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Old 04-08-2020, 07:21 PM
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cpl35 cpl35 is offline
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Join Date: Feb 2020
Posts: 1
Default L5-S1 Re-Herniation, ADR activL approved/scheduled (with concerns)

Hello all at ADR Support! My name is Charlie and I live in the Washington, DC Area. I hope that everyone is staying safe (and sane) with the COVID crisis and it hasn’t created many additional medical problems for a community that already suffers enough.

I’m unfortunately posting as I’m considering an ADR at L5-S1. I would be having the Aesculap activL with Dr. Faheem Sandhu, MD, PhD who’s a Neurosurgeon and MedStar's Director of Spine Surgery in Washington, DC. I actually already have a date booked for the end of May with approval from my BCBS insurance, but I’m not entirely committed to the procedure and naturally I'm concerned with how in flux everything is given the COVID situation.

My background is I’m a 28 y/o, athletic male, 6’3” 195lbs. I first started having serious back pain in late 2011 after road cycling on an undersized bike with poor posture. The biggest difficulty I deal with on a day to day basis is an inability to sit for even moderate periods of time (right sided pain). Additionally, I have localized, right sided discogenic back pain. In 2012 I first showed a bulging disc at L5-S1, this bulge progressed to a significant herniation over multiple years/MRIs with the sitting/gluteal and back pain also increasing (although I never had any issues with radicular leg pain). I underwent an L5-S1 microdiscectomy in 2014. Unfortunately, I believe I re-herniated the disc quite soon after surgery and it was confirmed on an MRI three months later.

That being said, the re-herniation wasn’t compressing the nerve root and life (and sitting) were more tolerable from 2015-2018. As I didn’t - and never have had - any neuropathy, I also sought out the opinion of a top tailbone specialist, had an MRI, injections, and pelvic floor therapy but nothing really seemed to bring any lasting relief.

Even with the back, I had been able to get back into olympic weightlifting at decently heavy loads which generally seemed to strengthen and make my back/glutes feel better. Then, in June ’19 I was helping move furniture into a new apartment, felt a slight tweak lighting a mattress at an awkward angle, and a few days later I began having agonizing, right sided radicular leg pain and a deterioration of my already subpar back pain and gluteal pain/sitting tolerance. It’s not a continuous pathway of nerve pain, but S1 pathology with intermittent loss of sensation and burning in my right sided glute, calf, and foot.

Tried the conservative approach for over nine months, PT, daily walking, three rounds of ESIs, massage, chiropractic, acupuncture but unfortunately nothing has really moved the needle.

We ordered another MRI in February, the report reads: L5-S1: Stable right subarticular/paracentral disc herniation causing mild right lateral recess stenosis with abutment of the descending right S1 nerve root. Stable annular fissure. No foraminal stenosis. IMPRESSION: Stable mild right lateral recess stenosis associated with right S1 nerve root abutment secondary to right subarticular/paracentral disc herniation. No canal stenosis. Changes from prior right L5-S1 hemilaminectomy.

Both my original surgeon and Dr. Sandhu (separate opinions) suggested I would be a very good candidate for an ADR and it was something I had actually asked about prior to my MicroDiscectomy in 2014. My concern is that I’m able to be fairly active with many components of a “normal” life like non-contact sports, walking, exercise, (well-planned) travel but on the other hand, I’m significantly restricted/disabled when it comes to mundane components of a “normal” life like simply sitting in a coffeeshop or dinner or being able to tolerate the sitting requirements of a normal desk job (currently a good portion of my work is remote).

It feels in a way that I’m rolling the dice that the ADR will give me back the more “mundane” components of a normal, functional life while still allowing me to enjoy the activities I’m currently able to tolerate. My main fear is that it doesn’t and it simultaneously eliminates my ability to do the things I AM able to do even with my restrictions and pain.

(I’ve read the two and five year FDA studies on the activeL, gone through Aesculap’s Artificial Disc Patient Information Packet, and The activeL Artificial Disc: A Next Generation Motion-Preserving Implant for Chronic Lumbar Discogenic Pain and I have a lot of more detailed, patient specific questions which I’m sure are generally better for my surgeon but I’d love to discuss with anyone who has had the implant).

I’m hoping more to just get a general feel from others about my situation and prospects for ADR with the activL. I’ve attached screenshots of my most recent MRIs as well as a dermatome diagram map for reference for where I deal with most of my pain.

Feel sick over having to make such a weighty decision so any input, advice, or additional considerations would be highly appreciated.
Attached Images
File Type: jpg T2 SAG Lumbar (MRI).jpg (72.5 KB, 11 views)
File Type: jpg T2 SAG Lumbar II (MRI).jpg (72.8 KB, 10 views)
File Type: jpg T2 AXIAL Lumb Stack (MRI).jpg (74.7 KB, 6 views)
File Type: jpg Lumbar Spine Laterial (X-Ray).jpg (93.8 KB, 5 views)
File Type: jpg Dermatome Labeled.jpg (82.7 KB, 4 views)
2009 - Right (Hip) Labral Repair
2011 - Back pain cycling, inability to sit
2013 - MRI confirms L5-S1 disc herniation
2014 - L5-S1 micro-d (May)
2014 - MRI reveals L5-S1 re-herniation (August)
2015 - 2018 - Olympic lifting + increasing activity helps
2019 - Re-aggravation (June) moving furniture, first instance of radicular leg pain. Conservative care = no improvement
2020 - Approved/schedule for activL ADR

28 y/o, Male, USA, 6'3", 195 lbs., athletic, non-smoker
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Old 04-11-2020, 01:54 PM
annapurna annapurna is offline
Senior Member
Join Date: Dec 2004
Posts: 1,676

There's not a whole lot of people weighing in so I'll try to give a more general perspective. True failures of ADRs, where you get worse than you were prior to the ADR, generally fall into (1) you had structural changes in your vertebrae from long-term misalignment and you shouldn't have gotten an ADR, (2) you had neural plasticity problems from prolonged years of pain and the ADR can't reduce your pain, (3) the surgeon puts it in wrong. There's a huge number of other problems, like allergenic reaction to the alloy used in the ADR, biofilms from infection, etc. but the three I quoted seem to be the most common problems.

You can get really good imaging and spend time with your surgeon talking about #1. #2 is a bit of crapshoot but that is the reason why it isn't always a safe decision to keep putting off surgery forever. #3 is the real open question. I can only say that you should pick the best possible surgeon that you have access to, trust, and can afford.

With all of that in mind, most people seem to be reasonably close to fully functional. You can witness the number of people who posted here prior to their surgery, a few posts afterwards, and seemingly dropped off to live their lives.

There's also a question of what's "functional." Laura has hypermobility problems and three unconstrained ADRs. She'll basically live the rest of her life trying to make sure her core is very strong to provide dynamic stabilization where her ADRs can't do that for her. So long as she's fit, her spine doesn't limit her. Should she get lazy for a while, she ends up paying for it with a week or so of aching while she regains fitness. She's not taken pain medication for her spine in over a decade.
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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activl, aesculap, l5-s1, l5s1

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