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Artificial Disc Replacement

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:32 AM in Back Surgery and Neck Surgery
Hi, I posted for the first time yesterday my mri and made a humorous attempt at entertainment by asking if people could guess what procedure I might need as I wasn't going to get to see the neurologist until late this month. By some miracle, they saw some patients today and I got in. He says I need an artificial disc replacement, and the accompanying clean up of bone spurs. I have not had to live with pain long term; the headaches, neck pain and new right arm numbness are fairly recent, but are getting worse fairly quickly. He said I could do physical therapy, but it would not get to the root of the problem (pun intended) and if one waits too long the damage can be permanent. I already have a slight weakness developing in my right arm, my dominant hand. When it's put that way, I think it's a no-brainer, right? I'd kind of like to have the use of my right arm later. I am a 45 year old very active male, Modic Type 1 changes to endplates indicating edema, chronic disc/osteophyte complex, mild retrolisthesis, moderate foraminal stenosis, compression of the right C6 nerve root, bilateral facet arthritis,etc. Is it a cavalier decision to say let's just fix it now rather than waiting? Have people out there had good experiences with the artificial disc replacement at C5-6? Thanks for any help or advice!


  • I was also recommended ADR for C5/6 or C6/7 but the insurance did not approve it. Luckily the myelogram I had showed a really pinched nerve at 6/7 so my doc, a very good NS recommended posterior cervical foraminotomy at that level and then we wait a few years and see if we need to do ADR at 5/6 when the insurance will approve it. In other words I have options still. So far I am in very good shape, ten days after the operation.

    All the research I did on ADR showed good results, well at least as good as any other back surgery, and ADR patients have been very active since surgery. But they also recommended getting the most up to date equipment (I think there was something called Spinal kinetics that they liked) and definitely working with someone who really has done the operation a lot.

    On the other hand all the stuff I have read on this site about fusion shows that while the recovery time is longer, the ultimate results aren't anything to worry about either as they solve the problem and the recovery problems do go away. I saw a neurologist who told me that ortho surgeons have no problems fusing, but neurosurgeons usually try to avoid it.

    Lastly, I would read up on whether you really want to have surgery at all. I went to a different NS after 6 weeks of problems hoping to get a steroid shot in the neck but he did not do them and offered to cut me back then. I balked and tried all conservative measures I could for the next six months. Eventually the pain somewhat lessened, and indeed most docs tell you that back problems will solve themselves in about 3 months. But in my case the nerve was much too pinched and after 5 months of continued pain I suddenly began to lose strength in my left arm so I went to another NS (didn't like the 1st guy--too arrogant) and that's what led to my surgery.

    There is an ADR support forum but they are almost impossible to read and post on as they have a gazillion security measures. I hope more people talk about it on this site.

    Good Luck
  • jmooretx, you wrote:

    On the other hand all the stuff I have read on this site about fusion shows that while the recovery time is longer, the ultimate results aren't anything to worry about either as they solve the problem and the recovery problems do go away. I saw a neurologist who told me that ortho surgeons have no problems fusing, but neurosurgeons usually try to avoid it.

    I would like to know where you read "the ultimate results aren't anything to worry about...". I had ACDF on C5/C6 and I regret it. There is a phenomenon known as "adjacent disc disease". Basically, when they remove a disc and fused the vertebra together more stress is placed on the discs above and below the fused level. If you are retired and a "couch potato", then I guess it's not a problem, but if you are still active, then you can probably count on having an adjacent disc go bad at some point. Hopefully it won't happen for many years. In my case, though, it took less than five months for C6/C7 collapse.

    The very first doctor I saw for my neck problem was an orthopedic surgeon. He wanted to do surgery right away. I trusted this surgeon because he had operated on my mother some years before. However, my family and friends encouraged me to get a second opinion. At first I did not think a second opinion was necessary, but then I started reading about fusion and that is when I learned about adjacent disc disease. So, I decided a second opinion was a good idea.

    I went to see a neurosurgeon. The neurosurgeon's opinion was that fusion was not necessary. He recommended a "partial hemilaminectomy and decompressive foraminotomy". That is what I had. It resolved most of the symptoms I had been having, but I kept waking up at night with my right hand numb. An MRI showed no problems, so the neurosurgeon sent me to a neurologist, who prescribed clonazepam, meloxicam, and PT. I think the PT strengthened my neck, but it did not resolve the numbness in my hand, so the neurologist ordered a myelogram. The myelogram showed the herniation that the MRI missed (this is why I have no confidence in MRIs). After that, my neurosurgeon reluctantly recommended that I go ahead and have a fusion, but since he did not perform fusions he referred me to a different neurosurgeon. I met with that neurosurgeon and I liked him, but I kind of got the impression fusions were not his specialty, so I went to see an orthopedic surgeon. I did not get good vibes from this surgeon, but he offered to let me meet a couple of his patients. One woman happened to be there for a follow-up appointment. The other one actually worked there. Both of them were very satisfied with their results, so I decided to go with that surgeon. This was about 10 months after the first surgery.

    To shorten a long story, the fusion gave me very temporary relief. I think the level below C5/C6 probably went bad less than four months later. Now I have pain in my neck/shoulder, upper back and hands. Sometimes my arms. Most of the symptoms are on the right side.

    If I had it all to do over again, I would have had ADR from the very beginning. However, neither of the two initial surgeons I met with mentioned ADR as an option, probably because neither one of them performed ADR. If an ADR fails, you can always have fusion, but I'm not sure the reverse is true.

    My advice is to get opinions from different surgeons, both neurosurgeons and orthopedic surgeons. And before you go to see a surgeon, make sure he has a good reputation. Learn the risks and benefits of your options. Read other people's posts about their experiences with the procedures. Learn as much as you can before you let anyone cut on you. On the other hand, if you are having constant pain or numbness, don't wait too long or you could end up with permanent nerve damage.
  • I was perhaps a little too glib on the not much to worry about line, so what I should say is that while there are certainly many people who have had problems with fusion, and I don't want to downplay their problems at all, I have read equally many reports on this site from people who have been happy with the results from their fusion. No back surgery is without dangers and possible complications and any surgeon who is any good should not promise to be able to solve your problem 100%.

    I have posted a much longer bit on my research about ADR on another thread (the one labeled "ARD anybody?") in which I talk a bit more about the issue, including adjacent disc disease. I personally chose to avoid fusion as I had another option, and fusion is not something you can undo (nor, really is ADR, they cannot remove most models without further damaging the vertebrae yet). I agree that if you have another option it's worth checking it out. But given the difficulty getting ADR for most people in the US I also wanted to reassure people that fusion is certainly not the end of the world! And some people simply do not have another option.

    So if you are facing possible fusion or ADR just be sure to check out all the details and options and make sure you have the best surgeon and the best solution for you.

    All the Best <):)
  • My surgery and my life could have taken a tragic direction. My family doctor referred me to a surgeon. I was in so much pain I told him that I wanted to have surgery to correct my problem (spondy). He explained how they would remove the disc and replace it with hardware & cadaver bone. But, first he wanted me to go to PT. I went twice and it made things worse. Next, I had an epidural that lasted 2 weeks and 4 days. I scheduled a 2nd one, but right before the appt. I called the surgeon's office back and told them that I wanted surgery, instead. They set the date and mailed me pre-op instructions. The next time I saw the surgeon was the afternoon after my surgery. My surgery was successful and I'm fusing nicely (6 wks), and I have very little pain. I'm glad that I didn't have to go through several doctors and procedures, again, I was lucky. All I knew about the surgeon was that he had done surgery on my cousin, and I knew that my family doctor wouldn't send me to someone that she wouldn't use herself. I certainly wouldn't advise this approach. I'm just happy that it worked out for me.

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