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  #41  
Old 09-01-2011, 11:44 AM
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msrudy msrudy is offline
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Exclamation Poll for ProDisc for cervical issues.....

I agree that there needs to be a poll for ppl that have had ProDisc for cervical issues.I know it's not working for me and mine was c-5 c-6 level. I feel pretty dumb myself for not doing enough research on this implant before letting my surgeon cut on me. I did do research but not enough. I suffer daily with my muscles in my shoulders and headaches and tremors and spasms and neck pain and etc. I am still going and getting ESI (epidural steroid injections) in my neck. It hurts like H***! I am going for my fourth shot 9/9/11. I am so disgusted and feel bad for others that are going through what I am as well. I am glad for those that care to hear me scream! I just want relief!!

I feel like screaming at my surgeon but I never want to see him again or ever let him put another finger on me! I went for my follow ups and he still acted like I wasn't supposed to be having these problems and as if he didn't care and I know he didn't care cos he got paid and was done with me! I hope I don't have to suffer for the rest of my life but I am 1yr 1 month and 4 days post opp and it is getting no better and actually getting worse! I have tried everything, meds, PT,rest, ESI and whatever has been suggested. I will probably face another surgery to have this removed and then I will have to have a fusion, I suppose. I am seeing another spine specialist now and still have hope that he can help me but hear me when I scream because I do it silently to myself daily. I just have to keep on keeping on for my kids. No one understands what those of us with cervical issues go though so I am so thankful for the support and advice I get on here.

Thanks and much love to you all.
msrudy
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  #42  
Old 09-01-2011, 01:17 PM
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SISSYJOC SISSYJOC is offline
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Default Re: Poll for prodisc

I think there should be a warning note for new patients on here. If you choose to have adr surgery done DO NOT get PRODISC!
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May 5, 2010 c5-c6 prodisc ADR surgery in Yakima, WA. 16 months later after suffering every minute of every day I had a posterior cervical fusion c5-c6 over the prodisc surgery on September 9, 2011. June 18, 2012 posterior hardware removal of fusion. I HAVE ZERO PAIN!
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  #43  
Old 09-01-2011, 01:21 PM
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jss jss is offline
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msrudy - jkde - sissyjoc - dustman,

As someone that has had a miraculous recovery after a double cervical ADR, it sincerely pains me greatly when I see someone else (all of you) either receive no benefit, or even get worse after ADR surgery. You have my sincere condolences.

I truly don't know what the best action is for you, but from all I've seen and read in my decade long saga of cervical suffering, and the two years since my apparent cure with the M6 at the hands of Dr Clavel, I can tell you what I would do if I found myself suffering after a ProDisc ADR surgery. BTW:I swear that I'm not on Dr Zigler's payroll. I would travel to see the world's leading expert on ProDisc implantation and get his opinion; that is Dr Zigler at TBI in Plano, TX.

Here's why I would do that.

While we constantly hear of the continued problems that ProDisc recipients have, I have yet to hear such complaints from one of Dr Zigler's patients. I don't doubt that he has had bad outcomes, but they are sufficiently few and far between that we don't see them posted on these forums. (at least I haven't) I know that he see's other surgeon's ProDisc patients after bad outcomes as they've posted their experience here.

Dr Zigler is world renowned in both spinal surgery and ADR research (so he's esteemed by his peers). We never read ill words of him by his patients. (so he is well liked by is patients) We never read bad outcomes from his surgery. (so he is a preeminent surgeon) He is financially tied to Synthes, the maker of the ProDisc. (so he is financially motivated to see that his patients, and botched ProDisc patients of other surgeons have good outcomes)

In your shoes, that's what I would do and why I would do it.

Good luck, Jeff
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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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  #44  
Old 09-01-2011, 05:24 PM
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Harrison Harrison is offline
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Red face Bit of a Rant Here

This kind of conversation comes and goes through the years – I’ve been reading these topics carefully while also talking to patients since 2004. Please see this crusty reminder, an inherent risk of looking at this community as a “scientific” resource. This site does attract the largest number of pre and post-op ADR patients, which has always been the focus and goal. But it's a discussion board; nothing more.

Here are the facts as I see them:

1. Most patients who are carefully selected for artificial disc replacement do as good as -- or better -- than fusion patients.

2. Cervical patients generally recover more easily with ADR than lumbar patients and also have less pain; perhaps for obvious reasons.

3. ADRSupport community surveys continue to support these conclusions, but it’s time to re-evaluate the last six months of data.

4. Every practicing ADR surgeon has had patients that have done exceptionally well and others patients who have fared exceptionally poorly. (OK: that's my opinion and I can't prove it).
There are some crucial issues pertinent to patients’ recoveries that continue to be overlooked, even ignored, by both patients and doctors:

1. Patients are not Lego’s that can be disassembled and reassembled so easily. Degenerative disc disease presents a localized disease, a symptom of a compromised immune function – and an indication that the patient’s body is not healing as it should if it were completely healthy. Our specialized medical system only amplifies and exacerbates this “Lego” approach. We need to treat patients holistically to truly heal from a degenerative disease (see Dr. Max Gerson’s concept of totality).

2. Patients who make lifestyle changes (e.g., their diet) and way of life before and after surgery will fare better than others who fall back into an unhealthy routine.

3. Surgeons and patients show nominal interest in using advanced diagnostics to determine the pathology of excised spinal tissue from the ADR procedure. Given the small number of causes of disc disease, it’s amazing more patients do not ask their doctors about pathology testing of their diseased body parts. Undiagnosed problems like arthritis surely play a role in post-op pain.

4. Regarding disc designs, I’ve said this before: keeled designs are more injurious to affected/diseased levels, so that surely is a contributing factor to longer healing times and even complications. As well, keeled designs make revision surgery more complicated, as they weaken the vertebral bodies. That’s why I continue to be a proponent of cleated designs rather than keels. Synthes won the marketing wars, and poor surgical skills by a small number of doctors (particularly Stenum in 2004 and 2005) and law suits helped the “market” steer away from unconstrained (cleated) designs like the Charite'. Sadly, imprecise device positioning continues to occur in some patients. These positioning "errors" may or may not cause pain. Why? Absent of disease and inflammation, the spine and human body give us humans amazing compensatory abilities.
Please consider these points above, as I believe that they account for the wide variance in patient outcomes. I hope this is helpful, albeit "tough love."
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"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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  #45  
Old 09-01-2011, 09:36 PM
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MeggieLynn MeggieLynn is offline
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For those of us that are not doing very well, myself included, whether you're pre-op, post-op, or just contemplating surgery, I recently found a spine surgeon's website/blog that addresses some of the emotional aspects of chronic pain in spine patients. Some of you may relate to it, as I have, and may find it helpful. One of the excerpts from the site, in particular hit home with me & I realized I drastically needed to make some changes...or else I would never improve my situation whether I had surgery or not.

'One of the byproducts of anger is obsessing over negatives. With chronic pain it is deadly. As the brain focuses on the pain, the signal becomes stronger. As the pain worsens, you become even angrier. An endless cycle is set up and you spiral downward.'

He also addresses the fact that you have every right to be angry, for being in the current situation you're in. That it is not your fault and in many ways, you are a "victim" of the system. He offers some concrete ways to get you out of this downward spiral. Not by any means a quick fix, but something to work with while contemplating other options.

The surgeon's name is David Hanscom & he's developed a comprehensive program fro spinal rehab. He's also writing a book called: Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain. You'll find a draft of his book on the website. He was once a spine patient with chronic pain, had surgery (during his spine fellowship) and subsequently developed a spine infection.

He mostly deals with failed fusion patients - rarely even brings up ADR & while I don't agree with everything he says re:disc/spine pathology, I think the process could be applied to any of our individual situations. I won't say anymore, if you're interested, have a look.

The DOCC Project - David Hanscom, M.D.
http://www.drdavidhanscom.com
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*C4-5 and C5-6 Mild & moderate posterior broad-based disc bulges w/small posterior end plate osteophytes, mild spinal canal stenosis.
*C6-7 Broad-based posterior disc bulge w/small focal posterior central protrusion mildly indenting the anterior thecal sac, no canal or neural foraminal stenosis.
*SI Joint issues, Fibromyalgia, Chronic Myofascial Pain, Neurogenic Thoracic Outlet Syndrome
*Tx's-PT, 2 ESI's Interlaminar & transforaminal, 2 SI Joint steroid injections, Failed LBB for SI Joint
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  #46  
Old 09-01-2011, 10:28 PM
JEVE19 JEVE19 is offline
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and to think my hubby thought I was just being a female...LOL
Just kidding.
I definently think that being in pain all the time definently affects ones personality.
Especially when your sleep is interruped by pain as well.
Then add stress, insurance crap, kids, spouse, marriage, job, pets, etc, etc....
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10-14-2011
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  #47  
Old 09-01-2011, 11:35 PM
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laid up doc laid up doc is offline
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Meggie Lynn and others,

I watched the video where he talks about fusions, and says that a study he thought was well designed out of Stanford compared spondy vs discogenic pain pts and success rate of fusion. the guy who did that study - a Dr Carragee - seems to be on a mission to debunk discograms, using some pretty suspect methodology imho. this prompted me to investigate Dr Carragee, current literature, and just to think. everything i found is readily available on the web. i used google and combinations of search terms including "discography", "carragee", "spondylolisthesis", and names of the articles to find a whole host of literature.

i also found aetna's clinical policy on discograms to have a surprisingly useful summary of recent studies related to discography. Discography.

some thoughts:

1. this summary also explains the #'s i have been cited for success rates - looks like what your surgeon will tell you about surgical outcome depends on what study they like. had one guy tell me 50-60% (rate cited in Carragee study as "minimal acceptable outcome" - same Stanford guy as the one Hanscom cites), then another say 80% (from Hao study - apparently done in China, article in Chinese, and I can't find the abstract on the web).

2. also found this review of ADR vs fusion http://www.cns.org/publications/clin...0107000083.pdf

3. and this about side of pain and discogram
http://www.kalindra.com/annular_tear.pdf

4. in relation to Meggie's post - i totally agree with the premise that chronic pain and depression are comorbid and can drive each other. i have such issues myself and try to be very, very cognizant of what is psych vs physical. i know that my brain responds differently to pain than before i started w/ this disc problem.

this same guy out of stanford (carragee) did another study where he says that discogenic pain pts have a disproportionately worse psychosocial profile than those w/ spondy, infection, or "other" mechanical lbp. he seems quite confident in his conclusions BUT -- if you look at the study pts.... 57% of those w/ discogenic pain were WC. much lower in the other groups. every doc i have seen has mentioned WC as a poor prognostic indicator for surgery, and all have said that they will not operate on WC for lbp. http://www.kinesiouba.com.ar/docs/5/...-back-pain.pdf

fwiw, 2 of the clinics i've been to won't see people even for even no-fault accidents if they don't have their own insurance that will pay them.

6. more on Carragee and discograms... how are people with an entirely different diagnosis a "gold standard"? see abstract:
abstract:
A gold standard evaluation of the "discogenic pain" diagnosis as determined by
provocative discography.

Carragee EJ, Lincoln T, Parmar VS, Alamin T.

Orthopaedic Surgery Division, Stanford School of Medicine, Stanford, CA 94305,
USA. carragee@leland.stanford.edu

STUDY DESIGN: This is a prospective study of the validity of a positive test
result in provocative lumbar discography for the diagnosis of "discogenic pain."
OBJECTIVE: To investigate the hypothesis that provocative discography by strict
criteria accurately identifies a low back pain illness due to a primary disc
lesion. SUMMARY AND BACKGROUND DATA: According to the Sackett and Haynes
criteria for establishing diagnostic test validity, no test without a gold
standard external standard can be meaningfully applied. Provocative discography
as a test for determining "discogenic pain" has, to date, not been compared
against a gold standard. Absent a gold standard reference, there can be no
validity assessment or systematic improvement of test accuracy. This is the
first study to apply an external gold standard evaluation of the diagnostic
validity of discography in any manner. METHODS: Over a 5-year period using a
strict enrollment protocol, 32 patients with low back pain and a positive
single-level low-pressure provocative discogram, underwent spinal fusion.
Subjects with known patient selection comorbidities were excluded. Generic
surgical limitations/morbidity were controlled by comparison to the clinical
outcomes of a strictly-matched cohort of 34 patients having a well-accepted
single-level lumbar pathology (unstable spondylolisthesis). Treatment success
was compared between groups. RESULTS: In the control-spondylolisthesis group, 23
of 32 patients (72%) met the highly effective success criteria compared with 8
of 30 in the presumed discogenic pain cohort (27%). The proportion of patients
who met the "minimal acceptable outcome" was 29 of 32 (91%) in the
spondylolisthesis group and 13 of 30 (43%) in the presumed discogenic pain
group. Adjusting for surgical morbidity and dropout failure, by either criteria
of success, the best-case positive predictive value of discography was
calculated to be 50% to 60%. CONCLUSIONS: Positive discography was not highly
predictive in identifying bona fide isolated intradiscal lesions primarily
causing chronic serious LBP illness in this first study comparing discography
results to a gold standard.



ok so this post has become a repository for links. the aetna CP document has a lot of really interesting articles. i like reading them myself b/c i'm trained to do so... i haven't done my own stats analysis on any of them yet, but i probably will (w/ the help of my research attending from residency) and will let ya'll know if i come up w/ anything interesting. MOST articles that make it to a major journal/textbook are good studies, b/c they have been peer reviewed - but there are notable exceptions (ie, study now retracted from Lancet that linked vaccines to autism). i know an orthopedist in the bay area, will talk to him about what he thinks of Dr Carragee - though this ortho isn't a spine guy.

[special thanks to whomever scanned some of these articles and posted them under various strangely named domains. i don't subscribe to all of these journals and don't feel like trekking to the nearest med school and begging them for access.]
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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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  #48  
Old 09-02-2011, 12:00 AM
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laid up doc laid up doc is offline
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Harrison -

good points man, i have some additional thoughts:

I'd add that there is no accepted gold standard "workup" for evaluating pts for disc pathology and symptomatology, and there is such a thing as "drift" in indication - basically when something comes out, dr's sometimes offer the new tx, even if not the right one, to the wrong pt, and then the tx is blamed. many ppl think that this led to the demise of IDET.

one of the limitations of "evidence based medicine", or EBM, aka use of any given study to guide your decision making, is that in order for the study to apply to YOUR PATIENT, one has to consider the study design. you must look at the inclusion/exclusion criteria, study population, and various statistical constructs that a researcher may use to warp statistics. this is beyond the ability of many patients, which is really unfortunate. one is left to trust what a given MD tells them, and ALL dr's have SOME sort of bias, based on where they trained, their personality, tolerance of risk, personal experience, their patient demographics, etc etc.

as far as evaluating the "success" of surgery/role of any given disc or surgery -- if one does not properly identify pain generators and exclude non-discogenic sources of pain, ensure that the level that is being operated on is the sole pain generator... basically not do a thorough workup - then a level is picked to "fix" and may not be the right level, not be inclusive enough, or may not even be the source of the pt's symptoms.

another factor i will mention is patient expectation... another topic that is really variable in its assessment in research. one of my docs went into a lot of detail as far as what i should expect as a "good" outcome, should i decide to have surgery. others didn't, but i'm glad the one did. different studies define outcomes differently, and as i mentioned before, surgeons have different opinions of different studies, so there you go w/ another confounder.

ok i have rambled enough for one night... i have been meaning to write a post about evaluating literature, so there's a start. i'll start a new thread about research methodology somewhere and repost most of this posting.
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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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  #49  
Old 09-06-2011, 02:26 PM
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JKDE302 JKDE302 is offline
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I'm so damn dumb to have this surgery....

Why am I still alive...
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C4-5: Mild disc height loss with central annular fissure. Small broad-based left paracentral disc protrusion. Moderate central canal stenosis-the disc protrusion abuts and mildly flattens the left ventral surface of the spinal canal.

C5-6: Disc desiccation with mild height loss.Diffuse discosteophyte bulge and uncovertebral joint hypertrophy, moderate central canal stenosis- Severe neuroforaminal stenosis bilaterally, right greater than left.
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  #50  
Old 09-07-2011, 10:40 PM
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JKDE302 JKDE302 is offline
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Thumbs down

Can anyone post any links of successful pro-disc removal stories???

.
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C4-5: Mild disc height loss with central annular fissure. Small broad-based left paracentral disc protrusion. Moderate central canal stenosis-the disc protrusion abuts and mildly flattens the left ventral surface of the spinal canal.

C5-6: Disc desiccation with mild height loss.Diffuse discosteophyte bulge and uncovertebral joint hypertrophy, moderate central canal stenosis- Severe neuroforaminal stenosis bilaterally, right greater than left.
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