.
D'Ann
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DAnn
DDD/Cervical Stenosis
September 2010 MRI showed:
C6-7 disc moderately to markedly narrowed, mild retrolisthesis of c6 on c7 producing effacement of the thecal sac but no cord impingement, mild narrowing of left neural foramen;
c5-6 disc moderately narrowed, anterior and posterior disc bulge with mild anterior cord impingement;
c4-5 disc intact and normal height, potential posterior annular fissure.
Cervical hybrid surgery in Texas April 12, 2011, fusion at C6/7, Prodisc C at C5/6
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