[Artificial Disc Replacement / Revision] Artificial Disc Replacement Removal and Revision to XLIF Fusion + PLIF

[Gilbert P]

Hi Mark

I`ve been reading your story from the beginning and you are truly an amazing person to be so strong.
Thanks for your story and all the best on your speedy recovery.
keep us posted

Thanks

Gil

[mark-Perth]

Mark,
That is awesome news! It sounds like you are doing wonderfully, especially so soon post-op! I bet you will make a full recovery and be pain free in a few months! I love hearing a great success story and you are definitely one of them. Praying for many pain free days ahead for you!

Thanks Kathy. It definately shows the benifits of minimally invasive surgery as I seriously doubt I would have been able to handle an open surgery again , let alone feel so good so quickly after surgery.

I think having realistic expectations was very important going into a revision surgery as the chances of living a totally pain free life again aren't good, if possible at all. Its unfortunate but true and there aren't many articles that say the person is "pain free", but any improvement is better than none.
My surgery has definately been a huge success though and after living with unbearable pain, alittle pain like now is easily manageable.
Just being able to get out and have a life again has made it worthwhile.
Thanks for the well wishes
Mark

[mark-Perth]

Hi Justin, Terry & Gil

Thanks for the well wishes.
I dont know about being so strong thru this. I think it come down to knowing I didnt have a choice. I couldnt leave it like it was or my spine would have been stuck like that.
You can see on the front on Xray(AP) prior to the removal (26march) that the disc was fusing itself inplace crooked. There is a white line forming on both sides of the disc which was bone growth. That was actually visible on scans 30days Post ADR OP but was significally greater 3 months later so it shows how quickly something can self fuse.
At the start of the OP my back was 'flexed" in that area to make sure the bone growth wasnt solid under fluroscope. Luckily it did move otherwise they would have had to come from the other side which is abit harder and would have required more bone removed as the disc was further to the left. Im definately very lucky that it come out easily.
Thanks

Mark

[Liz]

hi Mark,

i'm glad you are doing so well!

it's amazing how fast you are reducing your morphine, and really unreal how much you were functioning on in the first place... you sound GREAT! Have you needed anything like Suboxone to deal with any withdrawal symptoms or are you handling the decrease OK?

i wish nothing but the best for you... you are extremely fortunate things went well after suffering so much for so long... a great surgeon, good timing on the removal (not waiting too long) combined with some luck all came together perfectly for your success.
i know you will LIVE each day to the fullest and i hope you feel better and stronger each week.

thanks for being a HUGE support and great friend to me off the forum... i am extremely grateful.

cheers to you...

Liz

[daveinaustin]

Mark,

It is so great to hear how you are getting your life back! You have been tremendously influential on many people, and have always demonstrated the importance of optimism.

-Dave

[mark-Perth]

Hi Liz

Thank U so much for all the support and well wishes. You really have been amazing friend through everything. If only I lived close enough to be able to come over and celebrate with a few bottles of great wine.

It really feels amazing to have come through this with a result like I have. I really cant believe the change some days, its just far beyond my best dreams. I think I would have to be crazy not to live everyday to the fullest now
I cant believe that I didnt buy a lotto ticket that day, luck was definately on my side!
But I definitely have a lot to thank Dr Pimenta for I can tell U.

Your comment also about not waiting too long is so true. Knowing it was fusing crooked so soon after implanting is horrible to imagine.

We arent as lucky to have suboxone available in Aus unless you become a registered drug abuser with the police. Crazy isnt it
Ive been doing great though just reducing the Mscontin. Im down to 40mg now and dropping 5mg every 2nd day. Its definitely harder the lower it gets but I havent yet had any sickness or withdrawals so Im very happy with it. I have just used a 30/500 codeine/Paracetamol tablets for any extra pain which seems to do the job or a topical Lidocaine spray but its been pretty rare that I have needed these.
The main thing I have found is controlling my exercise routine and day so I dont cause excess pain needing extra medications. I definately need plenty of rest as well to feel good.
I also cant believe how I was able to function before on that dose of opiates, if anything it was probably easier than now as I was so used to it. I feel alot clearer already although my memory has been shocking. Wierd
Hopefully in a few weeks I can give my body a total break for a while. That would be great.

Thanks for the amazing support. U have been my

Take care

Mark

[mark-Perth]

Mark,

It is so great to hear how you are getting your life back! You have been tremendously influential on many people, and have always demonstrated the importance of optimism.

-Dave

Thanks mate for all your support both on here and in PMs. U have been a great support and my thoughts are now with you to get better as well.

Hoping for a quick recovery for U.

Mark

[Fuzzy]

I am glad to read that you are doing will after such a difficult surgery.

I hope you will improve to much better then what those studies call a sucessful oucome. I wish you no pain and no opioids. Thank you for sharing your story. You are helping others!

[jamie5136]

Hi

I finally had my Maverick ADR removed and fused and thought it best to start a new post to explain how I got it out.

I travelled to Brasil to have surgery with Dr Luiz Pimenta at the Santa Rita hospital in Sao Paulo at the end of July 2009. Dr Pimenta was unlike any other surgeon I dealt with in the way he treated me with his willingness to talk to me on the phone and email me directly. He was the only surgeon to give me any confidence that he could remove the disc for me and also had experience with ADR removals. It really was extremely comforting with all I was going thru.

The surgery consisted of a lateral(XLIF) approach to the disc space which was thru a horizontal cut about 2inches long a few inches above my hip.

A hemi-corpectomy (partial verebra removal) was done to remove a section of Spine vertebra the same shape of the bottom keel of the ADR to expose the keel fully. With my case the top keel was on the angle and the bottom disc was resonably level so the approach was much easier with the bottom keel so the bottom vertebra was cut instead of the top one. OUCH!

With the bone out the keel can be accessed without having to distract the vertbra again. The Maverick ADR also has 2 small holes on each plate which enabled him to screw a small screw into 1 of the holes to have something to grab onto to pull the endplate out.

With the bottom plate out there is enough room for the top keel to be grabbed onto to remove thru the gap. (If only it was that simple)

By cuting a decent section of bone out neatly, the bone can also be put back inplace after to fuse as well, keeping the strength in the vertebra. Usually this is held in place with a small screw but mine didnt need one. By removing a decent section it also saves cracking the vertebra which can happen if they dont cut enough away.

I then had an XLIF fusion cage implanted to fuse the anterior section of the spine.

Cause of the Scoliosis I also needed to have a minimally invassive PLIF as well. Sometimes the revisions can be done with a XLIF plate and pedicle screws which go thru the same incision thru the side instead of having to cut the back muscles with a PLIF which would be alot less painful.

The PLIF was done thru a 2inch and 3 inch incision's. He had to cut one side longer due to the scholiosis to straighten it up.

The lateral approach goes straight thru the Psoas muscle which is probably the biggest risk with the lateral operation as there are alot of nerves in there. Just the dilation of the Psoas muscle often causes leg weakness and nerve irritation. During the surgery they were guided by Nuvasive EMG nerve monitoring so I had alot of shaven areas all over my body from the sensors.

I am unsure which nerve was disturbed with mine as the area's affected are very close to each other but I have some parasthesia at the top of the inside of my left leg. Luckily it doesnt effect my leg movement, just feeling. It doesnt cause pain but it also doesnt feel good when touched. It was something I was well aware of and prepared for so dont mind it at all. Its not something that is of concern and I have been told that no nerves were touched so the parasthesia should resolve itself with time.

The resulting fusion has straightened my spine and corrected the scholiosis and also restored the correct lordosis which was great to see. As soon as I was up walking the morning after surgery I felt much taller and straighter and was amazed to see the difference in the mirror. I was even more excited to see the xrays a few days later.

I spent 3 days in hospital after surgery which was shorter than I immagined, especially after what was done and was able to start reducing my opiates within a week of the surgery.

This is definately a much more difficult and dangerous surgery than puting an ADR in and should be thought about prior to ADR surgery. I wish I had gone straight to a fusion instead of thinking I could always have it fused later if the ADR failed. What a mistake that turned out to be. ADRs are designed not to come out easily and I definately found that out the hard way.

I hope some people are helped by this.

Mark

March 26, 2009



July 2009 Revision

Your case is so much like mine, but I am being told to do a posterior fusion and leave the sunken ADR in my body. I should have had a fusion at the get go. I don't know if I can find anyone in the USA to help me. I tried to go to the doctor's site that you mentioned as he has experience removing ADR's, but it is not in English. I tried to email leaving my number. I am desperate and scared to death. Can you contact me privately to talk or perhaps put me in touch with this doctor. I have heard about him from one other woman. Thanks!

[Carson]

Congratulations to you, Mark. Like many others I've followed your story reading from the sidelines and relieved to know you're knowing some real relief, much less cutting your pain from roughly 8/10 to a 3/10 Absolutely amazing! Enjoy every moment of your reduced pain, even when it still "tickles" at times.

Your strength and optimism in light of such a trying case is rare, sir. Thank you for the updates and your example of humility, patience, foresight, strength and hope. All the best to you in life and good health as you continue to recover, Mark.