Cervical & Lumbar Spine Problems -- Am I a Candidate for Artificial Disc Replacement?

[jss]

Terry,

Condolences on your condition. Over the past 10 years, I've had three surgeries on four cervical levels, and I do/did truly "feel your pain". Let me first ditto Jack-of-all-trades' statement, "The worst thing you can do is say 'well, you are the doctor'". You have a HUGE advantage over most of us in that you're a nurse and have a far greater understanding of human anatomy and pathology than most/all of the rest of us. I encourage you to use that fact to your advantage. You're "pre-existing knowledge" and research can prove to be enormous advantages; PLEASE use them.

There are many contra-indications to ADR, (osteoporosis, obesity, previous cancer, etc...); if you have none of those, as someone that's had two fusions, I would encourage you to avoid fusion unless there is simply no other way. Certainly $$$ can be a contra-indication, but I would encourage you to consider international options where possible. As you are assaulted by the same ten headed dragon as the rest of us (your insurance company), there is a very good source for this problem; Google "Laurie Todd". She claims to have a very good record in getting medical insurance companies to pay for procedures that they would otherwise not cover.

Sigh... Good luck!

Jeff

[tvdvmv]

I saw the doc and he said my only option is fusion at L2-4. He didn't say anything about my DD"s at L5-S1 just the fusion. I've also got the DDD at C4-7, he said when I'm ready he would have to fuse thos also. He also said even if he could do more than 1 level AD I would'nt be a candidate due to the fact I have >50% collaspe. I'm going to see about having the doc from India look at my films to see what he would recommend.

Where are your fusions and do you feel better, limited? Is your pain resolved?

Thanks for getting back to me it amazes me how much better my mood is since I have found others to talk to.
Terry

[Justin]

Hi Terry. I'm interested in this statement in particular:

He also said even if he could do more than 1 level AD I would'nt be a candidate due to the fact I have >50% collaspe.

Personally, I have never come across disc height as an "exclusion criteria" for an artificial disc replacement device. However, decreased disc height can result in advanced degeneration of elements of the spine (ligamentous, facet joints, etc.). Significant collapse of a disc can make an operation like artificial disc replacement more challenging. With that said, I've personally spoken to many surgeons that have placed artificial discs at levels where the disc space was minimal (some of these cases were literally "bone on bone"). Placing an artificial disc replacement device at a severely collapsed level is one thing, but how these patients ultimately do long-term is another.

Questions for you:

• Did your surgeon mention how your facet joints in your lumbar spine look? (Advanced degeneration of facet joints are a contraindication to artificial disc replacement surgery.)
  
• What "type" of fusion will your surgeon be performing?

We are here to support you and help answer any questions you have.

[jss]

Where are your fusions and do you feel better, limited? Is your pain resolved?

Thanks for getting back to me it amazes me how much better my mood is since I have found others to talk to.
Terry

Terry,

My fusions were C4/5 in 2000 and C5/6 in 2002. All sensory and motor impairment was resolved both times by the time I woke up after surgery. After each fusion, my mobility was noticeably limited, by me and by others that knew me. My ADRs were C3/4 and C6/7 in Nov 2009. The intractable, debilitating pain was gone by the time I woke up after surgery; though my left hand is still mostly numb. But with the ADRs, I have all of the mobility that I had prior the C6/7 blowing up.

I am so glad that you've gained some peace of mind on this site. I recall how difficult it was to be constant pain, all the while trying to make diligent and prudent (not to mention life changing) decisions.

From reading your doctor's prescribed treatment, it sounds like his approach to DDD is, "Well, all I'm trained to do, and all the insurance company will reimburse me for is fusing this patient's spine into a 2x4; so let's FUSE IT!" That was the approach of two of the eight doctors I approached before having the double ADR last November. Two of those doctors (my PCP and my anesthesiologist) had never even heard of ADR, and two more (a neurosurgeon and an osteopedic surgeon) were aware of ADR but dismissed it solely because it was something that they didn't do. In the Dallas area, where we live, there is available a wealth of medical options for DDD. I don't know what's available in Montana, but prior to making your treatment decision, I would strongly encourage you to expose your case to practitioners that treat DDD with a host of different treatments; the last resort of which involves fusing your spine into a fence post.

[tvdvmv]

Did you have your double AD in Texas? Was it covered by insurance or did you have to pay out of pocket? On the L2-4 I do have some facet degeneration on one side of L3 I believe. I believe this is a contraindication for AD but I'm thinking even if we had to fuse 1 could we not do AD at the upperlevel and also would it make sense to do AD's in L5-S1 while were there as my DDD in those two levels certainly isnt' going to get better. Just wondering if my thinking is reasonable or if I'm off base.

Where and who did you doctor with in Texas, as when I first started researching and before I found this site I was reading about docs in TX.

[jss]

Did you have your double AD in Texas? Was it covered by insurance or did you have to pay out of pocket? ...

Terry, my double ADR was done at the Barcelona Spine Center in Barcelona, Spain by Dr Pablo Clavel. I am currently engaged with Blue Cross Blue Shield of Texas to get reimbursed for as much of the $27533 as is possible. They've had my claim for six weeks and as of Friday its status is "Pending"; no one can tell me why.

... On the L2-4 I do have some facet degeneration on one side of L3 I believe. I believe this is a contraindication for AD but I'm thinking even if we had to fuse 1 could we not do AD at the upperlevel and also would it make sense to do AD's in L5-S1 while were there as my DDD in those two levels certainly isnt' going to get better. Just wondering if my thinking is reasonable or if I'm off base.

I have read that ADR is contra-indicated for cervical levels with either facet joint disease at the operative level, or with a fusion at an adjacent level. Lumbar may or may not be the same; I don't know. The contra-indication for cervical ADR with an adjacent fusion is, as far as I can tell, bureaucratic rather than medical. The FDA approval process for a new device/process is so finely granular that a device is not just approved or dis-approved, but rather approved for a very specific application only. As such, trials for new ADRs are almost always limited to those with no adjacent fusions. This eliminates many variables for the device manufacturers that want to get their device to market ASAP. I don't know, but suspect the same may be true of the contra-indication for ADR at a level with facet joint disease??? The FDA does allow for "off label" uses of some devices, such as ADR adjacent to a fusion, but insurance companies are notorious for not covering "off label" applications.

To me your thinking sounds reasonable; that is, addressing adjacent lumbar segments that have DDD that are currently asymptomatic but are expected to become symptomatic (ESPECIALLY if you have to fuse an adjacent level).

Where and who did you doctor with in Texas, as when I first started researching and before I found this site I was reading about docs in TX.

The surgeons in the Dallas area that I saw were;

- Richard Naftalis, who did my prior fusions. I have complete confidence in his ability to give me as good an outcome that can be had. Problem was, he doesn't do ADR and wanted to do more fusions; this time with BMP.

- Jack Zigler at Texas Back Institute. I was scheduled for ADR with Dr Zigler in 2008, but canceled because of my aversion to the ball and socket design of the ProDisc-C. Further, even though BCBS-TX pre-certified the procedure, he said that they DON'T cover off-label usage of the ProDisc-C, and that I would be required to cover the $50k of bills from him, the hospital, the lab, the anesthesiologist, etc... Like Dr Naftalis, I had complete confidence in Dr Zigler's ability to give me as good an outcome as could be had.