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  #1  
Old 08-31-2017, 01:50 AM
RedLava RedLava is offline
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Default Hello, new cervical case

Hello,

This is my first post to this forum so I'm not sure how it will be taken and I sure don't want to create anxiety for anyone with an existing ADR but I have some questions/concerns regarding ADR. I had an extruded disc at C6/C7 and moderate bulging C5/C6 diagnosed on MRI in December 2016. I was recommended by the first neurosurgeon I saw for C5-C7 fusion but cancelled the surgery as symptoms improved and eventually went away by March 2017. After some return of symptoms in July, my new MRI showed improvement of the C6/C7 when compared to the totally blown status it had last MRI so I'm not in a rush to get surgery and my symptoms aren't wrecking my life. I am having some return symptoms after a few months of left arm stingers, pins and needles and mostly left scapular pain but it's much better than last December when I was having severe left tricep weakness, numb fingertips and extreme pain.

Anyways, I saw my new (2nd opinion) neurosurgeon again today for some input, he recommended a 2nd epidural injection after the first one I got in August but I also asked him about surgical options in case this thing doesn't continue to improve for me. He suggested disc replacement (Mobi-C) for both levels might be an option for me. He's done 8 or 9 two-level mobi-c installs just this year. I asked him about the lifespan of the disc and he said it couldn't be known for sure but that based on hip/knee prosthetics he felt probably 15-20 years. This is a huge concern for me at age 39 because 20 years isn't that long and that sounds optimistic to even say 20 years seeing as the hip/knee people are usually elderly and don't move all that much anyway. I'm very very active. He said if it "wears out" that it could then be converted to a fusion. I asked him what that entails and it didn't sound promising, sounded more like they would just fuse the thing into the bones without removing it or at least not the metal plates since that'd probably take some serious chiseling and they would be hard to remove safely. Considering he's in his 60's I doubt he'd be the guy I'd be coming back to if the core wore out and flattened so what does he care right? (I'm being pessimistic here)

This guy came highly recommended and has a good history, yet seemed to not really have a long-term answer on how well this would go for me even if the short term results (5-10 years) might be great. Is there anyone here who has an ADR that's more than 10 or 15 years strong that is still doing great? Has anyone been told that they can expect the prosthesis to last their lifetime? I'm just really skeptical based on the hip/knee replacements since they're made out of some of the same materials, even if they do have to handle a heck of a lot more load than a cervical disc because I'm hoping to be able to do sports/running/lifting etc. with this thing. I worry that if I'm going to ultimately choose between ADR and ACDF it would be based more on long-term results and the hope of not needing another surgery. I'd almost rather take my chances with an ACDF than end up with a "messy fusion" being necessary in 15-20 years with an ADR. Any thoughts from the people in this community?

Once again I realize most of you have or are contemplating ADR so I'm not trying to create a sense of anxiety about it. I've seen the short term results and they look amazing. I just want to make sure this would be a good long-term decision when compared to ACDF, which also seems to have at best a pretty mediocre long-term track record.

Last edited by Harrison; 09-03-2017 at 08:41 PM. Reason: Added paragraph breaks
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  #2  
Old 09-01-2017, 11:04 PM
RedLava RedLava is offline
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Default Retracting my concerns

After a 3rd opinion from one of the highest regarded spine specialists in my area and then reading the wear rate tests on the Mobi-C I think I've answered my own questions. It sounds like removing the disc really wouldn't be that big of a deal since they often shave bone etc. when doing fusions and installing discs. This Dr. felt that removing the end-plates wouldn't be all that complicated anyway but that he's never had to do it with any long-term patients of over 10 years because they're not having any problems. The wear-rate tests posted on the FDA website are a lot more thorough than I had initially imagined and I can't see one of these discs wearing out in just 20 years, if ever, considering the beating they put these things through just to get an almost insignificant weight reduction to the core. I think the neurosurgeon who I had seen that suggested only 15-20 years of lifespan had simply not done much research or thought into it and threw out the hip/knee implant response because he simply didn't know. I feel pretty comfortable now going with ADR should the stronger symptoms of my disc-herniation return yet again.
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  #3  
Old 09-03-2017, 08:45 PM
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Harrison Harrison is offline
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RedLava,

I had my ADR in 2004 and my Charite' is holding up exceptionally well. With regard to revising ADRs, it's not a cakewalk, even for experienced surgeons by any measure. Has it been? Sure. How many times? I lost track -- it may be in the thousands by now.

For cervical ADRS, I would expect them to last a lifetime -- even for a younger person like yourself. Of course, you would have to be the perfect candidate and free of other disease(s) that would not contribute to further degeneration.

Hey, add a siggie please:

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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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  #4  
Old 09-04-2017, 06:17 PM
annapurna annapurna is offline
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Quote:
Originally Posted by RedLava View Post
This Dr. felt that removing the end-plates wouldn't be all that complicated anyway

Just so you know, I'd consider that opinion to be really good evidence that this isn't the doctor you should go see if you ever have to have revision surgery.

Well placed ADRs done in surgeries by competent surgeon in patients who's conditions warrant and ADR have lasted well beyond a couple of decades in the lumbar, where loads are expected to be higher than the cervical. Mind you, though, there's a lot of caveats in that sentence that can come back to bite you in the butt.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #5  
Old 09-05-2017, 01:49 AM
RedLava RedLava is offline
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Harrison, thanks for your reply. It's nice to hear that those lumbar discs are holding up so well and yes I would expect that the cervical discs would last even longer but my situation is slightly complicated in that I'm hoping to also return to Brazilian Jiu-Jitsu which I'm still currently doing and involves a lot of neck squeezing, rolling etc as well as running and weight-lifting so the lifespan of the disc is something very important to me. I'd hate to think that I'd have something in my neck I'd have to constantly worry about putting extra "mileage" on and wearing it out that much faster. AnnaPurna are you suggesting that you've heard or know of major difficulties in removing artificial discs that have worn out? The guy I talked to didn't seem to be suggesting that it would necessarily be a cake-walk, just that he was confident it could be removed should such a situation occur and that even removing it from the bone growth that locks them into place wasn't really a major problem since they often remove/shave portions of bone when doing surgeries. I got the feeling he had never actually had to do it or he would have said so, but that given the number of discs he's installed (40-50 Mobi-C's and several hundred others such as the Pro-Disc) that he wasn't all that worried about the disc wearing out either way. We were just talking worse-case scenarios.
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- 10/16 C6-C7 ruptured disc and C5-C6 moderately bulging disc confirmed on MRI in 12/16.
- Cancelled C5-C7 fusion surgery 02/17 due to near complete symptom improvement.
- Flare-ups of C6-C7 began again in 07/17.
- Considering C6-C7 Mobi-C replacement.
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  #6  
Old 09-05-2017, 09:36 AM
annapurna annapurna is offline
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There have been a number of revision surgeries reported or discussed here. I don't think that a single one was easy. Also, if I remember correctly, most of the revisions were performed by fusing around the existing ADR rather than removing it.

I admit that I was offering a flip comment but revision surgery isn't simple and someone who thinks it would be is likely not knowledgeable enough about it to actually do it now. I hope for your surgeon's other patients that he does a little more research about revision so he can understand the seriousness of it and doesn't give false reassurance for a position of ignorance.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #7  
Old 09-05-2017, 10:53 AM
RedLava RedLava is offline
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AnnaPurna,

Thank you for the information. I'm now reading some of the stories from the surgical revision forum and agree it sounds more problematic than I would have expected. That's a little disappointing but it's better I know the truth about these risks I guess. Should I need surgery I really can't decide which would be the safer choice between ACDF and ADR. All roads seem to lead to a fair number of horror stories.
__________________
- 10/16 C6-C7 ruptured disc and C5-C6 moderately bulging disc confirmed on MRI in 12/16.
- Cancelled C5-C7 fusion surgery 02/17 due to near complete symptom improvement.
- Flare-ups of C6-C7 began again in 07/17.
- Considering C6-C7 Mobi-C replacement.
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  #8  
Old 09-05-2017, 05:22 PM
drewrad drewrad is offline
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It is my belief that most ADRs are stronger than the natural anatomy. The real risk is natural anatomy and misplaced ADRs. As for durability, these things seem rugged. As for jujitsu, I know a couple fellow M6ers who roll on mats, both cervical and lumbar. They go hard too.
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Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #9  
Old 09-05-2017, 07:06 PM
annapurna annapurna is offline
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Quote:
Originally Posted by RedLava View Post
Should I need surgery I really can't decide which would be the safer choice between ACDF and ADR. All roads seem to lead to a fair number of horror stories.
Truism: There are horror stories for any procedure you look up.

Addendum: The horror stories spread faster and further than the tales of success, which leaves one to feel amazed that there are any good results out there at all.

This is a pet peeve of mine so please forgive my rant. I'll try to keep it short. Anecdotal information, like what you get from reading stories here, is horrible for forming a real picture of your chances for a good or bad result. Bad results are discussed and occasionally distorted and re-reported as if they were a new, different, bad result. Good results are often not reported at all because the patient is out living their life and not commenting on this board. Yes, there are a few of us that continue to post years later. I feel like Laura and I were led to answers beyond what we could have found on our own and we're simply paying back the good that was done on our behalf. That's why we're still here.

I can't tell you how to perceive risk. The statistical evidence I've heard suggests that the likelihood of a complete recovery to full functionality for a ACDF patient is lower than for ADR. I don't know this but I suspect that the likelihood of a well-emplaced ADR is lower than a well-fused ACDF but the functionality of a patient with a well-done ADR is much higher.

Functionality after a decade is still debated. At first, ADRs were touted as having much high patient functionality after many years. The evidence seems to still support that but emplacement mistakes and poor designs have clouded the data enough so it's a murky mess. If you chop out all of the "bad" data, ADRs seem to come out ahead. It's just arguing over what gets included and what doesn't, e.g. do you include Rich and Laura as "good" patients who have an obsolete lumbar ADR design but reject those patients who had it and did poorly because the design did have some flaws? That's commonly referred to as cherry picking data; statistical shorthand for lying.

Basically, do you roll the dice hoping for a really good outcome with an ADR or accept a less good outcome with a potentially lower chance for a really bad outcome? Remember also, you can affect your odds by surgeon selection and very careful discussion of your condition. Many of the not-so-good ADR outcomes were with patients who were borderline for getting an ADR at all. If they knew then what we know now, they would have at least understood the risks, if not have made different decisions.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #10  
Old 09-05-2017, 10:56 PM
RedLava RedLava is offline
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Quote:
Originally Posted by drewrad View Post
As for jujitsu, I know a couple fellow M6ers who roll on mats, both cervical and lumbar. They go hard too.
Thank you for that input Drewrad, it gives me hope. I feel like every time I talk to anyone at my current gym they're under the impression that should I need spine surgery, it would basically be the end of my 5 1/2 years on the mats. I know 2 guys from a previous gym who had fusion surgeries. One was a C5-C7 two level fusion on a guy in his early 50's and the other was a single level fusion (probably C5-C6) on a younger guy in his late 20's. The older guy just took a bronze in Vegas last weekend at a tournament and when I used to roll with him, I didn't even know he had an ACDF when he was trouncing me all over the mats. When he heard about my neck trouble in December he gave me a reference to the doctor that did both of their fusions, so I'm pretty confident I can get a good job done with fusion should I need one from that particular surgeon, but I'd still like to consider my options as neither of these guys have gone past the 5 year mark yet and who knows what the future holds for them. Also, it's not just the surgeon but the patient case that can affect the outcome. I've never broken a bone in my life, I have no idea if I'd have any kind of bone growth problems or anything like that.
__________________
- 10/16 C6-C7 ruptured disc and C5-C6 moderately bulging disc confirmed on MRI in 12/16.
- Cancelled C5-C7 fusion surgery 02/17 due to near complete symptom improvement.
- Flare-ups of C6-C7 began again in 07/17.
- Considering C6-C7 Mobi-C replacement.
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