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  #1  
Old 10-10-2006, 05:58 PM
kappa5070 kappa5070 is offline
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Hi everyone,
I have severe degenerative disc disease at L5-S1(diffuse buldging causing soft central canal stenosis & and bilateral IVF compromise), and moderate DDD at L3-L4. Im a 29 year old male currently attending Chiropractic College in Central NY state. I played college football and spent some time in the US Army light infantry, in case anyone is wondering why I have so much disc degeneration for a 29 year old. For the past 4 months I have been experiencing some urinary disturbances(trouble initiating, voiding completely, just a struggle to go) with pain in the perineum. At first it was worse and now it is much better, but not completly normal. I had some increased back pain when it all started, but nothing extraordinary. The neurologist said I check out great with reflex, sensory, and muscle strength, so he sent me to a urologist. The urologist couldnt find anything wrong with me and said it was related to my spinal condition. He put me on Cipro for 1 month in case it is chronic bacterial prostatiis. Im almost done with the Cipro and I feel it is not helping very much. Ive also consulted a surgeon who wants to do a ALIF fusion at L5-S1 with r-bmp gel and a interbody cage. He thinks it will be better than any ADR prosthesis on the market. Has anyone had any symptoms like mine? What do you all think of getting the fusion(is it really inferior to ADR, especially at L5-S1, maybe even a superior procedure)? It seems much easier than going through the insurance nightmare to try and get ADR. If my urination is affected by the bulging, degenerated disc, is it too late to get full function back after surgery? Im close to full urinary function, but I would really like to get back to 100%. I can live with back pain, but this is driving me nuts. Could I have Cauda Equina Syndrome without any loss of reflexes, strength, or ROM? Or is it just the disc bulging centrally into the Cauda Equina just enough to cause some visceral problems. With my history of spine problems it seems much more likely to me that this is from my spine and not some rouge prostate infection. Any feedback would be greatly appreciated and I am happy to be apart of this forum.
__________________
30 years old
DDD at L5-S1
Currently a Chiro student
Former Army Sniper
Waiting as long as I can before getting fusion or perferably ADR
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  #2  
Old 10-10-2006, 07:24 PM
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Eddie_G Eddie_G is offline
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Join Date: Apr 2005
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Hi Kap,

Sorry you feel pain like the rest of us here. The reason I jumped into the ADR camp was because I feel it's the most logical choice for me. I'm only 38 and I believe that immobolizing an area of the spine will put stress on my adjacent discs in the years to come and give me more problems. I've done alot of research, talked to doctors, went to a symposium and talked to people who have discs. When I saw all the smiling people who have had successful ADR surgery, I said, "I'll have what they're havin!" The stats seem better but whatever you do, get a GOOD doctor!

If I could hold out, I would hold out for the Maverick disc. It just looks fancier to me....

In the years to come they'll have injectable gells that become your disc, and even stem cells.

My need to end 3 years of pain and narcotics pushed my decision up so I waited patiently for the Prodisc to be approved on August 14 (on my Mom's birthday!) and fought the insurance company to get a good surgeon. They tried to tell me the Prodisc was experimental but I got doctors in my company to help me educate the adjuster that the 2,000.00 a month it took to drug me was alot more than a Prodisc surgery from a good doctor. I'm very excited about the prospect of having less pain.

If you're considering ADR you've come to the right place. You will definitly get educated quick here.

Welcome!
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #3  
Old 10-10-2006, 09:31 PM
annapurna annapurna is offline
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Just some thoughts to think about: First, MRIs are almost always done on your back with the spine unloaded. You might see if someone has a backpack style harness that can load your spine and see if the buldge gets much more pronounced under load. My wife's disk buldge wasn't anywhere near enough on the MRIs to cause her the numbness and pain she experienced but as soon as the disk was removed and ADR put in the numbness faded.

Second, though they can really mess up you permanently, you might need a myleogram to sort out how much impingement in your spine you really have. Try to avoid this as much as possible as the test has the potential for permanent scarring and lots of permanent pain if done wrong and can be massively unpleasant for a week or more even if done right.

Third, you should get someone to examine your MRIs or get MRIs if you don't have them to check for the condition of your facets at the affected level. You may be forced into fusion due to structural damage to your facets from the DDD transferring load from the degenerated disk to your facets.

Fourth, as you probably know from your schooling, if you do have Cauda Equina Syndrome you need to move out agressively to bring yourself to a point where you've identified an approach you're happy with and whatever doctors needed to pursue that approach. No one here is smart enough to tell you that you need surgery, but it if you're on the edge of Cauda Equina then you need to be able to react quickly if it gets worse.

All of that said, you asked for an opinion on fusion vs ADR. At your age, you do risk driving degeneration into adjacent levels if you fuse, especially as you have two non-adjacent levels affected now. You might try a combination of fusion and ADR, which has worked for some. You might find your facets or bone density or some other factor eliminate ADR for you, but by and large most of the people on this board like the fact that ADR preserves spinal motion, which has at least the theory of preventing future damage.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #4  
Old 10-11-2006, 02:10 PM
Cat Cat is offline
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Join Date: Sep 2006
Posts: 26
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Welcome Kap.
You have definitely found the right place. You will find a wealth of information and support from everyone here. I just recently stumbled onto this forum, and I've got to say that it has been my rock! I have learned more in the past two or three weeks on this board than I have in all of the rest of my research. The individuals here are walking testimonies of the ADR, good, bad, or indifferent. For the most part, the majority of the recipients have had positive results from their ADR surgeries. They are also very knowlegable. So read away and pick their brains.
Cathy
__________________
*1998 - Two discectomies and a fusion at L5,S1 (MRI, mylogram & epidural injection through coccyx bone) and surgery to repair spinal fluid leak
*2005 Discectomy at L4-5 (MRI, epidural shots, PT)
*2006 Discectomy at L4-5 (MRI, mylogram, & PT)
*Curr
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  #5  
Old 10-11-2006, 04:41 PM
kappa5070 kappa5070 is offline
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Thanks everyone for your feedback. Dont get me wrong, I love the idea of preserved motion, however what is the quality of that motion? If the motion from the ADR is not the same as physiological motion, you are putting your posterior motion segments(ie facet joints) at risk for premature degeneration. So, in a attempt to perserve the anterior motion segment(adjacent vertebral bodies with a disc between them), you could end up degenerating the facets. Your trading one problem for the other. With an ALIF fusion you can minimize adjacent level degeneration because the surgeon can set the lumbar spine in a proper lordotic curve. Also, at the L5-S1 level there is very little motion to begin with, so are you really affecting the spine biomechanics considerably by laying the motion segment to rest? Also, both ADR and ALIF procedures require the surgeon to cut and disturb the anterior longitudinal ligament( a long lig. running down the front of the vertebral bodies linking them into a kinetic chain), potentially disrupting the biomechanics of the spine. Now, Im not a big fusion advocate, I just dont know if the charite and prodisc-l are good enough to last 60 years in my spine. I dont even know if the coments I said about ALIF fusion and ADR are true, Im just relaying my surgeons opinion. Ive heard about problems with discs fitting the vertebral body end plates properly. Also, problems with pitting and wear in the polyurethane core. It seems all the studies on these discs are done in comparison to a 360 degree, highly invasive fusion. Not a modern, minnimally invasive anterior lumbar interbody fusion with r-bmp gel. I know the recovery and rehab is shorter with ADR. Also, it seems people are doing great with them. So, Im torn. I just wanted to offer the alternative philosophy that is still embraced by many spine surgeons.
Is insurance approving these things? I have BC option in upstate NY, I dont even know if I can get the opportunity to get an ADR. How do you go overseas? You need $30,000 in liquid cash or you cant see Dr. B? Can you finance it, or get insurance to pay? I just wanted to strike up a philosophical conversation about the risk/benifit analysis of fusion and ADR. Also, I would love any advice on how to get in front of a good ADR surgeon for the ADR camp prospective. I appreciate any feedback and hope everyone is having a realatively good day.
__________________
30 years old
DDD at L5-S1
Currently a Chiro student
Former Army Sniper
Waiting as long as I can before getting fusion or perferably ADR
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  #6  
Old 10-11-2006, 08:43 PM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,586
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Responding to your questions. Sorry about the brief comments.

If the motion from the ADR is not the same as physiological motion, you are putting your posterior motion segments(ie facet joints) at risk for premature degeneration.

Reply: True, and this is an ongoing question but current computer modeling is much better at mimicing real life and has shown that the ADRs tend to perform only somewhat worse than a natural disk and much beter than a fusion for adjacent level forces.

With an ALIF fusion you can minimize adjacent level degeneration because the surgeon can set the lumbar spine in a proper lordotic curve. Also, at the L5-S1 level there is very little motion to begin with, so are you really affecting the spine biomechanics considerably by laying the motion segment to rest?

Reply: I've heard this several times and I've heard surgeons and orthopedic doctors committed to motion preservation say that L5-S1 has a great deal of motion. Whichever is true, you've got to figure that you'd eventually sacrifice your SI joints by fusing L5-S1.

I've heard about problems with discs fitting the vertebral body end plates properly.

Reply: Go to the best surgeon you can find. This is a problem with ADR as well as improper placement of the ADR. Either are pretty much a promise of failed ADR.

Also, problems with pitting and wear in the polyurethane core.

Reply: So far, the only studies that I know of are published by Maverick's (a metal on metal ADR) manufacturer and are fille with bad science or worse statistical analysis. Wear particulate can be a problem in theory but no one's reported firm data of it happening.

It seems all the studies on these discs are done in comparison to a 360 degree, highly invasive fusion. Not a modern, minnimally invasive anterior lumbar interbody fusion with r-bmp gel. I know the recovery and rehab is shorter with ADR.

Reply: You did point out one problem with the comparison study. Right now, anecdotal comparisons are the best you'll get.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #7  
Old 10-12-2006, 07:48 AM
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Harrison Harrison is offline
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Welcome, chiro Kappa! Sorry about your health situation. BTW, were you deployed to the Gulf? I was just wondering relative to any mycoplasmic infections (see Dr. Garth Nicolson’s work). What MRIs or X-Rays have you had? Any pending?

Here’s my opinion on your questions, using Anna’s approach:

Q: If the motion from the ADR is not the same as physiological motion, you are putting your posterior motion segments(ie facet joints) at risk for premature degeneration.

A: This continues to be a heated debate among informed patients, and (I believe) less so in the scientific circles. Docs/mfrs have the lead advantage of reviewing and analyzing the long-term outcome data before it is disseminated via the Internet. More on this soon in another new topic.

Q: Also, at the L5-S1 level there is very little motion to begin with, so are you really affecting the spine biomechanics considerably by laying the motion segment to rest?

A: The 5 and 10 year Charite outcome data reveals incredibly low adjacent level lumbar disc degeneration (app. 2-3% I believe), far lower than fused lumbar segments. Little motion at L5-S1? I doubt this is true for most people – especially active, young folks – just my layman’s opinion.

Q: I've heard about problems with discs fitting the vertebral body end plates properly.

A: For this reason, sizing of the end plates is critical. This is the surgeon’s job and they are carefully trained for this. (Some patients suffered through subsidence issues; much has been learned, thanks to the "patient pioneers.") This concern is also an argument for other disc designs, such as the Active L, which purports to “cradle” or cup the entire vertebral body, distributing weight & force evenly. For people susceptible to osteoporosis, they should think carefully about this issue and talk to their surgeon about their concerns.

Q: Also, problems with pitting and wear in the polyurethane core.

A: AnnaPurna raises a good point, and their (2 folks behind the screen) scientific prowess is no match for me! But there are many documents and past topics on this. Here’s one:

Publication: Wear Particles and ADR
http://adrsupport.org/eve/forums/a/t...8961041281/p/1
__________________
"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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  #8  
Old 10-12-2006, 09:52 AM
kappa5070 kappa5070 is offline
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I was not deployed to the Gulf, that was before and after my time in service. Ive had x-rays and a MRI. X rays show a compression fracture on the anterior superior vertebral end plate of L4 and decreased disc space at l5-s1. The MRI shows DDD at the lowest 3 lumbar discs, severe at l5-s1. The L5-S1 disc is bulging diffusely, causing central canal stenosis and bilateral intervertebral foraminal compromise. Also a slight uncontained herniation on the left posterolateral portion of the disc. L3-L4 looks like it is beat up, but it doesnt cause pain. The pain is definatly over the L5-S1 disc. I have great facets and great bone density. Dr. Bitan turned me down for the kiniflex study because he thought my DDD at L3-L$ was too pronounced for the study(multi level DDD). Im not sure, but I think I could still be a candidate for the surgery as long as it is not a clinical study. The parameters are more stringent for the clinical studies, right? Anyway, got to go to systems physiology class. Any feedback is again much appreciated.
__________________
30 years old
DDD at L5-S1
Currently a Chiro student
Former Army Sniper
Waiting as long as I can before getting fusion or perferably ADR
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  #9  
Old 10-12-2006, 10:35 PM
bobb0 bobb0 is offline
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Quote:
Second, though they can really mess up you permanently, you might need a myleogram to sort out how much impingement in your spine you really have. Try to avoid this as much as possible as the test has the potential for permanent scarring and lots of permanent pain if done wrong and can be massively unpleasant for a week or more even if done right.
Could you expand on this statement and explain specifically what is at risk when a patient is asked/required to obtain this procedure?

thx bob
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  #10  
Old 10-13-2006, 04:36 AM
annapurna annapurna is offline
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Posted in 2004, more can be found in FAQ and site search


I had a myleogram about a year and a half ago for the same reason - unresolved nerve pain post ADR. Myleo's are great in that they don't require computer-assembled imaging to show nerve compression - they just outline your nerves with dye so that they're visible on a plain x-ray. If you were at Mark *******'s last luncheon, you will remember Dr. Zeeger's excellent description of how a myleogram works (champagne glass and other "thought aides").

In terms of what to expect, I think that it's a lot like getting an epidural shot or facet injection. You get scrubbed, get a "bee-sting" local shot, then the doc inserts a super-fine spinal needle right into the fluid around the nerves in the central canal (mine was put in near L3-L4). Once the dye is in, they tilt the table you're on to get the dye to go to all the nerves (above and below) and take pictures from as many angles as possible. If there is some compression (like a pinched nerve), the dye will stop and not travel where it should, and you can tell that that nerve is compressed (really simple).

Here's the big cincher!!!! Since you're poking a hole in the dural sac (fluid bag that's around all the nerves), you can have some problems. The big, big problem is reaction to the myleogram dye that results in nerve root scarring, or arachnoiditis. This is bad news on burnt toast, so to speak. You can avoid it by making sure that your doc uses water-based dyes that are know to not cause this condition - I'd ask ahead of time. The second problem you can get is a "wet-tap" where the hole from the needle does not close over and keeps leaking spinal fluid due the pressure-head (no pun intended) of the fluid above the hole. When you loose enough fluid, you can get a MASSIVE headache that goes away more or less completely when you lay down. I got a mild one for about 72-hours post-myleo that went away on it's own. There are special needles that leave a flap that helps the holes seal and are intended specifically for myleograms and spinal taps. It would be a good idea to ask about that too.

Having given all the dire warnings, I can tell you that it is a good test that is relatively free of artifacts. The doc positioned the fluroscopy monitor where I could see it, and I got to watch my nerves get outlined with the dye as it migrated up and down my spine - very neat! You can do a CT scan afterwards as well, which can give more info, however, expect some artifact on the CT around your ADR.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

"There are many Annapurnas in the lives of men" Maurice Herzog
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