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  Florian
My Artificial Disc Replacement Story

I am a German immigrant to the United States and I currently live in San Francisco, Calif. I am a 35 year-old male. Here�s my story.

As far back as I can remember, I never had problems with my back. I started working with computers when I was 15. Maybe this relates to everything that happened later, but I don�t know for sure.

In the summer of 1999, I saw a chiropractor the first time for back soreness. In retrospect, maybe this wasn�t the first place I should have gone. This was shortly after I moved to the US, just as I was getting established, and I was sleeping on a futon that was giving me backaches in the mornings. After moving around for half an hour, those aches usually went away so I didn�t look into it. After all, I blamed the futon for it.

Later, the backaches became so severe that I sought help. The chiropractor applied heat and did some adjustments that relieved me of pain. In addition, I started swimming on a regular basis. This was enough to get me through the next year.

However, exactly one year later, the backache returned, this time more violently. In the mornings after getting up, I couldn�t walk for five to ten minutes. Rising from bed was very hard; I needed to pull myself up using the chair next to my bed. Then I usually just stood there, waiting for things so settle. I then carefully moved into the shower and raised the temperature to as close to boiling as possible. A long hot shower helped me start my day.

This came also in a period of lots and lots of work where ten to twelve hours were the norm -- not to mention the weekend work! Crazy, crazy.

So, again, I went to the chiropractor seeking help, but this time the adjustments were hurting like crazy. So, I stopped these treatments and sought an orthopedic professional. After calling around, I found it was not easy to find one that was willing to see me immediately. That was my first encounter with the US medical system. Only later, I learned that for serious problems, it is common to go to the emergency room right away -- something I wasn�t used to.

I managed to sneak in an appointment that was two weeks in the future, so I had fourteen more days of extreme trouble moving around. One day, I was standing in my room and I must have done a silly movement, but the next thing I remember was that my left leg�s upper muscle part was contracting and moving so violently, that I had trouble standing. At the same time, unbelievable pain started to shoot around in the back and the leg. I was screaming and my roommate came in trying to hold me up. However, any change in my posture was torture, so I was standing there for half an hour waiting for things to settle. After this incident, I again tried to reach the orthopedic doctor, but their office just told me that my appointment was just ten days away, so I needed to wait. Well, I learned my lesson.

Finally, on the day I saw him, things (of course!) got much better. It really seems to me that the days, when I see a doctor, things get much better. I wondered, why does this happen? Anyhow, the doctor was doing a basic x-ray and didn�t see anything special. My L5-S1 disc was a little bit narrowed, but everything else seemed to be in good health. I was given a prescription for physical therapy, some free VIOXX and a follow up appointment.

The anti-inflammatory helped quite a bit, and so did the physical therapy, but over the course of the next three years, a cycle developed which included worse symptoms, more doctor visits, more injections (a total of four), more prescriptions for physical therapy and more VIOXX samples.

After these three years, the doctor told me, that this is all he could do, and he sent me off to his colleague Dr. Beyers - the first spine surgeon I met. Two MRIs were taken over the next year, showing nothing too severe at the L5-S1 level. Moreover, the spine surgeon explained his reluctance to do any surgery without knowing what was �really going on,� so he scheduled me for a discogram.

Being a little bit nervous, I made a tiny mistake by stating that the enormous pain from the L5-S1 injection feels a little bit �to high up�, which led to a �non-conclusive� result of the discogram. Silly me. It was hurting like crazy, but it wasn�t 100% the same pain, it was just 95% of the same pain. Perhaps by being overly precise, I ruined my chances for a treatment solution.

The spine surgeon couldn�t commit to surgery (which was to be a fusion at that time) with such results. For the first time, I heard that I might need to live with my symptoms and pain for the rest of my life. What a downer! However, things got worse again, and I was seeing him again half a year later. A new MRI was made, because my leg pain started to move randomly around from left to right; and pains were now in both legs. This gave Dr. Beyers the impression that something new must have happened, so he wanted to take a diagnostic look. The MRI indeed showed very mild disc herniation. However, the doctor was puzzled; he was saying that such a small thing never should produce such intense pain. Nevertheless, to try things out, we scheduled a microdiscectomy. Surgery was scheduled, but ten days before the actual date, the pain again jumped from the left to the right side of my leg, and I notified Dr. Beyers. He immediately canceled surgery and again was saying: �Florian, your case just doesn�t make sense.�

In order to get a tighter diagnosis, he was ordered another discogram at the L5-S1 level with a different surgeon. This time, I needed to chip in more money, because Dr. Derby from Daly City wasn�t participating in my Blue Cross PPO. However, this time the discogram experience was quite different. I clearly felt my �usual pain� and absolutely nothing at the L5-L4 level. He also injected some medicine into the disc in order to see if I get some relief from it over the next weeks and months. In addition, I had a relatively pain free month after the injections. The report stated that I clearly (without any doubt) suffered from degenerative disc disease at the L5-S1 level, with all other discs looking very good.

Back at the doctor�s office, Dr. Beyer offered fusion surgery if I desired so. He explained that it really depends on my pain experience. The risks of surgery need to be traded off with the potential pain relief. So I left him in late September with the understanding that I could get surgery from him anytime, I just needed to check with him a month before. However, at that time, I was preparing to visit Germany for a month, so the plan was to get surgery upon my return.

At this time, I bumped into Michael Wong from San Francisco, and he pointed me to Dr. Zucherman, who performed the single level FDA ProDisc trial at St. Mary�s. I was very grateful to him for the referral.

Scheduling an appointment with Dr. Zucherman was difficult. I called them four or five times and they always promised to call back, but they didn�t. The next time I called, I just left a message on the answering machine that I would be in the office tomorrow morning at 9:00 AM and would wait there until I got an appointment. That helped and I they called me back with an appointment time.

In late October of 2003, Dr. Zucherman was seeing me, asking to bring my MRI films that I collected while I was patient with Dr. Beyers. He was looking at them and saying something along the lines of �� total disc collapse �� something I never heard before from any other doctor looking at my pictures! He was asking me how long I dealt with this situation, to which I answered �over three years!� He stated that it was about time to fix it.

Dr. Zucherman explained to me the idea behind the ProDisc and the FDA trial, and at that particular time was in continued access, so there wouldn�t be any randomization for me. However, the trial was about to close, so I would need to make up my mind quickly. In addition, my insurance would need to be responsive as well.

I didn�t hesitate to agree, and to my surprise, my insurance agreed to pay. Surgery was scheduled for January 20, 2004, just a week after my return from Germany. I was one of the last patients at St. Mary�s receiving a single level ProDisc.

Surgery & Recovery

On the day of surgery, I was a bit nervous, but after a while and some fancy fentanyl medication, I was happy with everything around me. In Germany, I was a paramedic for 15 months (as a replacement for military service, which you have to do, no way around it), so I was comfortable with all the IV�s and everything.

Then I was anesthetized, and I woke up.

The first thing I realized that my back pain was gone. I always felt like some big machinery was grabbing and squeezing my lower spine -- putting tons of pressure on it � and now that feeling was gone. That was so good! Of course, everything else hurt: the incision, my left leg and my throat. I found myself in a bed in a nice room, the nurses explained the pain-relieving button to me (PCA) and I had no problems being �trigger-happy� with it for the rest of the day.

The next morning, the first attempt was made to get me out of bed. I did walk two steps before I fainted, and the nurses caught me and helped me back to bed. However, during the next day, a few successful steps were made. Dr. Zucherman�s assistant explained to me that they found very large bone spurs growing towards the spinal canal. It was very likely that those very the main pain generators. In addition, they found that the old disc was torn and lots of scar tissue was developed which seemed to be very old. Therefore, they asked me if I had a back injury about 15 years ago. I can�t remember anything like that!

Things got better and better. I was discharged after a week and I continued to rest there.

However, I was sweating very much every night. With two towels under my head, I was using up five to six shirts each night. Otherwise, everything would really soak in sweat and everything became very cold.

Suddenly, after two weeks, I had a high fever and I called Dr. Zucherman's office to see if he could see me the next day. However, he had no idea what the cause could be, so he prescribed and x-ray. I was sent home with antibiotics and pain relievers.

At the same time, I started developing problems doing big jobs in the washroom. I was thinking this might be the result of constipation due to the hydrocodone (at least makes a little sense). However, after not fulfilling my duties for five days, an enema was applied, without big relief.

Also, I started to notice some left flank pain, but that was minor compared against the pain from incision and the distraction pain.

However, one morning I woke up and I had severe pain in the left groin. So, I took of and went to visit the Emergency Room in St. Mary�s because I wasn�t able to schedule an appointment with Dr. Zucherman. Even though they promised to call me back in an hour, they didn�t -- even when I let them know that things were getting serious.

After a small wait at the ER, the first suspect was that I had some sort of infection (because of the groin pain) so I needed a urine test. However, the doctor on duty was checking out my abdomen and found some problems on my lower left side. He checked with the CT crew what contrast I need to take and brought it to me: three nice bottles of Barium Sulfate (please drink one each half-hour... thank you very much!). I was brought into the CT room and was hooked up with an IV for contrast (my nemesis); as well as the rectal contrast that was pumped with and electric motor into my behind. A nice sum of four liters. I will never forget this.

The CT was made and I heard phone calls being made and I just made it to the next washroom to rid myself of all the contrast. The doctor came back and appeared concerned. He was saying that my left ureter was obstructed and my kidney was two times as big as it should be. Also, a mass of three kilograms was in the left abdomen and they guess it�s very likely urine. That mass was squishing everything else to the side, which would explain why I had problems doing my duties earlier the week. He said the urologist was on his way home (it was a Sunday) and that surgery was necessary.

Dr. Grady (the urologist) came in and explained the situation in detail to me. The idea was to put a stent through the ureter to remove the obstruction. So, surgery number two was scheduled for that evening.

Recovery � And Surgery

Then I was anesthetized, and I woke up�again.

But the surgery was not successful, because whatever obstructed the ureter was really stuck! Once again, I returned to the hospital and another attempt was made to drain the fluid. This time, a big needle was but into my left flank going directly into my kidney. This was done while I was awake in the radiology department, and the radiologist had the most fancy protective clothing I had ever seen. Again, Fentanyl was keeping me sane, while the catheter was reaching its destination. When it finally got there, a big relief was felt. Lot�s of ugly liquid drained over the next three days and the nurses kept a detailed record about how much came out of my body.

The idea was to drain everything as thoroughly as possible, because a repair surgery of the ureter has better results if there�s no excess fluid in the area. Sadly enough, I didn�t see Dr. Zucherman during this time, because he was on vacation.

After a month with two artificial drainages from my body (one being connected to the kidney, the other being a normal foley) my bladder decided to spasm because of the foley. So, I took it out (which was alerting to Dr. Grady) but when I was showed him how professionally it was done, he said I did a good job. It is very hard to sleep when one has tubes and bags of urine all about, with no tossing or turning allowed. Also going out in public was a challenge, because the kidney tube could be source of great infection.

Dr. Grady was talking to Dr. Zucherman over the phone about my situation -- they discussed the possibility of infection from the ProDisc. In that case, it may have been required to take it out, but I though my body was strong enough to ward off any infection to prevent this from happening. During that time, Mark organized a lunch with Dr. B. in downtown San Francisco. In that meeting, I asked him what could have happened to me � Dr. Bertagnoli commented that my situation was very unusual.

Any way, repair surgery for the ureter was scheduled a month later and two urologists took the honors.

Surgery & Recovery

Then I was anesthetized, and I woke up�again.

I found a very long scar on my belly and 28 metal clamps. Nothing compared to the almost invisible scar Dr. Zucherman left behind. But Dr. Grady explained that since they didn�t really know where the point of obstruction is, they needed to trace the ureter all the way from the kidney down to the bladder. They found that an inch of the ureter �died� because its blood supply was cut off. Also, a blood vessel next to the ureter was gone as well -- which might explain my initial complaints about groin pain, because that vessel was responsible for drainage of the left testicular area. In the meantime, I developed a large left side hydrocele (fluid accumulation around the testicles). But this wasn�t my main concern at that time.

The bladder was mobilized by cutting off some �holding� muscles, and pulling it up a bit on the left side to make up for the missing piece of ureter. A hole was cut into the bladder and the ureter was re-implanted. A stent was put in the ureter to ensure that the new connection remained open.

Recovery for this procedure took longer then the recovery from artificial disc replacement, which was actually occurring at the same time. However, I couldn�t do all the physical exercise I should have done because of the foleys, bags, pipes and stents.

The stent was taken out a month later using a long endoscope entering my body at the only possible location. The hydrocele still wasn�t making any attempts of healing itself, so Dr. Grady removed a lot of fluid with a very big syringe. But it came back to its original size just one day later.

So, six months later in November 2004, a CT scan was performed in order to check on how well the re-implantation was doing. And surprise -- it wasn�t doing well. The connection almost closed itself, the kidney and ureter were enlarged, and drainage was weak. I started to wonder, �what are the long-term chances for my left kidney recovering?� Dr. Grady was quite serious about fixing it within the next couple of days. I recall thinking that things �must be serious.�

Dr. Grady scheduled the surgery and he suggested fixing the hydrocele in the same procedure, to which I agreed.

Surgery & Recovery

Then I was anesthetized, and I woke up�again.

A new, bigger stent was in place and the hydrocele was officially fixed. They gave me a prescription for medication but St. Mary�s didn�t have a pharmacy open.

The stent was inside me just two weeks this time and it was taken out the same way the last one did. Usually you don�t feel the stent in your body, but you surely do when you�re in the washroom. At the end of the �watering� procedure, there is a very strong pain that is breathtaking, but it lasts only seconds. It is not sharp, but very dominant.

The hydrocele went away after two weeks, but I still had to fight with the insurance because they thought the hydrocelectomy was done for infertility reasons! After all that I was through, I could deal with this inconvenience.

No More Surgeries � Final Recovery

So right now, I am felling OK. And where am I now? Here�s a list:

- Back pain mostly gone, if I take NSAID
- Leg pain mostly gone
- Left ureter re-implanted, will the connection stay open over the years?
- Left kidney went through a lot, will it last?
- Mild retrograde ejaculation, will it improve over time?
- Bowel seems to be buckled a tiny bit, can only do my duties after coffee. Will that improve?

Still, after all those hassles: Yes, I would do the artificial disc replacement surgery again. I am very thankful to Dr. Grady. He always took the extra-time to explain things, something I value and do not receive from many other doctors.

I think it�s important to point out that the complications are all on the access surgeon�s plate and that was not Dr. Zucherman. I write this, because I think Dr. Zucherman is an excellent doctor. After almost four years of suffering, he was the first one who figured out what was really going on with my spine. I just was on the unlucky �<1%� side of things.


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