[Artificial Disc Replacement / Lumbar] 2 Level ProDisc L3/L4 and L4/L5

[GregA]

Hello my name is Greg I live in Hockessin Delaware
I am 43 ,married with 3 kids all boys 1-9 year old , 2-6 year old twins
My first back surgery was 2002 I was getting my son out of the bathtub and twisted while handing him to my wife and herniated L4-5 left side I was out of work for 6 months after having a micro discectomy done
Second Back surgery 6/8/2010 2 Level pro disc @ L3-4-L4-5 .
Problem started at work on 12/22/2009 ,I am a tech for ford motor company I was working on a truck reinstalling an intake manifold on the engine . I was using a shop supplied step to gain access to the engine and while bent over fully stretched out installing the intake the step stool shot out from under my feet,when that happened i arched backward so not to fall into the engine compartment and fractured the 2 discs .
Not long after the accident the doc`s did mri`s, ct scans, x-rays, bone scans, multiple epidurals,sent me to a therapist before having a discogram done . discogram was performed and verified that the 2 discs were fractured .
bone density scan performed before surgery . surgery performed 6/8/2010 no complications. Entry point pain was not good it took 2 weeks before i could get my self out of bed without wanting to scream .
The pain from the discs being ruptured was cured but am still having pain bending over and after standing more than 45 min meds take care of some of the pain .
Surgeon has started me back with therapy to try and diagnose where my pain is coming from after 2 weeks every other day the therapist has narrowed it down to the surgery point .
The surgeon has suggested installing a DSS® Slotted Coupler from Paradigm Spine he is saying that it is almost like having a fusion done but having an ability to still have movement .
I talked to surgeon 1/12/2011 . now I am here
I will be browsing the posts hoping that someone else has had the same things done as I need done and have had done. Today is the first time I have visited this site and hope to be a help to others ,and hope others might be able to give good advise in return
Thanks
Greg A.

[Justin]

Hi Greg,

Welcome to the Spine Patient Society.

I had the Dynamic Stabilization System, DSS™, by Paradigm Spine implanted by Dr. Bertagnoli in Germany. Here's a link to my experience with the DSS: Dynamic Stabilization System: DSS™--motion (non-fusion, 5/14/09, Dr. Bertagnoli).

Why is your surgeon recommending the DSS for your situation? I see you are only around the 6-month mark post-op. For many Spine Patients that have artificial discs implanted, it can take up to 1.5 - 2 years for a "complete" recovery. I remember after my 2-level lumbar ProDisc (see my signature) that I was still seeing improvements at 2 years post-op.

You mention that you are still having pain bending over and for standing greater than 45 minutes at a time. I would venture to say that a good percentage of Spine Patients with multilevel lumbar artificial disc replacement still experienced pain at 6 months when bending over. Personally, I know that I had to change my position frequently to "be comfortable."

Are you having any gross instability with your spine (have your ProDiscs subsided [sunk into the vertebral body], or shifted from their initial placement)? ---> Have you had any recent imaging of your spine done?

What kind of pain are you having? Constant, intermittent, shooting, burning, stabbing ? // where is the pain located? // does the pain radiate down your legs? // What makes the pain better and what makes it worse? //

What type of conservative treatments are you currently doing? Remember, physical therapy should be a daily activity after a two-level lumbar artificial disc replacement surgery, not only when your surgeon prescribes the treatment.

Let me know if you have any specific questions about the DSS and we're glad to have you here.

[KBear]

I agree with Justin. Six months is still pretty early out of spine surgery to be 100%. I had only a 1 level disc replacement at L4/5 and it took 12 months for considerable relief and 18 months before I was pain and medication free. I have heard it is very normal to experience relief for up to 2 years (or more in some cases). I actually had to increase my pain medication around the 4 or 5 month post op point because my pain just wasn't going away. It got worse before it got better. I was very limited through the first 6-9 months and still pretty limited up until 18 months. I'm now able to do whatever I want (I am pregnant, so that does limit me), but within reason. I still don't do certain activities such as carry heavy things or act like I'm invincible like I used to (oh to be young and dumb again.....)

[Hooch]

Yeah I agree with the mob, I wouldn't be jumping into another surgery at 6 months out, espescially you say a lot of your pain has been relieved.

I would get stuck into the PT for a number of months, work on strengthening and activating your core and maintaining neutral spine in your functional movements. If you haven't done this first and continue to do it you shouldn't be a surgical candidate.

[txbearsfan81]

Im new to all of this too. Well to knowing what to do, not to back pain. I was considering getting an artificial disc put in because it made more sense to me then just fusing the area where there used to be a natural disc. Seems to me from this post and others that getting an artificial disc may not be the answer. Please keep us posted on what you decide and how that stabalization system works out. Never heard of that before but that may be good for my degenerating discs.

[GregA]

hello thank you for your replies
Justin I don't know the time line for pain as I have never talked to anyone that has had these discs done.
The first 2 months after surgery seemed to be back pain free,the last 4 months the pain seems to be getting worse
the more I do the worse the pain feels , Christmas shopping was the worse going around to different stores with my fife
In and out of the car and just walking around for a few hours at a time was bad.I did not ask my doctor why he was being so quick to do another surgery I just assumed this is the way it is.
"I know that I had to change my position frequently to "be comfortable." " Justin this is exactly the way I am, ether sitting or standing sometimes laying down.
I have had x-rays,mri,bone scan, done in the last 2-3 months and the doctor says that the implants look good no fractures of any of the vertebrae no settling or dropping of the implants and there is not any instability at all. I have more flexibility than I ever had it hurts like hell to bend and flex.
The last 2 weeks I have been working with my therapist and he had me trying different stretches ,one where I would lay on my stomach and do a fake pushup " call it" I would leave my legs and hips on the table and just push up my upper half several reps there was no pain the first day but the next day the pain was severe. The next day he had me pulling my knees to my chest while laying on my back there was some pain doing that but when I got up off of the table I was able to bend over with little to no pain but that would only last about 15 min my flexion backwards was about he same with little to no pain after doing that knee to chest.
My pain is coming from my lower back area above and around the surgery area the pain is constant burn needle stabbing pain. When I first got hurt I was having the nerve burning in my right lower back that radiated around my hip and buttocks and into my groin that was taken care of on my very first epidural. Since that time I have never had any nerve pain around my waist or down my legs.
I am not doing any regular therapy . just diagnostic therapy, when I was doing some basic stretches the pain increased so the doctor stopped all therapy. I try not to do much during the day I walk,do chores around the house,go to the store,go to my kids events. the longer I am up and moving around the more pain I feel.
I have a surgical consult with the doctor in 3 weeks I think now I will have allot more Questions to ask him when I go.

txbearsfan81 Knowing what I know now, Feeling what I feel now,I think I would do it again.The pain of my fractured disc with the juice"Nucleus pulposus" running out hitting my nerves Was not fun .If I had gotten the fusion I know that I would not have the flexibility that I have now .They did tell me that a fusion is irreversible and that you can always go forward with a disc implant. I don't know if these stabilizers will help but I cant stay in pain so I will try if I think it will help .

Greg A.

[Cindylou]

Welcome Greg. I do concur with all the other responders to your post, that additional surgery at this time is definitely premature and NOT warranted, 6 months after 2 level lumbar disc replacement. This is not medical advice, of course, however it is strong layman recommendation....after having been there, just like all the other folks who responded have "been there." Who is your surgeon, if you don't mind my asking? You really need to give yourself at least 12 months minimum, before you start barking up the surgery tree again. Be patient. Give your body time to heal and start doing your physical therapy more regularly at home, of course, within limits, because if pain really increases like you have stated it does, than you need to back off some, but don't quit altogether. Not good. The body is meant to move, and at 6 months post-surgery, you should be doing some physical therapy, as I stated earlier. Good luck during this healing phase and I hope you will give consideration to all that has been offered. Wishing only the best for you, Cindylou

[Justin]

Hi Greg,

If you physical therapist is making you do activities that are hurting your spine and that are causing great pain, I would speak with them about exercises that you can doing without hurting yourself. I had to "draw the line in the sand" with my physical therapist after my 2-level artificial disc replacement in 2003. I was her first patient with such an operation and I avoided certain exercises that I knew were too much for my spine to handle.

Recovery from spine surgery is a tricky balance of not doing too much and not doing too little. The more one lays around and is inactive after spine surgery, the more difficult their recovery will ultimately be. Those Spine Patients that spend most of their days in bed are actually causing more harm than good--this can set one up for a quick downward spiral.

Unless there is gross instability of your spine or your artificial disc has drastically subsided, I personally believe that thinking of having another surgery at 6 months post-op is extremely premature. 6 months post-op is still very early post-op when in regard to artificial disc replacement. Most lumbar Spine Patients experience distraction pain and this can last anywhere up to 2 years post-op. Your body just went through a MAJOR traumatic event and it is still in the early phase of healing.

At your surgical appointment in 3 weeks, I would definitely question your surgeon and get his take on your situation. I think you will find that most surgeons will be reluctant to operate on a patient 6 months post-op, even if it is what they do for a living.

Good luck and keep us posted.

[GregA]

I guess I should have been a little more clear with the therapist deal, he was doing "diagnostic" therapy trying to pin point a location where the pain was coming from. I will definitely be talking with my doctor about all of the concerns addressed to me here!
I do not feel that there is a need to let everyone know my doctors name at this time he is a very good doctor in this area and has had a very good record of success.
My doctors quickness may be from my urge to get well quick. I may be too aggressive in wanting to feel better quickly.
With a wife and 3 small kids I need to be able to keep up with them, and I cant and that drives me crazy.

[Hooch]

Gday, the other side of the coin is that your surgeon might have seen something in the follow up mri or cat scan. If it's clear on imaging that your facets have degraded seriously over a few short months then the surgeon may see a clear indication for posterior stabilisation. But before that they'd probably try a few steroid shots in the facets and pt to see if they settle.

You'll need to do PT work on reactivating your deep core musculature, TA, multifidus etc. If these muscles are not functioning correctly for you you will likely be in pain regardless. Say 'transverse abdominus activation' and 'multifidus co-contraction' to your PT, if they don't know what you are talking about get a new one.