VERY Comprehensive report, incl. a list of ALL ADR studies

[Trish]

I remember a while back seeing an unbelievably comprehensive list of ALL the worldwide studies ever performed on ADR. (At least it looked that way to me.) I think it was Matt4Ana and his amazing talents that found it.

However, I couldn't find it again in here and didn't want to bug him for it. So you may have already seen it but here it is again.

It was written by Canada's Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care for the Ontario Health Technology Advisory Committee.....whew...(imagine that on your business card!)

It includes ALL research available on ADR up to April 2006. (Of course there's a disclaimer that they may have missed something, but I seriously doubt it.) I've already asked them if they will do a 2007 update, even though ADR was approved there in 2006. I'll keep you posted of their response.

Artificial Discs for Lumbar and Cervical Degenerative Disc Disease – Update

What's it good for? Why should you care?

I am using it to try to convince the Norwegian Health Ministry that ADR is no longer experimental. You might use it to convince whatever powers that hold the purse strings (e.g. insurance company, worker’s compensation board, daddy, etc…) that it’s a superior choice to fixation. It thoroughly reviews the benefits and detriments (both medical and economical) that the government faced in deciding to implement this form of treatment.

Economic, can be a dirty word to us patients. No matter how inhumane it sounds, insurance companies will not come around and approve ADR until they realize that in the long-term it truly is the most economic form of treatment for a certain percentage of back pain sufferers.

Happy reading!
(Here is the front door to this fabulous Canadian Ministry of Health: http://www.health.gov.on.ca/english/providers/program/m...ech_adr_040106.html)

[Kim_Dean\'sWife]

Wow Trish! I will be printing this out- thanks for posting it! It not only looks as though it will be beneficial in the insurance battle, but a most interesting read, as well.

Kim

[Harrison]

Thank you Trish! Nice digging!

[Trish]

<span class="ev_code_RED">Here is the response from Canada's Medical Advisory Secretariat:</span>

Thank you for your inquiry to the Medical Advisory Secretariat.

There are currently no specific plans to conduct an update analysis to our review of Artificial Disc Replacement for Lumbar and Cervical Degenerative Disc Disease. As you know, this technology review was updated in April of 2006 and it is not the policy of the Medical Advisory Secretariat to conduct annual updates to its body of reviews.

Reviews prepared by the Medical Advisory Secretariat on behalf of OHTAC will be updated from time to time as required. Specifically, OHTAC has adopted the policy that a health technology review be updated :
<UL TYPE=SQUARE>-By request from healthcare providers, MOHLTC, OHTAC, or Health Technology Utilization Guidelines of Ontario (Health TUGO)
-If there was ambiguity at the time of the original review, due to conflicting or inadequate evidence, and now there is new, high quality evidence available
-If important study results were anticipated but unavailable at the time of the original review, the results of which may significantly affect the magnitude of effect, efficacy and safety
-If safety concerns regarding the technology have emerged since the original review was completed.[/list]Best regards


<span class="ev_code_RED">And here is my follow-up question</span>:
To whoever responded to my question:

Thank you very much for your quick and informative response! I was afraid that would be the answer. I did not read the entire approval document but it seems the devices have been approved for use. It makes sense to not expend any more time and resources in updating the report.

There were a few people in the US, UK and myself in Norway, who were hoping for a 2007 version so that we might use it to convince our respective powers-that-be to finally realize that this treatment is out of the experimental stages. Of course, there is a need for more journal studies for many reasons, e.g. to better predict which patients will find pain relief or to develop a post-surgical rehabilitation guide for artificial disc replacement (ADR) patients, etc...

Unfortunately, many of us are still waiting for ADR expenses to be covered at least to the extent that fusion is covered. In other words, many ADR candidates are given only fusion as the only alternative. If we want ADR we must pay for it ourselves.

The belief is that by maintaining the experimental status of ADR these governments and/or insurance companies mistakenly believe that they are saving themselves money in the short and long-term.

I had hoped an update might be forthcoming since I saw that April 2006 was apparently the third version. It appears the Medical Advisory Secretariat issued the first version in 2004. http://www.health.gov.on.ca/english/providers/program/m...ech/techlist_mn.html

In addition, I somehow (haven’t a clue how) have got my hands on a table, from the same report, with July 2005 written in the footer.

I believe that 2007 version of your report, with all of the recent interim and completed study results, would have conclusively proven that in the short and long-term ADR is the most economical. At the very least, it is not more expensive than fusion or other treatments available today.

I recognize that as an American citizen living in Norway, I do not have even a tenuous right to ask anything of the Canada’s Medical Advisory Secretariat (MAS). However, I would like to point out that an update would appear to be warranted under your bullet point no. 2 in the list of adequate reasons for generating an update:

“If there was ambiguity at the time of the original review, due to conflicting or inadequate evidence, and now there is new, high quality evidence available”

There was not exactly ambiguity, but the 2006 update found only one large scale randomized-controlled study with one Level-1 evidence, were a “full assessment of the methodological quality….[was]…possible. I believe that 2006 provided us with many new study results on ADR and I would leave it to a professional like yourself to determine if they provide Level – 1 “high quality evidence.”

Finally, I thought you might want to see what is being said about the report at http://adrsupport.org/eve/forums/a/t...1/m/2991040142.

Regards,

Trish Espedal
Stavanger, Norway

[CindyLou]

Thank-you as well, Trish. I'm printing out this behemoth of a document as I write this. All the while, keeping my fingers and toes, and any other body part I can manage to cross, that my ink cartridge doesn't poop out on me! I will diligently wade thru this to highlight specifics for my case. I am finding things a little more dicey for me, with needing a 3 level lumbar adr. There's lots of good stuff for 1 level. I don't want the boss to hone in on that specification. In any event, many thanks again for the digging!

[Linda]

FYI
I was involved in a 2 level ProDisc trial back in 2002 that was not listed.
Linda

[Trish]

Linda,
I have not read the entire report thoroughly, but I think they only reported on studies and not private or individual patients' surgeries.

However, if your surgery was part of a study, would you mind giving me the details?..official title and/or its study number? I'll pass it along to Ontario and anywhere else I see a "comprehensive list" that doesn't list your

[Josh Camman]

Hi Everyone,
Here is a report from the Queensland Goverment that recommended the use of Artificial Intervertebral Disc Replacement Surgery. Hopefully this may be of some use.

http://www.msac.gov.au/internet/msac/publishing.nsf/Con...AD35ED216E990FC7CA25
71420004A192/$File/MSAC%201090%20-%20Artificial%20Intervertebral%20Disc%20Replac
ement%20(AIDR).pdf

[Linda]

Trish,
It will take me a bit of time to get the information you want. It was an FDA 2 level randomized study for the lumbar ProDisc done at Texas Back Institute in October of 2002. I should be able to get that information because unfortunately I am in need of a 5th ADR because of messing up L3 lifting a morbidly obese patient while in radiology school. Even more unfortunate is that the only place I can get one is overseas and that is financially out of the question for us. We are still paying for my 2 level cervical procedure done in 2005. I have been in such tremendous pain, especially leg burning and pain that I have gone ahead and opted to have an extraforaminal discectomy at L3 knowing that it will only help the leg pain and not the back pain. At least that will allow me access to the newer technology once it reaches approval in the States. It is so disappointing knowing that there are at least 3 procedures that could help both the leg and back but I am not a candidate here in the States for any of them. I had a discogram a few weeks ago and found out I now have a lateral tear in L3. My leg is in constant pain and is getting very weak. I need another disk and the surgeon doesn't even want to talk about fusing "on top of my pretty new disks." I just hope that my body holds up after the discectomy a week from Thursday at TBI and that when something better comes along here in the States I will be a candidate for it. The surgeon here tells me there are some exciting things coming. Believe it or not though, I am not getting any younger!
Best wishes,
Linda
ProDiscs L4/5, L5/S1, C5/6, C6/7 and needing one at L3/4 but can't afford to go back to Germany even though I sure wish I could

[Harrison]

Just refreshing this topic for the new folks in the community in case they missed it...