Thoracic ADR?

[JK2234]

My stepdaughter has scoliosis and had 4 of her thoractic discs removed and the vertabrae fused. She really doesn't exhibit any limitations from the loss of motion.

Thank you for letting me know that, how is she doing?

[sportsnut3007]

I know axiomed is working on them. Bob, how did you get such bad back man lol does it run in the family or what. My family doesnt have any history, so im thinking it was due to a basketball collission in mid air and me falling knocking my spine out of alignment till recently went to a chiro who popped me and now I dont pop so i guess its "straight now" Idk though always thought chiros were a littel on the quack side lol but im hoping im better now some how lol. Or it could just be bad genes with just me some how idk lol.

[trkdoc714]

She's doing fine. The surgery took place in 2004. She just graduated HS this spring. The surgeon took her from 85 degrees to less than 20.

As far as my back goes, there were a lot of events that could have started the DDD. HS football, gocart, motorcycle and 1/4 midget wrecks, skydiving, auto accidents or having an ex-wife on my back for 16 years.

I haven't been doing any product research as I'm hoping my Mavericks set off the metal detectors at the Pearly Gates. I'll do some research into the thoractic ADRs. That's pretty interesting. I would think the surgical procedure would require a lateral approach to avoid major organ and spinal cord hazards.

As far as chiropractors go, the last one I visited probably did more damage than good. But by that time my discs were probably too brittle to be manipulated.

Bob

[KBear]

I couldn't agree more with Greg and Bob about the thoracic spine. You couldn't pay me enough money to put an ADR in my T-spine, no way no how. I think it would cause more problems b/c you are adding more motion than what God intended it to have. I'm obviously not a doctor and this is my opinion based on my own research. I also would fuse L5/S1 without a second thought, I know a lot of people have ADR's at that level and a lot are doing great, but there is another good size percentage who are not doing great with ADR at that level.
Fusion does get a bad reputation, and it's unwarranted. I was led to believe that fusion was the worst possible outcome and to never do it (by doctors at that). I had one refuse to fuse me when I begged and cried (read: had a breakdown in the office) that I could not live like this (she referred me to chronic pain management for the rest of my life and said there was nothing else they could do for me). My uncle seriously has at least 6 levels fused, and it's probably a lot more than that. He has most of his L & C spine fused and is in his 60's. His spine has been treated bad his entire life, from motorcycle wrecks, to daily heavy lifting, smokes 1+ packs of cigarettes a day, does not eat healthy and so on. The man has lower pain levels than I do, recovered from his last operation in 6 months and can bend over and touch his toes, can turn his head side to side and has absolutely no motion lost. I can't even touch my toes! He is the poster child showing that fusion does work and is a very valuable tool.

[KanRunMo]

I have a compression fracture at T10 and T11, among all the other things. I thought they must mean the vertebrae so I was looking into kyphoplasty, the balloon/bone cement procedure. Now I wonder. I'm surprised they don't do ADR at those levels. I guess with the "cage" fusions you can get the height back from degenerated discs just as with ADR. I will be seeing an orthopaedic in August so I will find out.

[trkdoc714]

I'm not certain but I think the fracture will be a contraindication preventing an ADR.

Justin's more learned (he's a Dr. now) and may be able to shed more light on the thoractic ADR possibilities.

Good luck in August!

Bob

[Justin]

I'm not certain but I think the fracture will be a contraindication preventing an ADR.

Justin's more learned (he's a Dr. now) and may be able to shed more light on the thoractic ADR possibilities.

Good luck in August!

Bob

Not yet, Bob. I still have a few hoops to jump through.

[Carson]

Some good info on thoracic approaches including NuVasive's newer lateral XLIF approach here

Really impressed with this company NuVasive. They're putting in real work. Definitely a company to watch.

[MDE]

From my understanding the thoractic levels have limited range of motion +/- 3 to 4 degrees. My stepdaughter has scoliosis and had 4 of her thoractic discs removed and the vertabrae fused. She really doesn't exhibit any limitations from the loss of motion.

Access to and the limited range of motion of these levels make it prohibitive for a surgeon to safely choose an ADR over fusion. The increased range of motion of the current ADR designs could actually create more spinal issues due to up to 12 degrees of motion at a level normally with a 3 to 4 degree range.

As far as ADR for the L5/S1 disc space, there is a school of thought that this will prevent adjacent level complications of the SI joints and L4/5 disc. The normal range of motion of the L5/S1 is +/- 8 degrees. I guess it is a matter of specific pathology of the patient.

Recovery (as forcast for me) was longer for fusion than the ADR (6 to 12 months v.s. 8 to 12 weeks). This also was a consideration for my decision.

Bob

TRKdoc ‘s post is very good. A few additional comments:
1) There is almost no flexion extension or lateral bending ROM in the T-spine, however there is decent amount of rotation.
2) The thoracic spine is extremely stiff, which is why there are high stressed joints at the thoracolumbar junction and the cervicothoracic junction. These are areas of particular interest when there is instability and will almost always require fusing to maintain stability.
3) The upper thoracic (T1-T3) can be treated similarly to the cervical spine during fusion cases, but because there is little benefit (very little motion and a much higher difficult of an anterior approach) it is typically only fused posteriorly. There have been ADRs done in this area, but it isn’t typically a recommended procedure.
4) The lower thoracic, and even the upper lumbar, is a much more difficult anterior approach as well. As has been stated a lateral approach is common, however this is a very rare area for DDD to occur. Most of the issues you see at T10-T12 are compression fractures due to landing extremely hard on your feet or pelvis. Fractures are never an indication for disc replacement because the problem is not the disk, it’s the vertebral body. Kyphoplasty and other height restoration surgeries can be done to restore the vertebral body height and then can be fused afterwards to maintain stability. Also, sometimes they’ll completely remove 1 or 2 vertebral bodies and all associated disks and use what’s known as a vertebral body replacement. This is also typically stabilized through the use of lateral or posterior instrumentation.
5) The middle thoracic combines the worst of all of the above. Extremely difficult to approach, the ribs make the lateral approach more difficult but really the only option for access to the vertebral bodies, the posterior approach only allows fusion and is still difficult due to the small size of the pedicles compared to the relatively large forces involved.
Pretty much anyway you look at it, an ADR in the thoracic spine is not providing any benefit while adding risks and complications.

[trkdoc714]

MDE,

Great information. I'm glad I don't have to face that type of issue at this point.

Who knows what direction technology will takes us in the future. Thanks to people in your profession it's exciting to think our children and grandchildren will find the present day debilitating physical problems easier to access and correct.

Bob