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Old 08-13-2012, 03:12 PM
zenmunk zenmunk is offline
Senior Member
Join Date: Aug 2012
Posts: 280


Thanks for your reply. Tomorrow, I'll ask my neurologist if a foraminotomy could disqualify a patient for ADR surgery.

I met with my ortho surgeon today. I tried to get in as many questions and concerns as possible (I had a lot of them), but it's always hard, because these specialists are always in a rush. He had me do some range of motion movements to check for pain, and neurological movements to check for nerve pain and weakness. He said I passed all the tests well.

He doesn't think my fusion was damaged. He doesn't think I'm anywhere near needing a surgery at this time; not even a partial microdiscectomy to remove any disc material which may be compressing/irritating the nerves. He doesn't think I need a follow-up MRI or x-rays at this time to check on the fusion and the condition of my L4-5 segment. He said that if the neurologist wants to give me another EMG, then that couldn't hurt to see if the test detects any nerve damage, but he couldn't detect any during his examination. I didn't like hearing that he didn't want another MRI, not because I enjoy the test, but because I just want to be sure I'm not degenerating faster than he thinks I am. Doctors don't have x-ray vision; they are limited regarding what they can detect in someone's back.

He said that I will just have to tolerate the pain and sciatica when they occur (they will inevitably flair-up from time-to-time), and that I should work hard with my physical therapy to strengthen my back and core muscles, and try to avoid activities which put a lot of pressure/pounding on the lower back, like running for long distances.

I'm glad his examination didn't turn up anything serious. However, just tolerating back pain and sciatica feels wrong. I mean, of course I have to tolerate the pain when it comes, but other than the physical therapy aren't there other conservative pain management treatments I can get? I didn't get a chance to delve into that with him. I have a follow-up appt in 3 months.

Tomorrow, I'm going to ask the neurologist about getting another MRI; maybe he'll agree to order one. I'll also ask about my options for pain mgmt. outside of physical therapy.

Lastly, there is a new therapy that's being used to treat DDD (Jim alluded to it earlier in the thread) which is what I have at the L4-5 lumbar vertebra. Basically, they take stem cells from your bone marrow or fat tissue and inject them into the diseased disc with the hope that it will repair itself, either arresting or retarding the degeneration.

One of the doctors doing it is Tim Davis out of L.A. If you know of any others, please let me know. Check out this short video about it. I very well may contact Dr. Davis and see if I'd be a candidate for such a procedure. It's meant to treat early DDD which is what I currently have, but it won't stay that way forever. If it worked, then it could buy me a lot more time before I'd need to have any kind of surgery. I didn't get a chance to ask the ortho surgeon about it, but I will ask the neurologist tomorrow.


1992: Bilateral bony fusion @ L5-S1
10/2013: M6 @ C5-6, C6-7 & L4-5
8/2014: Anterior Foraminotomy @ C3-4 & Posterior Lumbar Decompression (iO-flex)
1/2015: M6 @ C3-4
1/2017: Revision @ C3-4 (M6 replaced with new M6); M6 @ C4-5
4/2017: Posterior micro-decompression @ L4-5 & L5-S1
1/2018: M6 @ C2-3
8/2018: Revision @ C3-4 (M6 replaced with anterior fusion (no plate or screws))
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Old 08-13-2012, 09:29 PM
Jen93312 Jen93312 is offline
Join Date: Aug 2011
Posts: 87
Default Disqualification for adr

Hi James,

I explicitly asked my surgeon (from Cedars Sinai) that question before my foraminotomy and he said absolutely not. I know that is a contraindication for clinical studies, but hopefully not in the other instance!
C3 Bulge
C4 Bulge
C5 ruptured
C6 Bulge
7/2011 epidural that caused a "fragment to present itself"
10/2011 C5-C6 Foraminotomy & removal of fragment
Positive for left-sided Hoffman's reflex
Effacement of anterior spinal artery
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Old 08-13-2012, 10:55 PM
laid up doc's Avatar
laid up doc laid up doc is offline
Senior Member
Join Date: Sep 2010
Posts: 775

keep in mind, as others have mentioned, that MRI findings DO NOT = symptoms. if you're having intolerable symptoms, push for a discogram to confirm (or even refute) the disc as a pain generator and then assess your options.

hard to say if you'd benefit from epidurals if your pain generator isn't identified.
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week! if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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Old 08-14-2012, 04:23 PM
srajan0929 srajan0929 is offline
Senior Member
Join Date: Mar 2011
Posts: 175
Default hi

honestly, i dont see what the rush is into have the surgery. in case of your first one, yes that made sense. I was in the same boat as you. i had a two level DDD and my first surgeon told me to tolerate it as much as I can and to focus on strengthening my trunk muscles. I however still decided to get a microdisectomy at although it did alleviate my symptoms, i ended up getting a spinal infection that was terribly traumatic. you can always get an ADR a year later down the line after exhausting all conservative options.

if your doctor feels surgery is not necessary, i would trust him.

there isn't a data out there that is over 20 years old regarding aDR. and even if there were, the sample size is so small that you cant conclude anything effectively from it.

have you tried prolotherapy?
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.
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Old 08-14-2012, 08:30 PM
annapurna annapurna is offline
Senior Member
Join Date: Dec 2004
Posts: 1,651

Originally Posted by srajan0929 View Post
honestly, i dont see what the rush is into have the surgery.
The rush isn't to have surgery. The rush is to make sure you start the investigation and understand your options for surgery before pain and disability limit your ability to do the research. Surgery shouldn't happen until you have a fully thought out answer but you shouldn't delay the research until you're too disabled to hunt down the necessary information. If, for instance, your local doc says that the best neurologist for doing EMGs is a two hour drive and you've put off any decision making until you're unable to sit for more than 10 minutes at a time, you're going to be making your decision without the best information possible. Is it critical? Probably not, but little compromises will add up to lead to a poor decision. If nothing else, you need to be confident enough that you have time to walk back out of a surgeon's office, refusing to work with him/her, if you have a bad feeling. If you wait until you're desperate, you might accept a compromise that you'll regret later.

Originally Posted by srajan0929 View Post
there isn't a data out there that is over 20 years old regarding aDR. and even if there were, the sample size is so small that you cant conclude anything effectively from it.
This is true for current ADR styles. The Charite has been in use for almost 30 years. That sample size and lifetime is a reasonable indication of the concept of an ADR. Beyond that, it's how much of the individual ADRs' marketing literature to believe.
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - minor C5-6 instability and facet damage, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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artificial disc design, artificial disc replacement complications, spinal surgery

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