ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > New Member Introductions

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.


Reply
 
Thread Tools
  #11  
Old 11-28-2011, 04:05 AM
Harrison's Avatar
Harrison Harrison is offline
Administrator
 
Join Date: Oct 2004
Posts: 6,983
Exclamation In case you missed this important topic...

http://www.adrsupport.org/forums/f51...ications-9620/

__________________
"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
Reply With Quote
  #12  
Old 11-28-2011, 04:37 PM
Slackwater Slackwater is offline
Senior Member
 
Join Date: Aug 2007
Posts: 782
Default

Quote:
Originally Posted by Benjaminrbecker View Post
Gents,

Dr B gave me a quote of EUR 32.

also Dr Pimenta in Brazil, Clavel, Zeegers and Boeree.
It is very difficult to know how to proceed from here. (~Agree)

Z has provided by far the most comprehensive review and diagnosis of my condition (at a cost of EUR500; Boeree also charges, GBP250). The one sticking point I have with Z is that he recommends Active L, which is not second generation (not shock absorbing). He suggests Active L because he says that it is custom made for each recipient, whereas all others are not.
Best wishes for your side.

reference Activ-L documents, LINK

The biomechanics of lumbar levels varies slightly between L4-L5 and L5-S1. There is more compressive shear at L5-S1 because of vertebral angles, in general, and this can be erased by individual biologic variability of vert.angles and facets (angles) add another variable x person within ranges.

Look at the BBraun site / docs and you will note there is a specific mention of L5-S1. I

The Activ-L S1 plate is an additional option for the surgeon to address patient`s anatomy.

There are patients who have a sacrum with a rather round or egg shaped cross-sectional footprint.

For those patients the S1 plate has rounded posterior edges and can therefore be placed close to the posterior rim of the S1 vertebra without these edges protruding into the spinal canal.

This might enable the surgeon to use a larger size compared to the standard plate, which reduces the risk of subsidence and nerve root
irritation.

The S1 plate is just an option, there are of course cases, where the standard plate will fit better. X-ray templates are available which can be used for preoperative planning in order to define the appropriate plate type.

Anterior or oblique insertions are possible with a minimum disc height of 8.5mm.


Fixation: activ-L can have a keel like ProDisc or spikes. There are biomechanical tests showing better long term stress results, less chance of hiccups with spike-only. It is only lab testing, not in-vivo.
Reply With Quote
  #13  
Old 11-28-2011, 08:15 PM
Dingie Dingie is offline
Senior Member
 
Join Date: Oct 2011
Posts: 146
Default

Hi,

I am in a similar position, I believe I may be looking at a 2 level l3-l 5. I am having my discogram on 12/1/11, hopefully will know more. I have pretty much decided on Dr. Clavel assuming he wants my case

It is a long arduous and scary decision making process, I have found this site to be extremely helpful. Good luck with your decision process. In the end we all make what seems best for us

Dingie
__________________
50 y.o.
WW athlete- triathlete, runner, tennis
2008-0nset of pain..MRI-DDD L4-L5 annular tear. Pain labeled discogenic with radiation to unilateral hip, no radiculopathy
2009-facet inj, radiograph ablation, SI joint injections, cryoablation stubborn no relief
2010-retired d/t pain. more injections
2011-IDET of L3-L5. Pain unchanged, up 50 lbs!
2011-Lumbar ADR recommended by Ortho and 2 neuros. In appeals w/ins. May choose Europe for M6
Need to lose lbs
Reply With Quote
  #14  
Old 11-29-2011, 01:57 AM
christinlal christinlal is offline
Senior Member
 
Join Date: Nov 2010
Posts: 103
Default Hi Ben,

I have just had a 2nd adr surgery with Mr. Boeree, and thank God every single day. I have alot of issues with a ProDisc C but I do not know if the the lumbar ones are problematic.
I would absolutely recommend Mr. Boeree, it was the best decision I have made in my life, and I spoke with Drs B, Zeegers, both analyzed my case, dr zigler in tbi, the fda limits the adr to only prodisc, and I would NOT want to chance having another one in my spine.
I wish you safety, and a pain-free future.
Christine
__________________
12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
Reply With Quote
  #15  
Old 11-30-2011, 09:03 PM
Slackwater Slackwater is offline
Senior Member
 
Join Date: Aug 2007
Posts: 782
Default

Quote:
Originally Posted by Slackwater View Post
reference Activ-L documents, LINK

DEL.TEXT noted -> minimum disc height of 8.5mm.
An interruption made me post before finishing the draft response above.

The minimum disc height ~may be of interest depending on a patient's MRI translation into a metric measurement. There is talk of over distraction pain that I acknowledge. Maybe the posterior longitudinal ligamet is innervated. The facet joints need to line up is a major factor.

The footprint Anterior-Posterior (AP) and Lateral is ~important so the ADR / TDR sits on cortical bone, not the cancellous (or trabecular, soft porous interior) bone.

Small or incorrectly sized implants will lead to subsidence, sinking into the vertebrae. Subsidence will mean the facet joints will not line up correctly. Subsidence will be a reason for re-operation and defaulting to Fusion.

Subsidence was listed as a significant factor in the early ADR / TDR operations. "Complications of Artificial Disc Replacement: A Report of 27 Patients with the SB Charite´ Disc" van Ooij et al, 2003 Journal of Spinal Disorders & Techniques, Vol. 16, No. 4, pp. 369–383.
"subsidence of the prosthesis in 16" © 2003 Lippincott Williams & Wilkins, Inc., Philadelphi
A personalized disc replacement is a good concept. Biologic variabillity is normal. Subsidence does not appear to be a major ADR / TDR issue today because of surgical training or awareness created with the earlier patients where the literature comments by surgeons mentioned "size mis-match".

The latest Canadian study published 2010 (?) Link mentioned subsidence: average 1.7 mm (range 0-4.8 mm). Full text of the Canadian study is available (LINK). Figure 1 showing subsidence and radiographic disc size illustrates a ~possible footprint mismatch to my "untrained eye". The device sizes may be limited and that was the best match.
Subsidence was present in 44 of 53 (83%) patients at the L5–S1 level and was exclusively seen at the posterior part of the inferior end plate of L5. The mean subsidence was 1.7 (range 0– 4.8) mm, meas ured at 3 months after surgery. Although there was a marginal progression of subsidence beyond this time point, it was not statistically significant. Subsidence had no effect on the range of motion at the replaced segment and did not correlate with clinical outcome. In patients who underwent an L4–5 TDA, subsidence occurred at both end plates: mean subsidence was 0.9 mm at the inferior end plate of L4 and 1.75 mm at the superior end plate of L5.
The Chinese study Oct 2010, Zhonghua Yi Xue Za Zhi LINK, on 1 and 2 level Charite' for up to 60 months listed "no subsidence".

activ-L
"Clinical results show, that in approx 47.5 % the application of a small height (less then 9 mm) is indicated." (The activL quote is directly from the BBraun literature / pdf, this requires a look-up on pubmed for clinical reference? I believe the numbers on are on the hard disk)
S = (26 x 31)
M = (28 x 34.5)
L = (30 x 39)
XL = (33 x 40)

ProDisc II L (LINK) Product Insert
10 mm minimum height
m = (27 x 34.5)
L = (30 x 39)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~
LINK-Full Text
Eur Spine J. 2008 Nov;17(11):1470-5. Epub 2008 Sep 13.
Footprint mismatch in lumbar total disc arthroplasty.
Gstoettner M, Heider D, Liebensteiner M, Bach CM.
Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Clin Biomech (Bristol, Avon). 1997;12 Suppl 1:S1-S63.
Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine.
Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K.
Reply With Quote
  #16  
Old 12-05-2011, 02:03 AM
Benjaminrbecker Benjaminrbecker is offline
Junior Member
 
Join Date: Nov 2011
Posts: 5
Default

Christine,

Thank you for your message. I take from your message that you did both procedures with Dr Boeree and that he used the Prodisc for you?

Many thanks,

Ben
__________________
DDD at L4 & L5
Done nearly all non-invasive treatments
Considering ADR
Reply With Quote
  #17  
Old 12-05-2011, 02:07 AM
Benjaminrbecker Benjaminrbecker is offline
Junior Member
 
Join Date: Nov 2011
Posts: 5
Default

Dear Slackwater,

Thank you very much for taking the time to write and provide such extensive information. I really appreciate it.

You have provided another important aspect to consider; subsidence. I have not reviewed the information at length yet but it appears to suggest that a "custom" fit option may be best given that each persons dimensions and issues are unique and due to the possibility of subsidence.

I will review the information at length.

Thank you again.

Ben
__________________
DDD at L4 & L5
Done nearly all non-invasive treatments
Considering ADR
Reply With Quote
  #18  
Old 12-05-2011, 05:24 AM
srajan0929 srajan0929 is offline
Senior Member
 
Join Date: Mar 2011
Posts: 175
Default hi

i think nick does the m6L
__________________
2006-weightlifting accident.
2008-2 level disectomy/laminotomy. completely healed.
2010: car accident. reherneated
2011-diagnosed with two level DDD L4-L5 L5-S1
2011-ESI performed then 2 level disectomy/lami
12/11: Diagnosed with spinal infection. Currenly on antibiotics (ivy). changes in mri due to infection. rushed to the hospital. got surgical drainage and a laminectomy at l5 and another partial laminectomy at l4.
Reply With Quote
  #19  
Old 12-05-2011, 11:03 AM
Jstuckey's Avatar
Jstuckey Jstuckey is offline
Senior Member
 
Join Date: Nov 2010
Posts: 305
Default

Yes, Mr Boeree is not a fan of the Prodisc, and currently prefers M6.
__________________
Joey Sue - 50 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick! Still doing great.
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
http://healthyback2011.blogspot.com/
Reply With Quote
  #20  
Old 12-05-2011, 11:48 AM
christinlal christinlal is offline
Senior Member
 
Join Date: Nov 2010
Posts: 103
Default Hi Ben,

My ProDisc C was done in 2009 here in Tampa.

Nick Boeree did the M6 a level above, and decided not to remove the (misaligned) ProDisc as it is doing it's job - removal is not a good option due to the large keels.
__________________
12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
Reply With Quote
Reply

Bookmarks

Tags
artificial disc designs, artificial disc replacement complications, lumbar arthroplasty, lumbar artificial disc replacement

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -4. The time now is 01:30 PM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.