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  #1  
Old 05-05-2012, 03:03 AM
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bkw4216 bkw4216 is offline
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Default ADR Contraindicated for MS Patients?

Hi There,

I am scheduled for Artificial Disc Replacement Surgery in Germany, June 29th by Rudolph Bertagnoli (one of the best spine surgeons in the world). I've been told by Dr. Jens R. Chapman (U.W. Medicine Orthopedic Spine Surgeon), one of the best in the country, that ADR is contraindicated for MS patients for the following reason:

The increased neural membrane sensitivity present in MS patients would become increasingly hypersensitive with the introduction of artificial discs due to the irritation caused by the procedure combined with preservation of motion which would exacerbate the neural membrane hypersensitivity as opposed to a fusion, which would not.

I've been told by Dr. Andrea Fenk-Mayer, a surgeon on Dr. Bertagnoli's team at the ProSpine Clinic that they've never heard this before.

There are no clinical studies to support the hypothesis but I know Dr. Chapman to be an expert so I'm basically caught between two experts with conflicting opinions. I was diagnosed with MS (Relapse/Remit) in 2004 and have cervical disc problems since 1995. Now it appears that surgery is in order and the standard path is a fusion. It seemed like ADR was a fantastic alternative.

I've also contacted the Texas Back Institute about this and hope to hear back from Dr. Scott Blumenthal next week.

I have no reason to doubt Dr. Chapman and many claim that Western Washington is the MS capitol of the world so he's definitely got anecdotal evidence. I also neglected to ask him what the effect of having ADR would be. I am following up with another doc on his team to get more questions answered

Has anyone heard anything about this?

Thanks, very much.
__________________
Brian Whelan - Age 52
************
1977 - Diagnosed with Congenital Spondylolisthesis
1981 - Fusion L4-5
1992 - Fractured C4
1995 - First herniated disc discovered
2004 - Diagnosed with MS
2012 - Now have Stenosis, DDD, and C3-4 thru C6-7 with varying degrees of problems. L4-5, L5-6 Fusion recommended. Also learned of ADR.
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  #2  
Old 05-05-2012, 04:47 AM
annapurna annapurna is offline
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Default

I've never heard of this but Laura and I have had no reason for the subject to have come up in our many discussions with doctors so that shouldn't mean much to you.

I'd attempt to throw some logic at this. You have extensive damage in your c-spine. If you attempted to fuse from C3/4 through to C6/7, you'd have a huge immobile section there and would likely have cause huge amounts of localized movement at C2/3 and C7/T1 (I think that's the next segment, please forgive if I have it wrong). If the concern is the ADR motion leading to localized nerve irritation, I can't see how that unnatural motion at C2/3 and C7/T1 wouldn't do pretty much the same thing. Your lumbar spine is similar with an already existing fusion at L4/5 and damage at L5/S1.

The problem of throwing logic at something like this is that your body is too complicated and some tiny fact that I don't know could completely invalidate the whole thought process. I would, though, make sure Dr. Chapman understands how many bad spinal levels you have and isn't thinking that you're just dealing with a single level ADR. If that were the case, I could see the argument in favor of a fusion being weak, but potentially suppportable. With as much damage as you have in your spine, I just can't see it.
__________________
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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  #3  
Old 05-05-2012, 10:12 AM
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jss jss is offline
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bkw,

Condolences on both conditions, and welcome.

I don't know the answer to your question, and like Jim said, that none of us have heard of Dr Chapman's contraindication doesn't mean that he's wrong.

I've seen a few patients proceed with ADR against a contraindication; with about half having very bad outcomes. I only say that to encourage you in your current endeavor of being very very sure before proceeding against that contraindication.

Another thought... Will your MS doctors continue to treat you after going against their advice? Many US spine doctors will not continue to see a patient that has gone to Europe for spine surgery.

There is a young woman that posts on this site under the handle of tumblebug that discovered that she had MS the first year after her cervical ADR. She has not kept us updated on her progress. If you PM'd her she might have some useful information for you.

Good luck, Jeff
__________________
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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  #4  
Old 05-05-2012, 03:03 PM
Mike59 Mike59 is offline
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Hi Brian,

I have checked the literature that I have access to, and I can't find any reference for MS being a contraindication for ADR. That doesn't mean that there isn't something out there about it. I am interested to know if anyone else has heard of this.
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Mike59
C6-C7 fusion in 1990
C5-C6 fusion in 1997
C4-C5 Pro Disc Nova in 2011, Bogen, Germany
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  #5  
Old 05-08-2012, 05:13 PM
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bkw4216 bkw4216 is offline
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Thanks, Jeff. My neurologist will continue to treat my MS issues regardless of what I do with any surgeries. He is also unaware of any contraindication.

My problem is determining whether the contraindication is real or not. There's no clinical trials to support or contradict the position. Dr. Chapman is a very bright man and I believe he probably sees more MS patients than most other folks. There's no valid reason to doubt him but it bugs me that two ADR hotshots (Dr. Blumenthal at Texas Back Institute and Dr. Bertagnoli) have never heard of such a contraindication.

I haven't cancelled my surgery date but I'm still not sure what to do. Dr. Blumenthal has agreed to evaluate my films so we'll see what comes out of that.
__________________
Brian Whelan - Age 52
************
1977 - Diagnosed with Congenital Spondylolisthesis
1981 - Fusion L4-5
1992 - Fractured C4
1995 - First herniated disc discovered
2004 - Diagnosed with MS
2012 - Now have Stenosis, DDD, and C3-4 thru C6-7 with varying degrees of problems. L4-5, L5-6 Fusion recommended. Also learned of ADR.
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  #6  
Old 05-08-2012, 09:45 PM
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tumblebug tumblebug is offline
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Posts: 18
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As I mentioned in my PM reply back to you, I had no MS symptoms, lesions, or diagnosis previous to ADR surgery. The surgery did trigger a massive flare and that's when I was diagnosed. In the past 11 months since surgery, I have had 3 MS flares. Perhaps it's related to the ADR, perhaps not. I'm very interested to see what response you get from the hotshots!
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  #7  
Old 06-12-2012, 03:35 PM
ally ally is offline
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Join Date: Jun 2012
Posts: 17
Default MS

I was also diognosed with MS some 12 year ago, I have never had any clinical symptoms but have had many MRI's and they found 3 lesions, I was told that if you did not have any symptoms or any changes after severl years, you would probley not ever have any. In the past 2 years I have had to start wearing glasses to read, migrains for 10yrs, but that is about it, well untill now when my back problems seemed to just pop up last Dec 2011. Anyways I will be watching for any further info anyone has on this, and of course relay anything I learn. Actually thought maybe it was time to get in touch with my nuero Dr. and see about getting an MRI on my brain again to see if anything has changed.
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Diagnosed with DDD on my L3/L4 and L5/S1
Have not had a second opion yet but will do that when i get all my results officially. Tried PT and also shots with no relief.
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  #8  
Old 06-18-2012, 01:00 AM
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bkw4216 bkw4216 is offline
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Join Date: May 2012
Posts: 4
Default Heading to Germany for surgery on June 29th

All,

Trying to get any further info from Dr. Jens Chapman in Seattle proved to be fruitless. The only way he'd give me the information I was seeking was face to face and the first appointment I could get was July 5th. Neat huh?

I heard back from Dr. Blumenthal's patient coordinator a day or two after my last post. Dr. B said he was unaware of any contraindication and that he was willing to look at my films so I overnighted them to his office and within 3 days I had another response from his patient coordinator saying the doctor thought I'd be a good candidate for ADR. He said the few lesions he did see were above any of the potential discs they are talking about replacing so he didn't see a problem.

One of the things that stood out in Richard's documentary on ADR was that most of the people interviewed emphasized how important a good relationship was with your doctor, particularly in the area of communication. The more I thought about it I had Dr. Chapman in Seattle who was the guy I went to for a second opinion and, after I failed to ask all of the questions I should have, wouldn't give me any further information to help make a decision until after I actually needed it. Then I had Dr. Blumenthal in Texas (by the way, Thank You, Mike, for your encouragement to follow up with his office), who was technically, not even my doctor, and he responded twice within a week to my questions and evaluated my MRIs and X-rays.

After a week of a lot of prayer, and watching Richard's video, I decided that I was going to go forward with the plan to go to Germany. My wife and I leave Seattle Thursday, June 21st. I check into the hospital in Bogen June 27th, and surgery is the 29th. I'm scheduled to be in the hospital for a week and will remain in town for another week after that, per their orders. I'm psyched to meet Dr. Bertagnoli and his staff.

I'll keep you all posted on how things go.

Thanks again to Richard for this website.

Brian.
__________________
Brian Whelan - Age 52
************
1977 - Diagnosed with Congenital Spondylolisthesis
1981 - Fusion L4-5
1992 - Fractured C4
1995 - First herniated disc discovered
2004 - Diagnosed with MS
2012 - Now have Stenosis, DDD, and C3-4 thru C6-7 with varying degrees of problems. L4-5, L5-6 Fusion recommended. Also learned of ADR.
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  #9  
Old 06-18-2012, 01:31 AM
srajan0929 srajan0929 is offline
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Join Date: Mar 2011
Posts: 175
Default hi

hey you know...i am not going to condemn someone to go or not to go to a particular doctor. but i have been around spine forums the past 3-4 years and have heard numerous negative things about bertagnolli. these comments are deleted now. i don't know why. infact, many negative comments of other surgeons have completely disappeared. its kind of awkward. but the real question is, would you still go to a surgeon if you heard of an extremely bad news? my 2 cents says no...

but on the same line, i have recently seen surges in people going to stenum in germany and having good outcomes or to any other doctor. again, its so easy to create an online profile and fabricate your problems and then finally say "oh...i feel completely painfree this doctor saved my life" yada yada yada. when in actuality this person never had a problem in the first place.

no one says this...but this is just something you should think about. also, pimenta and zeegers is not some one you should sleep over and i personally, would choose one of those two guys over anyone currently in the market. you can check out zeegers in facebook. he was a collague of dr. boeree. so thats atleast some good news right?

another thing...asia spine surgeons are perfectionists when it comes to surgery. singapore has many prominent hospitals with top surgeons. even thailand. they don't care about your money because surgery is so cheap over there. in the order of 10k for a surgery.

anyways, i am not going to discourage you from your decision. but just realize, the prodisc might not be the right disc for you. heck, i would rather go with the active L over the prodisc...
__________________
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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  #10  
Old 06-18-2012, 11:03 PM
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laid up doc laid up doc is offline
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Join Date: Sep 2010
Posts: 775
Default No noo nooooo!!!!

autoimmune diseases are nothing to f- around with... we (physicians) don't understand them very well, there are many of them and many people who don't fit neatly into the boxes. it's one of the areas of medicine that is still poorly understood due to its complexity and heterogeneity. i'm not a rheumatologist... when i see a patient w/ lupus/RA/MS and i think they may have a problem related to that disease, i am scared and on the phone w/ their specialist PRONTO.

if someone looks you in the eye and says that an implant won't do anything to your MS, they are flat out lying.... because THEY DON'T KNOW, and they are too cocky or greedy to tell you as such.

i would be scared out of my mind to get an implant that can't be removed if i had an autoimmune disorder... especially MS, which goes off the charts awful if it goes haywire.

last on my list of implants, were you to decide you MUST have ADR, would be a prodisc - b/c the chromium/cobalt alloy is less stable and pieces will get into your bloodstream. this can cause further autoimmune reaction, or a local problem... all VERY BAD STUFF.

you're a one in a zillion case, probably no spine surgeon has put an ADR in a person w/ a KNOWN autoimmune disorder. azhure is 1 person - what you'd call a case study - but a warning sign nonetheless. autoimmune disease is one thing that will disqualify you from nearly any clinical trial not aimed at those diseases, including prodisc/charite/bryan/any other spine device.

i know people have had varying degrees of success with different surgeons around the world, but i wouldn't trust any inventor of any device to put something in my body when there are better alternatives out there, any further than i could throw them. i'm a strong gal, but i try not to stress my implant

PLEASE, PLEASE, i IMPLORE you, tread with serious, serious caution.
__________________
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!
laidupdoc@gmail.com 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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