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Removal of 3 level ADRs & converted to 3 level fusion

steve55ssteve55 Posts: 86
edited 06/11/2012 - 8:37 AM in Back Surgery and Neck Surgery
In Feb 2009 I had a 3 level Artificial disc procedure in Bogen,Germany. I could tell immediately after surgery that my pre op pain was 100% gone and by 3 months I was 100% pain free. Problem was that my 3 mo x rays showed C6/7 ADR was subsiding, possibly the C4/5 also. My doctor advised me to stay pat and see if the subsiding stops. Well, it only got worse and before I knew it, the C6/7 ADR was right on top of the C5/6 ADR!! It was like my vertebrae bone was getting eaten up as the ADR was sinking. FInally, my German doc arranged for me to have my surgery with him in Lacrosse, WI. This was of course a rare event for him as 99% of his surgeries are done in Germany. I think he felt a responsibility or obligation to fix me. This was nice to see. Well, they did numerous bone density tests which revealed very strong bone denisties. They just couldnt figure out why my disc was subsiding. ANyways, Their plan was to remove the subsiding ADR and fuse me at that level while still saving the other 2 ADR's, assuming I had enough Vertebrae left to hold the bottom 2 ADR's. Corpectomy (removal of the vertebrae) was a possibility if he didnt feel I had enough bone left to fuse me with. Well, they open me up and lo and behold they are shocked at what they find. It was something that no one ever even remotely expected! I had a raging STaph infection!! And it was hiding as undetectable. They did blood work on me during surgery and it came back negative for elevated white blood cell count. The only way they confirmed what they saw was by doing a durect culture from a piece of bone that vusually showed infection. So, they removed all 3 ADR's and did a 3 level fusion via hip bone graft and a corpectomy or partial corpectemy (removal of what was left of the C5 vertebrae) at the C5 vertebrae.

Never had much pain after surgery. In fact, as long as i was laying still in bed I had no pain. Stopped all pain meds 1 week post op. By week 2 I was able to fast pace walk for 20 minutes without limping from my hip. Though last few days the hip has gotten a little tender so I have a slight limp again when I walk. I returned to work pretty much full time within 2 weeks!! I did have numbness in my thigh which thankfully had turned into soreness, which I believe will soon yield to having full sensation back. My german doc explained that he graphs hip bone differently than the american docs and said it would yield a much better result and so far based on othetr hip graph patient stories recovery time, perhaps he is right. He graphs it from the middle center , via shavings off the side I believe, instead of taking it off the very top part of the hip as american docs do. At least this is how I understand it.

I had gotten 4 second opinions with top ADR doctors (since we cant post doctor names, Ill post tehir initials for those of you who are familar with who the top ADR docs in the US are. (JR and RD in los angeles). None of them, inlcuding my German doctor even remoteley suspected that the cause of my subsiding ADR was an undetecable infection. During the 6 hour surgery, they took photos and documented everything. Apparently my case is extremely unique, a first. I was told that I will be a case study for the medical community. Ya see, the few times so far that someone has caught a infection in the spine, an infection will show itself very quickly as the patient will be very sick, fever, pain etc. They will immediately go in and remove the hardware. BUt not me. This staph bug stayed under the radar and was eating my bone for breakfast, lunch, and dinner. Im now on IV infusion therapy for 2 months to rid of the staph infection.

So far, the 3 level fusion has been painless and I felt pretty good after 7-10 days. NOw the challenge is to fully fuse as fusing at 3 levels is harder to do. Im waiting on a bone stimulator from my doctor so I can speed this process up.

I dont know what to expect in regards to ROM loss. Though Ive been told by people ho have had 3 and 4 level cervical fusions that the loss is not very noticeable or bothersome, mostly up and down loss more so than left to right loss. I've read about many people who have had 3 and 4 level cervical ADR's done , many over 10 years ago and they are still doing great with no adjacent level issues. This was great to learn about.

Lastly, regarding adjacent level degeneration, I was told by the neurological nurse that C1/2 & C2/3 and C7/T1 are very rare to blow. C1/2 & C2/3 are constructed very differently than the other C levels. She said basically, C4 thru C7 are the most vulnerable discs that give out due to adjacent level degeneration pressures, and as I already have those levels fused , I have a better chance at not needing further surgeries due to adjacent level deterioration. This also matches what I read on the internet. SO, now I feel alot more positive about having so many levels done. BEsides, I had no choice, I was EXTREMELY miserable pre surgery, pain level 9 in the evenings and life was a living hell. I surely had no future if it wasnt for surgery giving me my life back. I didnt want to be a narcotic pain pill junkie with a pain pump and besides, the pain was affecting my overall health and compromising my immune system. Life was pure hell. Anyways, I gave the ADR's a try, but it just wasnt in the cards for me to keep them. That's life I guess.

I know Im not out of the woods yet as I have yet to fuse. If I dont fuse that might cause issues down the road and require another surgery. But so far, 2 weeks post op, I am 99% pain free! I feel fortunate. I am fortunate that surgery has fully relieved all my pain given how horrible it was presurgery.


  • I'm glad things seem to be turning out OK -- sounds like you've really been through a lot. I am curious how you ended up in La Crosse or why the German surgeon was operating on you there? When you have time, please explain!!
  • It's good to hear that the fusion is making your pain go away. I thought about ADR for months but I am in so much pain and I'm going for the fusion. I am scared but your story just helps me to reaffirm that I am making the correct choice for me. Too bad you had to go through the misery of the ADR's failing. Did they put you on antibotics after surgery? That is scary. I'm hoping all goes well with the whole swine flu stuff when I have my surgery in November. How long were you in the hopital after the fusion?
  • gwennie17 said:
    I'm glad things seem to be turning out OK -- sounds like you've really been through a lot. I am curious how you ended up in La Crosse or why the German surgeon was operating on you there? When you have time, please explain!!
    Well, its quite a story. The German doc's team initially offerred me revision surgery there in Bogen (with Dr B) for $18K. But I cant afford that after paying $42K for the initial surgery. Im plum out. I had actually planned on surgery with Dr J.R. in Los Angeles for $10K but 4 days before the surgery I cancelled because my German doc met me at DFW airport here in Dallas as he was passing through advised me to call off the surgery to see if the situation would self correct and stop subsiding. 2 more months went by and X rays showed a worsening of the subsiding and my pain was at a pain level 2 or 3, so something still needed to be done.

    Dr B then met with two docs from the TX Back Institute (Dr Z and Dr G I believe)while at a conference in Vienna where the docs from the TBI agreed to let him perform surgery on me here where I live and they would simply be assisting. I live in Plano, TX, 5 minutes down the road from the TBI. (Im not sure if I am allowed to spell out Dr names here so I am providing initials hoping that is ok)But when the TBI docs got back from the conference, they renigged on their offer to let Dr B fix me here. I had warned Dr B that they didnt want to see me there, but Dr B was absolutely certain they would say yes to him and he told me not to worry. I actually believed him because Dr B's is world renowned and he comes to the US to train other docs on ADR's, and he works very closely with the TBI docs. But it didnt work out that way as I suspected it might not. And I know why. Ya see, TBI believes in psychological tesing before approving surgery. Back in 2008 I had taken a 700 question test(took me 3 or 4 hours to finish it) and they told me I failed it because it appeared as if I was contradicting my answers or not being honest with my answers. I was very upset at this because I know in my heart of hearts, I answered them as honestly and openly as possible. I know Im normal and well adjusted and besides, how can a pysch test prevent a patient from getting pain relieving treatment or surgery. I thought such an idea was nuts and in fact, discriminatory. I know of other patients who went to TBI and compalined about the way they were treated by the pysche lady they use up there for all this testing and meditation stuff they make you do before being cleared for surgery. One lady was actually denied surgery, they told her she was too depressed. Eventually, a different TBI doc overrode the decision and she was finally cleared. My issues with their psych lady is that she is comes across as being on a power trip , almost as if she enjoys telling the patients they have to go through her first and they may or may not be able to get surgery depending on psych test results. Well, this is how she came across to me. I was so infuriorated and fed up fed up with her power trip attitude attitude and having to come in for several psyche visits, and being accused of lieing on my testing etc etc, I complained to Dr Z at the TBI about why I was having to jump through all these psych hoops and loops. I know I should have probably shut up and put up with it but for some reason it really ircked me that I was being put through all this psych stuff for something that was a physical based treatment. So, in a nutshell, I think the combo of failing their psyche test and my complaining about it put me on the TBI Blacklist. I was told by a patient advocate who works with all these docs in the US and germany that one thing particular about TBI is that once TBI gets it in tehir mind that you are not the right patient for them, you will never be accepted as a patient with them again. SO be careful if anyone plans to go there for treatment. Great docs, but they will wash you out if you fail psych tests. Its because they want to uphold a high successful surgical outcome record that they institute this policy. Apparently, they think that studies hsow that depressed people or mal adjusted people bring down their surgical success outcomes. Kind of sad to deny treating people in pain just because they are worried about their surgical success %'s. But they are some of the best spine docs in the world.

    Ok, sorry for that off topic rant there. FInally, after TBI withdrew their offer, Dr B found another American doc who was willing to let him perform surgery on me here on the US. I kind of figured that it was also a training oppurtunity for the american doc as very few American docs have done ADR removals. I believe most docs try to fuse ADR's in place when things go wrong. Apparently, ADR's can be tricky to remove, though cervicals are easier to deal with than a lumbar. My insurance covered most of the procedure and arrangments were made such that the disc manufacturer paid for whatever the insurance didnt end up covering. I think they wanted to do the right thing and as it turns out, the disc manufactuere sent reps to witness and photograph my surgery. I think they were worried that their product had a problem with certain patients like myself, but they didnt know what that problem might be. No one knew why my disc was subsiding. It turns out that the problem was the infection, not the ADR. SO, Im glad I could contribute to their learning curve on this new technology. I would like to think that they got their monies worth by documenting my surgery and learning from my case. I believe they have never seen a case of disc subsiding due to a undetectable staph infection. So, the next time a patient has a subsiding disc, protocols will probably call for tesing for infection. BUt blood work wont necessarily detect an infection, they'll have to find more direct ways of testing for that in the future.
  • kendrak said:
    How long were you in the hopital after the fusion?
    2 months of daily antibiotics infusion therapy(nurse comes to my house every day).

    I was in the hospital for 3 days, mainly due to my hip soreness. If it wasnt for my hip, I could have left the very next day.
  • Wow. You've been through so much. It is a testament of your strength that you've been able to survive this. Thank you for sharing your story.

    I have a question, if you remember, to ask your surgeon if you don't mind. Not that an infection is in any way a good thing, but I was curious about a remark a NS made to me at work. He said that though all infections are bad, "there's nothing like a staph infection to make a good fusion." Not that he would suggest intentionally doing that, just that there was a small silver lining to a bad situation. I'm curious what your doc might say about that, if that is indeed a true statement. Your doc obviously seems to be recognized worldwide as an expert. So, if you remember, would you please ask him and post the answer? Thank you and good luck!
  • Yea, he told me that fusions after a staph infection are much faster and better. But my staph was mainly in the c 6/7 ADR . The other 2 had little to no infection. But they were removed anyways because it's too risky to gamble leaving them in. Most likely, they had some staph bugs also.
  • Oh yeah, I understand about infected hardware needing to come out! Had a PICC line myself, but only for 6 weeks of antibiotics. Was just curious if the staph statement was true or not. TY for answering! Again, good luck.
  • Wow, incredible journey you have been on. Thanks for sharing it with us so eloquently. Bummer that you had to go through it all, but it's cool to read a testament to some outstanding folks that obviously got together to help you out. Even though it was a training experience and some CYA for others, they didn't have to say yes. Glad that the goodness in them came through for you!

    Heal well!

  • How about another update? How are you doing by now? And what is planned? Are you in pain?

    Would you encourage others to go to Germany for ADR at this point?

    Happy Halloween!
    xx Gwennie
  • Do you think the staff infection was from having so many levels done and being opened up for 6 hours?

    I mean 6 hours sounds like to long to have an open wound on your neck...
  • Sorry to hear the ADR's didn't take. You've been through quite a bit and I hope you have continued relief with the fusion. I wish you all the best in your recovery. :)

  • Sorry to here about your troubles. In 2001 I had a micro diskectomy L4-L5 here in the state's. About a week after surgery I became real ill yep! the old staff it too was eating my vertebral body (the bone) UM UM UM nasty critters they cut me open and debride
    (scraped it all out closed me up) at the same time they put a tube in my chest going to my vena cava so I could addminister an IV (Vancomycin/ Primaxin) 4 times daily for 2 months. I feel your pain brother.
    I'm sad to here your ADR failed becouse of the infection. I have 2 M6 in my neck for about 15 months now they seem to be doing well so far. I hope your revision surgery does you well. Keep us posted.
  • Dose anyone know how to add picture to post?
  • gwennie17 said:
    How about another update? How are you doing by now? And what is planned? Are you in pain?

    Would you encourage others to go to Germany for ADR at this point?

    Happy Halloween!
    xx Gwennie
    As of 11/6, Im doing very well still. Im 99% Pain free, working full time easily, and the hip discomfort is barely noticeable. Im able to do 20 minute uphill treadmills with no problems. I feel I am still improving. I just cant wait to get rid of this neck brace and get the PIcc line out of my arm so I can feel normal again. I feel like the borg (in star trek) kind of. LOL
  • Steve

    I had a 4 Level ACDF on Aug 25, 2009. Was in hospital for 23 hours then home. Got bone stimulator after 2 weeks. Went for 3rd post op visit on Nov 4. Lower 2 completely fused, upper 2 approx. 75% fused. They used my bone spurs and 4 titanium cages and 10 screw. I feel great. I do walk a lot and that seemed to help. Also prayed a lot. Did 6 weeks PT only on lower body and shoulders.

    Good luck
  • Before I was able to go ahead with ADR my surgeon took x-rays of my spine to ensure it was straight. It has been proven throughout Europe that if the area they are inserting the ADR is not within a certain percentage of straightness, the ADR can start to move out of place. My surgeon will only do one ADR at a time too, to ensure it heals properly etc and then a year or so down the line, if it is OK, he only then considers operating again in another area. There is strict criteria in the UK for ADR surgery which I believe parts of Europe are not so strict about. Hence, there are only a handful of surgeons in the UK that specialise in ADR.
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