Am I a candidate for ADR?

[hey_look_its_dave]

"Dear Mr. XXXXXX,

Thank you for sending your pain history. Dr. Wagner has reviewed your documents. An artificial disc replacement is not recommended, because of a hemilaminectomy before. The only indication is a fusion."


I don't get it. I had the disc trimmed. To get at it, the surgeon went in from the back. He had to cut some bone to get in of course. There's no other way in. So why do I see everywhere that you can have ADR after having the disc trimmed, but yet I'm ineligible?

Figures. This is devastating news. I'm so upset I can't even tell you.

[hey_look_its_dave]

The operative (disc trimming) report states:

"The patient was given a general anesthetic in the supine position. He was flipped prone on the Hall-Relton frame. The back was prepped and draped in a standard fashion. The skin was injected with 1:500,000 epinephrine solution. I performed a left-sided L5-S1 interlaminar dissection. A portion of the inferior lamina of L5 was removed, as was the superior portion of the lamina of S1. The ligamentum flavum was removed. A portion of the inferior articular facet of L5 was removed. I identified the traversing S1 nerve root. I used a Kerrison to follow this nerve root across the lateral recess to the level of the neural foramen. I then mobilized the nerve root medially. There was a moderate disk protrusion present here. I made a rectangular incision into the posterior annulus of the disc space. I then removed the disc material by piecemeal. There were some prominent fragments posteriorly, so I used a reverse-angled curette to push these fragments into the disc space. Once this was done, I then used a pituitary to safely remove the fragments. At the end of the posterolateral decompression and discotomy, the left S1 nerve root was completely free of undue pressure. I could easily mobilize it medially and laterally to the level of the neural foramen."

This doesn't seem to me to be a hemilaminectomy, as the MRI report stated. On the web, a hemilaminectomy is where they remove the entire lamina on one side. He only trimmed it. I can see it myself on the images.

I just sent AlphaKlinik the operative report. Maybe that'll help. I also asked...nay begged.....if I could Fedex my MRI CD to them so they can see the images for themselves.

I'm seriously crapping my pants.

Sorry for all the endless posts.

[2cool4U]

"A portion of the inferior articular facet of L5 was removed."

I think that's key here. ADR requires sacrificing of the anterior longitudinal ligament, thus slightly worsening the support structures of the spine. The posterior support must be intact. Absence of a facet would result in some loss of stability, probably more so in rotation but more motion would occur on the surgical side with flexion/extension, as well.

Don't consider it as an absolute blow to success. L5-S1 fusions have a higher success rate than other levels. You also will likely be able to get care locally or regionally rather than head overseas. Good luck.

-tc-

[hey_look_its_dave]

Just so everyone is aware, if you're thinking of getting a disc herniation trimmed now, and then plan to get an ADR later at AlphaKlinik if necessary, THINK AGAIN.

"Dear Mr. XXXXXX,

Hemilaminectomy is a common procedure and how you have said, it was cut the part of the bone and removed the slipped disc herniation. General our surgeons don’t do it ADR, when the hemilaminectomy or laminectomy is done in the same level.
If you want, you can send the MRI to us, but the recommendation stay the same.
We offer also the fusion in our house."

Dave

[CharlesinCharge]

Dave,

It may be that Alpha Klinik will not do an ADR after a hemilamenectomy, but I know there was a member on this site (Terry) that had one and later had a two level ADR at Stenum. It would certainly be CRAZY to go all the way to Germany to have a fusion, you can have one done here and your insurance will pay for it, they most certainly won't pay for you to go out of the country to have it done. But, I would check with other ADR surgeons and hospitals, I know that Alpha Klinik is not the only game in town and their opinion is just that---their opinion.

[Harrison]

Dave,

By now, I am sure you have read this thread in the most active forum:

ADR Risks, Complications, Disqualifications

In my opinion, this is one of the most important topics on this site. Though posts go back to 2004, this 2008 topic is a good summary of possible contraindications for ADR. That said, as we've seen, there continues to be significant variances in "patient selection" for ADR surgery. More specifically, some surgeons may be accused of "cherry picking," rightly or wrongly. This is more apt to be seen in clinical trials, where adherence criteria may be more strict -- because the guidelines are more detailed.

Keep searching and learning if you can. If you find that you are tired from sitting & reading, find a few meaty topics and print them out for reading when you are relaxing. E.g., for this topic, go to "thread tools," then click on "printer-friendly" topic.

Jack, Sara, Tim, Kim, Charles -- thx for helping Dave think through some of these difficult steps.

[hey_look_its_dave]

Thanks everybody.

This week has been an emotional rollercoaster. But I'd be wandering around in the dark without your site, Harrison.

I did take a look at Stenum, but there seems to be an abundance of horror stories (at least, more so than for AlphaKlinik), and the website heist really grinds my gears. Harrison took the gentlemanly route and threw the law in their face. I'm more childish, and with a knowledge of computer in/security, I would've hammered them into the ground that way. Either way, Stenum is not for me.

The crazy thing is, there was a newspaper article here in Toronto a few months ago (near the end of 2009) which said that the current waiting time to get a fusion here is 10 years. That's right....years! Insane. I suppose a newspaper won't make that stuff up. They focussed on a woman who went to India to have it done. Worked out well for her. India, however, not for me.

I'm seriously considering going to AlphaKlinik for fusion. If Zeegers will do it, I would say I'm definitely in. Why have the bozos around here do it?

Thanks again to everyone for their support - truly a life saver, and I mean that literally.

There's so much suffering on this board, it boggles my mind.

Anyway, even though I'll probably do fusion, I'll keep updating in case it's of some interest.

Dave

[hey_look_its_dave]

I had the wrong newspaper. It was in the Toronto Star.

If you Google "toronto star" and "Woman got my life back after surgery in India", you'll see the state we're in over here.

Dave

[hey_look_its_dave]

Hmmm. On my original issue about whether disc herniation with nerve compression disqualifies someone from ADR, Dr. Bitan's website reads,

"The disk involved has to be studied with an MRI and a discogram. The main complaints should be back pain, which eliminates cases of severe spinal stenosis, and acute nerve compression by a herniated nucleus pulposus."

The word "acute" is interesting.

Dave (more confused than ever)

[annapurna]

Originally Posted by hey_look_its_dave

Just so everyone is aware, if you're thinking of getting a disc herniation trimmed now, and then plan to get an ADR later at AlphaKlinik if necessary, THINK AGAIN.

"Dear Mr. XXXXXX,

Hemilaminectomy is a common procedure and how you have said, it was cut the part of the bone and removed the slipped disc herniation. General our surgeons don’t do it ADR, when the hemilaminectomy or laminectomy is done in the same level.
If you want, you can send the MRI to us, but the recommendation stay the same.
We offer also the fusion in our house."

Dave

You may be mixing things. A laminectomy removes part of the vertebral body, which would really mess you up for future ADRs. A discectomy removes the bulged part of the disc, which shouldn't affect future ADRs.