New information

[WILLIAM]

Is there anyway of getting the information from this website www.medtechinsight.com/ReportA307.html without having to pay over two thousand dollars ?! seems like it might help prospective patients.

[Harrison]

William, that's a great idea, but research firms make their living by selling these reports. Sometimes, they will sell you a chapter for "x" percent, saving you some money.

If you have specific questions, I can ask/research on your behalf. Or simply ask them here, maybe we can help!?

[WILLIAM]

Yes I was hoping someone might have some 'inside ' access to these reports..........I am writing as someone facing surgery in late April. I have been offered a total disc replacement (downside... no possibility of revision and no knowledge of how this will perform in fifteen years time) but am interested in the less invasive, revisable techniques that are beginning to become more popular and which my surgeon believes will be the way ahead......specifically nucleus replacement...such as Spinewaves NuCore injectible nucleus, Pioneer's Nubac system, Raymedica's PDN-solo, and Discdynamics Dascor system in particular since I have speficically been offered this as an alternative.....(downside...new technology...good results so far but nothing beyond a year or two). I have also been offered a dynesys type operation that would only be in place for a year, effectively 'splinting' the disc thereby giving it time to heal. Again this would be revisable if it didn't work (and would buy more time to for newer technologies to emerge/be tested). If anyone out there has information on any of these techniques....preferably firsthand experience...then I would much appreciate it. Thanks and happy New Year to everyone.

[WILLIAM]

sorry, putting this in a different forum as I think its in the wrong place.

[ZorroSF]

I'm ignorant to those new techniques, but I could say that I would not want revision surgery. It sounds great in theory as a backup, but the more revisions you have the more scar tissue that will build up and may even prevent you from undergoing ADR surgery in the future. I could only say choose wisely. undergoing many surgeries is traumatic on your body, pocketbook, and your personal life.

Since you already know of what techniques exist, I would contact the companies and find doctors in your area that preform them to gather more info. doctors in clinical trials can't give out exact numbers, but they can steer you away from the poorer resulting outcomes.

[Alastair]

I think what Zorro said, is so important that you should listen with great care to it and that was

You do not want revision surgery!!

You need to get this operation "right " the first time, revision surgery is extremely difficult and dangerous and quite often it's not participated in by your original surgeon.
Best,
Alastair

[Alastair]

From Spine
Anterior Exposure of the Spine for Removal of Lumbar Interbody Devices and Implants
Posted

Hoan-Vu Nguyen, MD; Behrooz A. Akbarnia, MD; Bruce E. van Dam, MD; Kamshad Raiszadeh, MD; Ramin Bagheri, MD; Sarah Canale, BS; G Mark Sylvain, MD; Robert Barone, MD; Gary Bench, MD

Author Information

Information from Industry
OA Treatment -
View an interactive Webcast reviewing the spectrum of current treatment options for OA of the knee, as well as patient case studies. Abstract and Introduction
Abstract
Study Design: A retrospective review of a consecutive series of 14 patients operated on between March 1998 and April 2005.
Objectives: To report on patients having undergone revision lumbar surgery anteriorly to remove interbody devices placed anteriorly or posteriorly and to determine the incidence of associated complications.
Summary of Background Data: The popularity of interbody lumbar surgery has grown in recent years. Consequently, the number of anterior revision procedures has increased. The risks associated with anterior approach for revision procedures and interbody device removal, in particular, have not been reported.
Methods: The results of 13 consecutive patients who had removal of interbody devices through an anterior approach and 1 patient with removal of anterior fixation (7 males, 7 females; mean age 43 years) were reviewed. The procedure during which the original implant was placed was a posterior lumbar interbody fusion in 4, transforaminal lumbar interbody fusion in 5, and anterior lumbar interbody fusion in 5 patients. Four attending spine surgeons performed the procedures with the assistance of 4 experienced access surgeons.
Results: Ten of 14 (71%) patients had complications associated with anterior exposure of revision surgery. Vascular injury is the most common complication (57%). Vascular complications occurred in 100% (4/4) of the revisions of previous posterior lumbar interbody fusions and 80% (4/5) of previous anterior lumbar interbody fusions. The complication rate at L4-5 and L5-S1 was 89% and 40%, respectively. There was 1 postoperative mortality.
Conclusions: Anterior removal of lumbar interbody devices placed anteriorly or posteriorly has a high incidence of complication. Average blood loss and hospital stay are increased with revision anterior surgery. The vascular complication rate is 2-fold higher at L4-L5 level compared to L5-S1.

Introduction
Lumbar interbody fusion has become an increasingly popular method to achieve interbody arthrodesis. Both anterior and posterior approaches have been described. Interbody fusion has the advantage of a better blood supply, restoration of disc space height, and compression of the bone graft compared to posterolateral fusion. The anterior approach also provides access to a greater disc space surface area but carries the added risk of serious injury to the great vessels, abdominal adhesions, retrograde ejaculation, and a higher incidence of morbidity. These risks are even higher with revision procedures.

In 1984, DeBowes et al[1] introduced the metallic cylindrical intervertebral cage for cervical fusion in horses. Since that time, similar designs have been used in human beings, and numerous structural grafts developed to achieve stability and enhance fusion. These innovations have included the introduction of allograft, metal, and carbon-fiber type cages.

Initial interbody fusion rates with threaded metallic cages were promising. Kuslich et al[2] reported 4-year results with the BAK (Sulzer Spine Tech, Minneapolis, MN), with a fusion rate of 95.1%. Ray[3] showed a 96% fusion rate with use of the Ray threaded fusion cage (Surgical Dynamics, Norwalk, CT). However, subsequent results with stand-alone cages have been less acceptable. Button et al[4] reported a 3-6 year follow-up of stand-alone BAK cages. Ten of 46 (22%) patients required revision surgery, including 9 for pseudathrosis and 1 for lateral cage placement with nerve root impingement. The overall nonunion rate was approximately 30%.

Revision surgery for pseudarthrosis and interbody device migration is technically demanding. In many instances, it can be accomplished by supplementation of the interbody fusion with posterior fusion and fixation. In certain cases, removal of the interbody devices, originally placed anteriorly (anterior lumbar interbody fusion [ALIF]) or posteriorly (posterior lumbar interbody fusion [PLIF] or transforaminal lumbar interbody fusion [TLIF]), is required. These devices can be removed both from anterior and posterior approaches. However, there is an increased risk of neurologic deficit with posterior removal and vascular injuries with anterior removal. The anterior approach has been our preferred technique for removal of interbody implants because it allows for better exposure and access to interbody space without the risk of neurologic injury. To our knowledge, this is the first report on patients with complications associated with such anterior removals.

Section 1 of 6Next Page: Materials and Methods

[WILLIAM]

thankyou for that rather scary article. Point taken but I should point out that in your report NONE of the original operations involved disc replacement. Also, the surgery required for partial disc replacement is much less than for TDR. It is also not performed anteriorly.