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  #1  
Old 04-25-2016, 11:31 PM
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Ozphysician Ozphysician is offline
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Default In the research phase - any experiences with the XL TDR ?

Hello all,

New to the site, live in Australia and I'm a local Sydney based primary care physician. Having recently been through stem cell treatment for my facets which are much healthier now [see my post in regeneration lab], I'm looking at ADR / Fusion options for my two lower lumbar levels which are moderately degenerated and wont last. They are largely asymptomatic but I have lost lordosis and the weight bearing on my facets is and will continue to take a toll. I plan to be proactive.

Having just been through a period where I have managed to re-grow cartilage in my facets via stem cells and PRP, Im very conscious of the impact mechanical movement that an ADR can or may promote, so I have been researching the various prostheses on the market and surgical techniques.

I'm interested in any experiences members have had with the XL-TDR. Its a ball and socket model but because of the lateral technique used to implant it, they leave the ALL and PLL as well as part of the annulus in tact providing more rigidity in the joint. I would be looking to have this put in place at L4-L5 and a STALIF fusion at L5-S1


Any feedback or comment ?
__________________
Lumbar DDD progressing for the last 15 years
Facet joints with mild arthrosis at L4/L5 and L5/S1
Two ESI's only too afraid to have more [causal link to arachnoiditis]
Otherwise suffered in pain on and off
Recently had stem cell treatment for facets which have improved markedly
Looking at hybrid solution in the coming months
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  #2  
Old 04-26-2016, 12:53 PM
FutureRobot FutureRobot is offline
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Unfortunately, I think the XL TDR was a big failure. I remember reading up on this through google and it never really made it past the trial. So you are largely asymptomatic?
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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  #3  
Old 04-26-2016, 02:07 PM
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Cynlite Cynlite is offline
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I'm following your threads on stem cells. Thanks for posting the information as I'm very interested but, haven't found someone in the Phoenix area that I want to go to yet. I'm really amazed that it worked out so well for you and restored your facets! That's a great endorsement. It's pretty expensive here in the U.S. Every office I have spoken to charges $10,000 or more for treatment. I'm just not sure who to trust for this type of procedure.

There is a surgeon in Colorado, Dr. Kenneth Pettine, that was involved in the stem cell trials. One of his patients on this board is a big fan and has had stem cell injections from him. I have not seen any f/u images so it's hard to gage how much of her recovery was from the two ADRs and fusion surgery versus the stem cell treatments. I sent him my information last year. In addition to stem cells, he recommended a fusion device for my lumbar you might want to check out. It sounds like it's the next best thing to ADR because it attempts to preserve range of motion. I'm not sure under what conditions it is appropriate. I just thought I would share it with you in case the information is useful.

http://www.coflexsolution.com/content/what-coflex

Also, if you haven't already checked out Dr. Clavel in Barcelona, I would recommend that you get an evaluation from him. I worked with Dr. Zeegers, Dr. Bierstedt and Dr. Clavel last year (all are in Europe.) I was impressed the most with Dr. Clavel and will go to him for ADR surgery if I can get past my hurdles. He has an amazing track record with his patients and the post surgery images I have seen show perfect placement of the ADRs. There are a few members here that have gone to him that did not have a perfect outcome but, of all the surgeons I've talked to, I think he's the best.
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2006: epidural shots did nothing; 2 surgeons recommended 2 level fusion, I declined.
2007 - 2010 4 foraminotomy and cord decompression cervical surgeries and 2 endoscopic discectomy T7-T8 surgeries; total 6 with Dr. Jho (Pittsburgh,PA) My C6/C7 autofused around 2009.
2013 - 2015: epidurals 3 times (again did nothing) and 4 Radiofrequency ablation (or RFA) procedures.
2016 more RFAs, hit the 10 year mark of this insanity and pain, 3 level M6-C ADR with Dr. Clavel May 19, 2016
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  #4  
Old 04-26-2016, 05:54 PM
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Ozphysician Ozphysician is offline
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Hi Futurerobot

Thanks for your feedback.

Yes largely asymptomatic but L5-S1 is down to 7mm with a small vacuum phenomenon. I wont go ADR at that level - if an ADR goes wrong it seems from what I have seen and heard, that it will go wrong at that level because of shearing forces and variable lordosis angles [makes placement just so critical]. That's obviously only my personal view and there a great many successes of course but not going to do it. If I fuse that level then I will have to do something about the level above which is dessicated but still fairly stable and 11mm in thickness. I have been contemplating fusion then just leaving L4/L5 alone to see what happens - not sure about this just yet hence exploring options

There are two surgeons in Australia that still implant the XL TDR, one is a butcher and I'm no chance of going there, the other has had a few patients with good follow up stories at the 12 month mark. The theory is good but if there isn't a reasonable level of good outcomes I wont be going down that path

Thanks
__________________
Lumbar DDD progressing for the last 15 years
Facet joints with mild arthrosis at L4/L5 and L5/S1
Two ESI's only too afraid to have more [causal link to arachnoiditis]
Otherwise suffered in pain on and off
Recently had stem cell treatment for facets which have improved markedly
Looking at hybrid solution in the coming months
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  #5  
Old 04-26-2016, 06:28 PM
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Ozphysician Ozphysician is offline
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Hi Cynlite

Yes I have to say I was shocked by the results of the second CT. It blew me away. If my disks weren't so bad, well L5-S1 anyway, I would go down the regenerative path with them. I genuinely believe its maybe 5 years away from being the most effective treatment for people with mild to moderate DDD. Too late for me I think !

There are a few things that I think contributed
1. Facets being synovial joints have, even in a degenerated state a fair level of blood flow - which makes then more likely to be regenerated than disks of course
2. I cant overstate the lifestyle thing. no caffeine, no processed food, I renewed my faith in God, 1 hour of hyperbaric treatment every week, aqua aerobics, I gave up work for 6 months. I was due for a break
3. I'm about to go for my third IV treatment - so religious observance of booster stem cells I think is key
4. I had to convince the best interventional radiologist in Australia [my view of course] to do the injections under CT guidance for accuracy - this was key. If you can make it to Australia I highly recommend him and a couple of the biologics firms including the one who did the PRP and Stem cell harvest for me
5. Prices in Australia are much cheaper and our insurance system is different to the US, being far more open to "alternate" methods. All up the interventions were well under $9000 Australian and out of pocket was $4000

I am lucky in the sense that the articular members themselves haven't calcified - no amount of regenerative medicine is going to fix that

The Coflex has fallen out of favour here in Australia. I really need to understand better why that is.

Yes I'm hearing good things about Clavel, I just worry about post surgical care. Spain is a very very long way from Australia and doctors here are funny about follow up on someone else's surgery, but I might ask for an assessment

Are you looking at ADR's soon ?
__________________
Lumbar DDD progressing for the last 15 years
Facet joints with mild arthrosis at L4/L5 and L5/S1
Two ESI's only too afraid to have more [causal link to arachnoiditis]
Otherwise suffered in pain on and off
Recently had stem cell treatment for facets which have improved markedly
Looking at hybrid solution in the coming months
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  #6  
Old 04-26-2016, 07:15 PM
annapurna annapurna is offline
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If you have two levels that need to be addressed, one needing surgery and a second that might not, have you considered ADCT? Take the remaining nucleolus from L5-S1, culture, and reinject into L45. There are also a few people willing to do direct stem cell injections into disk but pretty few.
__________________
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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  #7  
Old 04-26-2016, 07:22 PM
FutureRobot FutureRobot is offline
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Just my opinion, but I feel like if you are asymptomatic, you can possibly push off surgery for a long time doing a ton of core work and strengthening. DDD is really common, and a lot of people live with it for many, many years with just a nagging ache (I've been doing it for 6 years). It sounds like you don't have nerve compression either, which is good. I guess it's good to be prepared, but if you are asymptomatic now, then there is reason to expect that you can halt the progression and need for surgery. At the end of the day, it's all about the pain, right? Some people go years and years with little disc height and very little pain...everybody is different. I guess I'm saying all this because I'm in a similar situation and do not want to have surgery any time soon.

As for l5-s1, I think Activ L is a pretty good disc for that level, as it's design is pretty sturdy. I would check with Zeegers and Clavel before doing anything though, definitely.
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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  #8  
Old 04-26-2016, 08:25 PM
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Ozphysician Ozphysician is offline
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Hi Futurerobot

It's a fair point and that's where Im at right now. My life has been seriously modified and at 45 years old I think I should be doing more but perhaps Im greedy. The risks [as with any surgery] are high and I could end up worse off. That has probably kept me from doing anything just yet. I must admit as a doctor I have seen patient scans far worse than mine who are asymptomatic, in fact I had a patient who's scans I kept on file that showed severe facet arthritis with encroachment into the foraminal space, three severely narrowed and dessicated disks and he could perform full flexion and extension pain free ! His pain was from an aneurysm pressing on the vagus nerve, hence the scan

Being a doctor I look at my scans and start freaking out - doctors make the worst patients
__________________
Lumbar DDD progressing for the last 15 years
Facet joints with mild arthrosis at L4/L5 and L5/S1
Two ESI's only too afraid to have more [causal link to arachnoiditis]
Otherwise suffered in pain on and off
Recently had stem cell treatment for facets which have improved markedly
Looking at hybrid solution in the coming months
Reply With Quote
  #9  
Old 04-26-2016, 09:00 PM
FutureRobot FutureRobot is offline
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Join Date: Jan 2016
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Quote:
Originally Posted by Ozphysician View Post
Hi Futurerobot

It's a fair point and that's where Im at right now. My life has been seriously modified and at 45 years old I think I should be doing more but perhaps Im greedy. The risks [as with any surgery] are high and I could end up worse off. That has probably kept me from doing anything just yet. I must admit as a doctor I have seen patient scans far worse than mine who are asymptomatic, in fact I had a patient who's scans I kept on file that showed severe facet arthritis with encroachment into the foraminal space, three severely narrowed and dessicated disks and he could perform full flexion and extension pain free ! His pain was from an aneurysm pressing on the vagus nerve, hence the scan

Being a doctor I look at my scans and start freaking out - doctors make the worst patients
Believe me, I start freaking out when I think of this stuff too. I'm getting my MRI early May and I'm already getting anxiety attacks at night. I'm 33. I also realize that most of the people on here (you can look at past stories) were barely able to walk for more than 10 minutes and were in utter agony when they decided to bite the bullet. I like to tell myself that we are a ways out from that.

We probably are very similar in that we are just preparing for the worst; it's how we cope with the trauma and having our future in jeopardy. I applaud you for the research though, as having a plan is always a good thing. You never know when the spine is just gonna give out. Until then, keep strengthening, doing planks, stretching. I've been doing Foundation Training and it's helped tremendously for the back pain...the foot stuff, ehhh, my cause for panic.
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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  #10  
Old 04-26-2016, 10:57 PM
annapurna annapurna is offline
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The advice I've given may times is to do all your research and figure out the plan to deal with your situation, even if you're not ready to pull the trigger on surgery. If nothing else, I've found that I can deal a lot better with pain and disability if I know how I can address it once it becomes time to do so.
__________________
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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