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ADR or ACDF

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:24 AM in Neck Pain: Cervical
:??

Hi everyone, I am new to this forum and deciding on a surgery this month. I am a 32 year old female, 2 cervical herniated discs at C5-C6 and C6-C7. I have seen 5 surgeons thus far for opinions on surgery. I am more confused as ever ! Can any of you please please provide me some feedback on either ADR or ACDF ? I was leaning more toward the ADR multilevel surgery, as I have been hearing about complications with fusion. Any help would be great !!

Here forever in pain :S
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Comments

  • Deed10- I have not had any type of surgery as of yet. I have a large bulge at c5-6 and minimal bulges at c6-7 and c7-t1. I have researched the ADRs and fusions.

    Fusions are good to take care of the discs compressing on the nerves but later on down the road the disc above and below the fusion go bad.

    The research I've done on ADRs is that they take care of the problem and act as your natural disc do absorbing shock. No movement losses. The only thing is that the ADRs only last an estimated 20 yrs. The research is still being done. The problem is what happens when they go out. I've read horrible stories where ADRs where placed wrong or moved and most Drs will refuse to take them out. Because of the dangers of making a mistake and paralyzing a the patient.

    Only one level ADRs are being done right now in the US. In Europe and Asia they will do up to three in the cervical region.

    It is a big decision to make and only you can make it. I would research as much as possible and make an educated choice. Me personally being young like you, 29, I am going for the Adr when my time comes for surgery. I feel that in 20 yrs they will have come up with something better on taking them out. I am looking for something that is going to give me the best chance at getting my life back and keeping it for a long time. Not just for a couple of years, more like a couple of decades.

    Read around in the forum. A lot of the people here have had fusions. You can read their outcomes. Some are doing great others not so great.

    I hope you find what you are looking for. Try this web site adrsupport.com Most of these people have had Adrs. Some with good outcomes some with bad.

    In the end you are going to out weigh the pros and cons.
    Clarissa

  • I recently had an ACDF at C5C6. I was given the option of the ADR, but I chose not to be a "guinea pig" at the start end of new technology. Too many questions and not enough long term data for me. I figure if I do have failure of my fusion or problems with the disks above or below in the years to come (which is definitely a con of fusion)they will have more info on the success rate of the artificial disks and I might consider it if I need to.

    The other big concern is cost. Check with your insurance company to see if the ADR is covered. Since it is a new technology, a lot of insurance companies won't pay for it because there's not enough data to show it is any better than a fusion. They aren't willing to fork out 2-3 times as much $$$ for a procedure that has an alternative, cheaper treatment.

    Good luck. BTW, I am two weeks out of my single level ACDF and doing great! Already back to work part-time and feeling much better than before surgery.
  • I am waiting in hopes I can have 2 level ADR. In Europe they have been doing them since the 1980's for every 1000 Europeans that get ADR only 35 in the US get them. I disagree with the FDA on "We dont know the long term effects" BALONEY!!! They know very well the long term effects in Europe, they also know the long term effects of ACDF resulting in more ACDF later on. My Chiro told me that he reads the medical journals in Europe as well as the US, and says the European journals are more "honest" than the US journals. Not exactly sure what he meant by that but I will take ADR over ACDF any day... As long as this country catches up with Europe and lets me have it! OK just my opinion on what Ive read, and obviously my frustration over all this shows in my post! I guess the best thing to do is research your options, talk to your docs, and choose what is best for you and your situation.
  • I had a Prestige ADR at C5-6 on 10-2-08 and I feel wonderful! I had to fight with my previous insurance and then took a different job (with different insurance) and it was covered. I don't know how the recovery is for ACDF but I know that with the ADR I was in the hospital overnight and then off work for 9 days and went back with no problems. I haven't had any PT. At this point I am not supposed to lift a lot but that is my only restriction. My arm pain comes and goes pretty infrequently and my neck pain is gone. Sometimes I will have some muscle tension. If for some reason you had to go from an ADR to a fusion due to complications with the implant it is less risky in the neck then the back (so I have read). I am only 26 and my MD wouldn't do a fusion on me because as I get older I would need more and more. With the ADR I don't feel any loss of motion, I can't even tell I have anything artificial in, I actually feel like I have better motion because I don't have the pain to restrict me. I used to work for an orthopedic spine surgeon that worked on a study for ADR in the lumbar spine so I was totally on board after seeing results first hand.

    If you need multiple levels you would definitely need to go to Europe because they don't even have any clinical trials for multi-levels in the cervical spine yet. When I was researching for my appeals I got a ton of info, let me know if you want me to email you some links.

    Did any MD recommend doing one level ADR for now and waiting it out until the US can do the other level? That would be the only chance for insurance to cover it. Otherwise it would be out of pocket to go to Europe. One patient a few years ago paid $30,000 for 2 level lumbar ADR (hospital, implant, surgeons fees, anesthesia, everything) plus airfare and any accomodations before/after her hospital stay.

    As far as cost of ADR in the US being billed to insurance, it is cheaper than an ADCF. An ADR is billed as an anterior discectomy with insertion of an implant (not a fusion). Also, it saves them money because you have less hospital time, no rehab, no brace, etc. My surgeons bill was less than $8,000 and the hospital bill was $34,000 and then of course some misc. bills (anesthesia, x-ray, etc.). My portion was my deductible, $250. If your insurance is going to cover it then it is like any other surgery, your deductible and any co-insurance.

    My MD said that the full recovery from ADR is two months because all you are waiting for is the soft tissue to heal. With an ACDF it is 6-12 months because you are waiting for it to fuse. I see increased costs right there.

    Hope that was helpful.
  • Ok heres the deal! I'm a 44 year old male. I am a building contractor that requires great physical demand. For fun I'm an avid snowboarder like you see in the movies and 16 mile day hikes in the summertime in the sierra's above my house is typical. In june of 08 I was told "Your neck is jacked"
    and offered a 3 level fusion by 3 different surgeons. "It is the GOLD STANDARD her in the U.S." Right! Folks it's time to think out of the box We are in a global market now. I did my home work and off to Stenum Germany I whent 08-22-08. I want to tell you "THE GERMANS ARE AMAZING" The hospital was supper clean, new and state of art. The docs are actually very conservitve and honest they won't opperate unless they feel it's absolutely necessary. The staff treats you like family they were very kind. Stenum popped 2 implants in my neck and I was back to work 2 weeks later forgetting I ever had a problem in the first place.
  • It's been 7 months since my ADR surgery in Germnay it's winter here Reno/Tahoe and i have been hitting the slopes hard. "I'M BACK" droping 25' cliffs on 55deg slopes I had some really good wipeouts at Christmas I did a head plant earning me 7 stitches in my lip. What I realize is that my implants are very durable " They can take a licking" I still feel great I'm ready for more. If I had been fused my head would have broken off. On another note the FDA is clueless they are broken like the rest of our government. I'm presently in the appeals proccess with my insurance to be reimbursed for my out of pocket expence of the surgery.
    I'll keep posting any questions please feel free to contact me.
  • I had my surgery done last Wednesday 2/11/09 Went with the pro disc c...Amazing!!!!!! I stayed the night only because I react to anethesia. The next day no cervical collar when moving slowly around the house or watching tv. I was driving by the following Monday no problems, can turn my head left/right almost fully, back to work Thursday no restrictions..doc told me I can golf this weekend, just don't go playing football...
    I also have issues at c4/5 and 6/7 but he (my doc) believes it wont be long before multi level will be approved..so I shall wait and get 6/7 done later..or maybe not if I stay how I am doing right now...neck paing gone..still a little tingling down my arm but the doc says this is normal as the nerve is settling down

    I hope it all works out for you, and in my humble opinion, I would try adr one level on the worst one and see what kind of results you get who knows it may work out for you as it seems like it will for me :-) Hang in there I know it sucks!!
  • Turbodog- It is great to hear from someone who has personal experience from having a double level adr done. What make are your adrs? How much did you pay if you don't mind me asking? What levels did you have replaced?

    You were offered a 3 level fusion you posted earlier. Why did you just get adrs at two levels? What about the other level that didn't get an adr? How are they doing?

    I hope you continue to have great success with your recovery. Keep us posted.
  • Longswl- You sound great. What kind of work do you do? Just asking to know physical level. When I do become a surgica canidate I am going to get what I can. As you said if one is all I can get I'll go for it.

    I am able to control a lot of my pain through maintenance but you know how that goes.

    Thanks for your experience. I always feel hopefull when I hear about good results.

    Best wishes on a good and speedy recovery,
  • discs. I was very interested in them myself when I was doing research before surgery. I was told that this was not an option for me. Not because of the multi level but because of all the other issues with my spine. I wish it was different but I am very happy to see folks doing so well and having such great results. I worry all the time about damage to adjacent levels to my fusion but I waited as long as I could get away with before having surgery. I lost a lot of range of motion and even after months of PT have very limited up/down motion and my side to side is at 70 to 75% which is about as good as it will get for me.

    Anyway, glad to see good results with the artifical discs. From what I understand there are even more incredible ones coming.

    LJ
  • Hello I was asked some questions.
    Answers:
    (1) My disc are the Spinal Kinetics M6
    (2) I had levels c5-c6 c6-c7 replaced (2)
    (3) Regarding the fusion option they wanted to fuse c6-c7 c5-c6 and c4-c5 the reason the U.S. docs wanted to include c4-c5 aswell is becouse of the added stress of fusion. The German docs felt that c4-c5 level was not in bad enough shape to replace with a Adisc.
    (4) The cost was 27,000eu included everything and hotels
    I just had to pay for flights extra.
    If I had the fusion option here in the U.S. it was estimated around $150.000.00 GO FIGURE
  • As I posted a few days ago, I am heading to germany for 2 level Cervical ADR with Dr EDITED. Ive researched this fusion vs ADR issue for 12 months and ADR in my mind seems to have far better results.(just my opinion based on 200-300 patient posts on various back boards regarding outcomes with both surgeries). And of course, fusion patients almost always end up needing further surgeries down the road. There are contraindictions for having fusion instead of ADR such as arthritic facet joints, but Id opt for the ADR anyday. Hope I turn out as good as I am thinking I will. :)

    Doctors name and contact details removed by forum Moderator (paulgla). We do not permit publishing specific doctor's or institution names and contact details.

  • Turbodog- The Spinal Kinetics M6. Wow, I've heard that is the best adr you can get right now. I hope you continue to do well. Take care.

    Steve- I am with you. I've read and know so many people who have had fusions in the cervical region and have had to have surgery again. Psyche tests? What does that have to do with anything?
  • I'm scheduled for surgery on 3/16 to get the Prestige disc at C4/5, and have been getting less and less enthused about it the more I learn about all the better discs coming down the pike. And I hadn't even heard of the M6 until now! That M6 is what I assumed an artificial disc would be like when I first learned that artificial discs existed. Getting a steel ball bearing stuffed into my neck seems pretty primitive in comparison.
  • Hello all,
    I received the Prestige Disc, C6/C7 on Oct 21st, 2008 at UC Davis. I have had EXCELLENT results. I was back to work in one week, pain free and traveling for work within two weeks. I actually have wake-boarded already this summer. I did have some small residual nerve pain in my hands because my disc had "broken" and part of lodged between my vertebra and nerves (so regardless of which surgery, I would have still had some residual nerve damange). I am 110% better than I was prior to the surgery.

    FYI, I have a letter in my hot little hands, from the FDA, on FDA letter head stating emphatically that the Prestige artificial disc is 100% FULLY FDA approved. It states that it is NOT experimental or investigational. I am happy to provide a copy of it to anyone who could benefit from it for their insurance.

    I will say, Anthem Blue Cross of Calif would not pay for it...but I am still in an appeals process. My appeal is July 16th. If it is overturned, I will let you know...say a prayer or send out positive vibes is you will...If we can get Blue Cross to pay (one of the last hold outs) it could help thousands of people like me/us/you!
  • I have a cervical fusion because I had multi levels of disk problems. I think that is the only difference between why some surgeons suggest the fusion over the disk replacement. Because I also have several in my back and my doctor said cuz i have 3 levels they could not do it.

    With the fusion I healed from the surgery in about 3 months. The entire healing takes about 9 months. I think the fusion was the right choice for me.
    2005-ACDF with Corpectomy at C3-C-5.
    2006-L4-L5 diskectomy.
    2009-Cervical laminectomy at C3.
    Steroid injections series x 4.
  • BrendaJC thats great news!
  • I am really impressed at how everyone on this site seems to have done so much research on this and come to pretty much the same conclusions that I did on my own before I found it. Turbodog’s story really hit home.

    Here’s my little story: I was in a car accident that totaled my huge truck and luckily only left me with a herniated disc in my neck C6/C7. The first surgeon who is renowned and supposedly “conservative” wanted to do an ACDF on me without question. My family doctor agreed. Then I saw a surgeon who said that he would not recommend the ACDF unless it was absolutely necessary and the pain was too much for me to bear. The problem is that I don’t think I am in the kind of pain that would require me to get a metal plate with screws drilled into my spine. I figured I would rather deal with it and possibly get surgery or something else later when there is something less “medieval” available.

    During this process I was speaking with my parents who were still stationed overseas in Germany. My dad had recently seen an amazing German doctor (Turbodog is exactly right) who performed surgery on him and who also performs surgery on many American soldiers over there, injured from the war. My parents thought that I should speak with this doctor about my issue. That is when I first found out about the Total Disc Replacement and that there was an alternative to the ACDF.

    When I called the first surgeon who wanted to perform the ACDF and asked him about it he not only didn’t answer my question, but actually said he was busy and had to go and “pick up the phone because someone was calling him.” He and his staff were annoyed that I was simply asking about it because it was something that he apparently did not perform. I actually remember him telling me it was not approved by the FDA when I knew that it in fact was.
    When I do get the surgery it will definitely be the disc replacement. That M6 looks amazing. Everyone should check out the site to the hospital in Germany where Turbodog went:
    EDITED
    Here is the sad truth about us compared to Europe when it comes to healthcare: “Disc Replacement, developed in Germany over 20 years ago, is now the new gold standard, and has all but eliminated the tragedy of spinal fusion (except in the US, where this process has been slowed by regulation).” AKA the FDA.

    Thank you everyone for your insight on this subject…certainly has helped reassure me.

    Here's the site to the doctor in Germany I was talking about if anybody was interested:
    EDITED

    Doctors name and contact details removed by forum Moderator (paulgla). We do not permit publishing specific doctor's or institution names and contact details.

  • I agree a disc replacement is a better idea. The pain after wards would be better as well. I asked my doctors about it before I had my fusion and if you need more then a single level then your not a candidate for this surgery. so it all depends on your situation. With a fusion of course you never have to worry about that area herniating again because the discs are removed. Having any spine surgeries is difficult and having to have hardware replaced would suck after having that operation.
    2005-ACDF with Corpectomy at C3-C-5.
    2006-L4-L5 diskectomy.
    2009-Cervical laminectomy at C3.
    Steroid injections series x 4.
  • this thread has put a smile of hope on my face today...

    can anyone post some more info about the M6 disc TURBODOG is talking about?
  • The M6-L artificial disc represents the company's second non-fusion, motion preservation product to treat degenerative diseases of the spine. The company launched its M6-C artificial cervical disc in Europe three years ago. To date, over 3,000 discs have been implanted. Like the M6-C, the M6-L lumbar disc is an advanced generation artificial disc developed to replace an intervertebral disc damaged by disc degeneration. It is the only replacement disc that replicates the anatomic structure of a natural lumbar disc by incorporating an artificial nucleus and annulus. Together, the nucleus and annulus are designed to provide the same motion characteristics of a natural disc.
    2005-ACDF with Corpectomy at C3-C-5.
    2006-L4-L5 diskectomy.
    2009-Cervical laminectomy at C3.
    Steroid injections series x 4.
  • I had ACDF in February 2009. If I had it to do over again, I would go with the ADR instead of the ACDF. It's only logical that fusing a section of your spine will lead to problems with the adjacent levels, especially if you are still young and active. More activity = more stress on the discs. I guess if you are retired and spend most of your time at home watching TV a fusion might be okay.
  • shortfuse5691 said:
    The M6-L artificial disc represents the company's second non-fusion, motion preservation product to treat degenerative diseases of the spine. The company launched its M6-C artificial cervical disc in Europe three years ago. To date, over 3,000 discs have been implanted. Like the M6-C, the M6-L lumbar disc is an advanced generation artificial disc developed to replace an intervertebral disc damaged by disc degeneration. It is the only replacement disc that replicates the anatomic structure of a natural lumbar disc by incorporating an artificial nucleus and annulus. Together, the nucleus and annulus are designed to provide the same motion characteristics of a natural disc.

    I just looked it up...this disc is serious everyone on this board should see this

    ^ The Future ?
  • R U Serious Turbodog?
  • BrendaJC, Weightlifter and Turbodog please come back and give us an update of how you are doing...PLEASE!!!!

    Your storys give me the hpoe to make it thru each day...
  • I'm thinking of heading back to Germany for some knees maby a hip and elbow. Just kidding. seriously the m6 implants have afforded me another great riding season last winter and oppertunity to work. still feeling great! THANKS :-C
  • After years of suffering with constant pressure in my head, throbbing headaches, tinnitus, palpitations with shortness of breath, rapid-fire sounds in my ears, some arm issues, discomfort swallowing, etc..., I finally found out that it was all related to my neck. I was involved in a whiplash accident about 14 1/2 years ago that resulted in chronic, progressive symptoms. Anyway, after finally having MRIs done last year, I found out I have two herniated discs and one bulging in my cervical spine. Also, I have bone spur complexes with cord indention, and the csf is blocked on both sides of my spine as a result. I was referred to a neurosurgeon who discussed multi-level ADR using the Prodisc-C, and I was definitely on board after learning about the differences between that and fusion. I am in the process of appealing my insurance company, but I am still researching my options. Yesterday, while searching online, I read about the hospital in Stenum and decided to fill out their form online. Today, I received an e-mail back with a lot of information and reference to a website that explains the M6-Cervical Disc. I am now beginning to think that may be the better choice.

    Years ago my husband and I went to Canada to have Lasik eye surgery done because although the Bausch and Lomb technology was created in the United States, the FDA had not yet approved the better machines for use here. I know we made the right choice because we both ended up with 20/20 and 20/15 vision. I guess the point I am getting at is that I believe we all have to do our homework and decide what is right for us. I have seen first-hand where the flaws are in our healthcare system, and I know I have to do what is best for myself and my family after weighing out all my options.

    The primary goal of insurance companies and doctors should be to get people better and to do it right the first time. Unfortunately, because of all the red tape involved, the best treatments often take far too long to get approved in the United States. Then the insurance companies often won't pay out for them and in the long run end up costing themselves a lot more money. I think they are "Penny wise, and pound foolish". They continue to call surgeries such as ADR 'experimental' which is ridiculous because it has been done successfully for years in other countries. In the meantime, so many people in the U.S. have been forced to endure years of suffering while the insurance company continues to pay for doctor visits, chiropractors, physical therapists, pain management, subpar surgeries, and resulting further spinal deterioration and often repeat surgeries. They'd rather pay for a lifetime of maintenance than to fix a person right the first time because in the short-term they pay out less - in the long run it costs everyone more money. Seriously, it makes no sense to me!!!!!!!! Sorry, I guess I needed to vent on that. Bottom line, I personally think ADR is the better option. At this point, it is just a matter of getting the best disc that is available at this time or waiting for something better to come along if you can wait.
  • ^catelynnw3 you should read this...another person just got back from germany after getting the M6..

    http://www.adrsupport.org:80/forums/showthread.php?p=83750&posted=1

    another positive M6 story .

  • Please consider ACDF as a potential worsening as a result. I was seen by work comp doctors and they all said ACDF. I requested a less invasive method in Florida by laser but because of fda approval, i was denied. I had ACDF on c5/c6 with fusion and feel worse than I ever did eighteen months without it.
    The recovery was slow, an incision is at least 3 inches across your throat, for a woman not exactly something you want to have on the fron of your neck. Expect numbing, spasms, and more pain on your neck shoulder blades and arm, if the arm bothers you now it may get worse.I suppose what I am trying to say is that if you can tolerate the pain before surgery, don't mess with it. Once you have an ACDF...that's it. There is no going back. I do not recommend this type of surgery onto anyone, unless you are at a point where the pain and weakness in your arm is unbearable. Try if you can a less invasive approach. Otherwise, know that you may en up feeling worse than before. I have found more research with negative feedback on this incision after my procedure than I did before. Best Regards.
  • "In the meantime, so many people in the U.S. have been forced to endure years of suffering while the insurance company continues to pay for doctor visits, chiropractors, physical therapists, pain management, subpar surgeries, and resulting further spinal deterioration and often repeat surgeries. They'd rather pay for a lifetime of maintenance than to fix a person right the first time because in the short-term they pay out less - in the long run it costs everyone more money" your statement is absolutely true. Work Comp in California rather pay more for ACDF than pay less for a less invasive procedure and you end up worse than before. Please do your research on any cervical spine surgery. It is not as it is explained, as simple. I had no choice. I was pushed into it by Work Comp and an inefficient attorney whom did not look out for my best interest. I had an ACDf WHICH ENDED UP BEING A HUGE MISTAKE.
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