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  #1  
Old 09-25-2010, 12:11 PM
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BJW BJW is offline
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Default Cervical Newbie DDD C5-7 w/Kyphosis

LATEST MRI REPORT IMPRESSION:

1) Borderline developmental stenosis with an 11 mm canal at C4.
2) Discogenic disease, C5-6-7, with moderate to moderately severe right-sided cord compression at C6-7 and to a lesser degree at C5-6.
3) Severe right C5-6 and C6-7 neural foraminal stenoses with the left-sided foramina being less significantly compromised.

LATEST XRY REPORT IMPRESSION:

1) Cervical kyphosis with slight retrolisthesis of C5-6 which is stable on flexion/extension views. There is, however, limited range of motion.



First, thank you to all who share so passionately on this site. I have benefited greatly from the stories and knowledge offered here and I have the sense that others have, as well!

Over two years ago, I felt a lightning bolt down my right arm while helping out a friend on a small home-improvement project. Within six weeks or so the first images were taken of my neck, revealing a bi-level condition (herniaitions at C5-C6, C6-C7). The first surgeon I saw wanted to know what I did to my neck. Since the “electrical jolt” occurred while overhead hammering, this was not enough to explain the kyphosis (C5 posterior). I can only assume that I suffered a trauma at some point during my decades of using my body intensely. I can remember landing on my head, being hit in the head, bumping my head, a minor rear-end collision, etc. The wonderful surgeon informed me that I would need a bi-level fusion--at which point this grown man started crying. I had been practicing Yoga for over 20 years, consciously using my body with proper biomechanics, and consistently taking extremely good care of this sack of bones (other than the bumps and bruises) so as to avoid this kind of situation. I was shocked. The surgeon told me I could try conservative care, but said that he’d see me “back here in a few months.”

It took me a long time to accept my condition. Through daily therapeutic exercises my initial pain level went from a 9/10 down to a 2/3 within a year. I regained much use of my right arm/hand. It’s been nearly 30 months since the initial flare-up, and my condition has deteriorated since my healing plateau of over a year ago. I have noticeable loss of strength in my right arm/hand. I have pain and numbness in my right hand—hovering at about the 1-2 range, increasing with exercise and activity. I have some tingling/pain from time to time in the sole of my right foot (spinal cord compression?). I also now have some weakness in the left arm and some pain in my left fingers at times. I have curtailed much of my physical life-style in order to curb my symptoms. The surgeon who ordered my last MRI/X-rays said: “Your neck is ****ed up. I don’t know why you’re not in more pain.” Most people who see me move (I still practice a soft form of Martial Arts/Dance) are dumb-founded when I explain my condition and the impending likelihood of reconstructive surgery to repair my neck.

They say, “You’ll know when it’s time for surgery.” My ego has slowly succumbed to my condition. I would ideally heal myself without surgery—who wouldn’t?—yet my quality of life has suffered so much—especially the loss of strength and reduced level of physical activity--that I am not sure waiting any longer is a good thing for me. I have gone back and forth about surgery over the last year. I have ruled out fusion. I am on the brink of going to Europe for a bi-level ADR with the M6.

I pose some questions to the forum:

Has anyone been able to restore their cervical curve after ADR? What appears to be the prognosis after ADR for someone with kyphosis of the cervical spine? Has anyone seen information showing that a kyphosis with in-tact/artificial discs will lead to adjacent-level deterioration?

Wishing all sufferers of physical pain much relief and healing!

Sincerely,
Brent


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  #2  
Old 09-25-2010, 03:26 PM
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jss jss is offline
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Brent,

Welcome, and condolences on your condition.

I went to Spain in 2009 for a double M6 ADR and thus far have had an outstanding outcome.

I've seen the before and after images of one poster on this forum that had cervical kyphosis before surgery. They had M6's implanted this summer at C4/5 and C5/6. The after surgery images clearly showed the natural curve restored. I don't know if M6 ADR typically reverses that condition, if the surgeon had to deliberately correct it, or if they just got lucky.

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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  #3  
Old 09-25-2010, 05:21 PM
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Harrison Harrison is offline
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Welcome, I am sorry for your years of suffering. You’ve asked some questions that really need to be posed to a highly experienced spinal arthroplasty surgeon – a doc that knows fusion and motion preservation. Also, if you could find a doc that has experience with multiple artificial disc designs, that knowledge may be helpful. Dr. Blumenthal at TBI comes to mind, as does Dr. Bertagnoli, who favors the ProDisc.

If I am not mistaken, Dr. Blumenthal has the most US experience implanting the widest variety of artificial disc design types; so his grasp of spine kinematics is a shade better than mine. Actually, I have no knowledge of spine mechanics – just an incredible appreciation for the complexity and miracle of motion! The more I read on kinematics, the less I know. Seriously.

Without a doubt, the most “normal” positioning of artificial discs translates to minimal loading and stresses of the device; thereby minimizing wear. So if the spine is unstable, mal-positioned or deformed, you increase your odds of complications post-operatively. So your question(s) are wise to consider.

Jeff offers a good point (thx Jeff!). If you have some time, you may be able to track these patients down and find out for yourself. In the meantime, these past discussion topics may help you:
Letter to the Editor: Regarding Bryan disc related cervical kyphosis
http://www.adrsupport.org/forums/f51...kyphosis-8134/

Effect of Modified Techniques in Bryan Cervical Disc Arthroplasty
http://www.adrsupport.org/forums/f50...2009-may-9977/

Sagittal Alignment as a Risk Factor for Adjacent Level Degeneration: A Case-Control Study
http://www.adrsupport.org/forums/f50...neration-5981/
And from the Internet:
Multilevel cervical arthroplasty with artificial disc replacement
http://thejns.org/doi/pdf/10.3171/2010.1.FOCUS1031
and:
Cervical spinal disc replacement.
J Bone Joint Surg Br. 2009 Jun;91(6):713-9.
Denaro V, Papalia R, Denaro L, Di Martino A, Maffulli N.
Department of Orthopaedic and Trauma Surgery, Campus Biomedico, University of Rome, Rome, Italy.

Cervical spinal disc replacement is used in the management of degenerative cervical disc disease in an attempt to preserve cervical spinal movement and to prevent adjacent disc overload and subsequent degeneration. A large number of patients have undergone cervical spinal disc replacement, but the effectiveness of these implants is still uncertain. In most instances, degenerative change at adjacent levels represents the physiological progression of the natural history of the arthritic disc, and is unrelated to the surgeon.

Complications of cervical disc replacement include loss of movement from periprosthetic ankylosis and ossification, neurological deficit, loosening and failure of the device, and worsening of any cervical kyphosis. Strict selection criteria and adherence to scientific evidence are necessary. Only prospective, randomised clinical trials with long-term follow-up will establish any real advantage of cervical spinal disc replacement over fusion.
Alas, if you are not exhausted with neuron and eye fatigue, see this important topic:

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

Please, please remember to share your experiences with us during your journey, as we are all in this together. BTW, what the hell is your screen name all about?!
__________________
"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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  #4  
Old 09-26-2010, 09:22 AM
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BJW BJW is offline
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Default Inspired

Thank you, Gentlemen, for the speedy reply to my post.
Jeff, over the past months I have seen your name several times here on the Forum. I am happy for you that you have had such an outstanding outcome to your ADR procedure. I am quite inspired by your comment regarding the individual whose pre- and post-op images show a restoration of his/her cervical curve. Do you have any clue as to how I might locate that person’s posts on this forum? I’ve tried with no success.
Thanks to you, Richard, for providing the technical references, especially the Bryan-related articles. I continue to be under the impression that my kyphosis does not rule me out as a candidate for ADR. My interpretation of the research articles is that patient and implant positioning during the procedure has a direct effect on post-procedure spinal geometry.
I am currently in correspondence with one surgeon in Europe regarding this issue and I intend to contact at least one other with my inquiry.
I’ll keep you up to date.
Sincerely,
Brent
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  #5  
Old 09-26-2010, 09:31 AM
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jss jss is offline
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Brent,

Here is a link to her "hello" post. She never mentions the kyphosis on this site, but we did discuss it via email.

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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  #6  
Old 09-26-2010, 11:07 AM
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Harrison Harrison is offline
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Brent, there are actually a few patients that have kyphotic conditions in their cervical spine. What I am not sure about is if these were defined clinically by the surgeon or the radiologist, or if the their were segments that exhibited kyphosis. And that does matter, no?!

Any way, I am doing admin clean-up in the outcome forum and came across Frank's outcome post. He had a 3 level in Florida (surprised? I was...) and he mentions kyphosis. He's helpful and accessible and also has extensive imaging pictures on his site:

Cervical C4-C7 ProDisc - Frank

If you talk to him, pls ask him to update or correct his post-op topic. I had to do some editing/guessing on his new hardware!
__________________
"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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  #7  
Old 11-27-2010, 02:09 PM
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catelynnw3 catelynnw3 is offline
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Default Cervical curve

Hi Brent,

I will try to scan and upload my "before" and "after" images soon. My husband was amazed to see the amount of cervical curve restoration post-surgery. It isn't perfect, but much better than it was!

Cathy
__________________
_____________
-Progressive symptoms for several years including chronic/daily headaches, constant pressure in head, chronic neck/upper back/arm pain and burning...(Might be the result of an auto accident 15 1/2 years ago while pregnant with son)
-Thankful new owner of 2 M6s at C4-5 and C5-6 compliments of Dr. Pablo Clavel ~ Barcelona Spine Center November 17, 2010

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  #8  
Old 02-21-2011, 07:43 PM
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DAnn DAnn is offline
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Brent, just in case this helps...

I saw my surgeon today (still making decision on cervical 2 level hybrid or 2 level ADR) and I asked him if my normal curvature would be restored post op. He said yes. A fusion (PEEK cage) or the ADR (prodisc C) would restore my lordotic curvature.
DAnn
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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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adjacent level degeneration, bryan cervical disc arthroplasty, cervical, cervical adr, cervical arthroplasty, cervical artificial disc replacement, cervical kyphosis, kyphosis, sagittal alignment risk factor, spinal motion preservation, spine kinematics

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