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Artificial Disc Replacement? Yay or nay?

Hi guys,

Have just been speaking to a company that organises ADR surgeries in Germany for NZ and Australian patients, as I am looking for options other than a fusion or just living my life on pain killers being unable to work which is what my current specialist seems to think is acceptable.

Has any one had this done or have any first hand experiences with this surgery? I am really trying to find any and everything that may help and give me some what a normal life again.


Thanks in advance.

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Comments

  • itsmedelaneyb, I am also investigating the possibility of artificial disc replacement for my spondylolisthesis, L4 over L5.  I also have lumbar spinal stenosis with some nerve impingement.  There are also these things called interspinous spacers (Coflex, X-Stop, etc.) that are for separating bones that are rubbing together and causing pain.  I am searching for information about these alternatives to fusion surgery.   I would be interested in any information you find.

  • itsmedelaneyb and BBJ

    I had a prodisc C artificial disc replacement surgery in 2014 Cervical.  I would be more than happy to answer any questions you may have.  Prior to my surgery I searched and searched to talk to someone that had an artificial disc but there was not much.  I can only speak from my experience and my experience was AMAZING.

    As i was going through my replacement I had co-workers that opted for the fusion - here we are 2017 and I am in a much better place than they are.  My recovery was faster and I feel great.  

    I was completely scared to have this procedure but I also knew I could no longer live in the pain my neck was causing - My surgery was actually done at a day stay surgery center, I went home that night with a drain tube - back to the doctors the next day to have the drain removed and honestly 3 weeks recovery.

    The pain after surgery was not good - however I also knew that my nerves were misfiring from being released and I kept telling myself that - I took the pain meds around the clock along with antibiotic, steroid and a few other medications.  The procedure it self went off with out a hitch - I will say I was very happy when in pre-op holding one by one each of the doctors on the team came in - there was one doctor whose entire job was to monitor my spinal cord and if the doctor for any reason was to come too close he alarms him - that made me breath much easier.

    No neck brace was needed either (which my co-workers had to wear non stop for 6 weeks with their fusion) - I had total freedom to move my head and it was like a rebirth how much I could move.

    I am happy to answer your question or anyone's questions regarding an artificial disc replacement - my cervical is great now - but I have lumbar issues now. 

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  • Hi @CassCoop, thanks so much! thats really helpful! Where did you get the ADR done? as I am in New Zealand no doctors here do it so would have to travel to Germany and most likely pay out of my own pocket, $70,000 is a lot of money to me unfortunately and am very hesitant to put myself in financial risk if the surgery doesn't work.

    Prior to the ADR what sort of things had you tried? had you had more conventional surgeries before going for it? I have had two discectomys and a repair of a dural tear and my specialist seems to think my pain could be a result of excess scar tissue, where my GP seems to think that its more than that as after my surgeries I have shown improvement for a while before the pain returning.

    Have you had any difficulties with doctors not knowing much about ADR/ hesitant to treat you post surgery? I am afraid that might happen in NZ.

  • Hi - my neurosurgeon wanted to do an ADR with the Mobi-C for my C5/6 - stated that I was a good candidate (46, no neck issues until rear-ended in car accident which caused tear and bulge & other stuff, progressed after 10 months of conservative treatment to cord compression and now having surgery 13 mo after accident). I read the material, and then went and read every study I could find on scholar.google.com on ADRs. Long and short of it, I'm going with the "gold standard" of fusion. There has not been a published peer-reviewed study of ADRs > 8 years. At the 2 year mark and the 5 year mark, there was no statistically significant difference between benefits and "adverse events" of ADRs vs. fusion EXCEPT the metal-on-metal disc replacements which were a mess of adverse events. I don't think anyone is using those anymore. The mobility difference for one level replacement is very small. We have about 30 years of data on fusions. No one knows how long ADRs will last and removing an ADR (which they wind up just doing the fusion anyway) is really hard regardless of type of disc.

    That said, here's what really got me. The FDA in the US only requires that the manufacturers prove that, within statistical boundaries, their disc is "not worse" than fusion. So for me, the idea of introducing an unproven long-term risk with multiple metals and materials into my body so that I could gain a smidge of range of motion was a no-brainer. Note that the FDA includes more items as adverse effects than the manufacturers' marketing material - I trust the published data more, and I trust the non-manufacturer-sponsored studies even more. 

    Note - I did not look at or consider multiple levels, and I only looked at cervical disc replacement. Lumbar disc data is much worse - many hospitals won't do an ADR lumbar because of it. Also I think the data on a 2 level replacement may be better, but I don't know. The last thing that got me was my PCP's story. She went in for a 1 level (cervical) fusion, and as soon as they moved things around, they saw that the other two discs were a mess, and so they switched to a 3 level fusion. Last year. Had they gone in with an ADR, they may not have seen the damage to the other discs (laparoscopic surgery has that risk of lower visibility), and it's harder to switch then to a fusion. I don't believe anyone (at least in the US) does 3 level ADRs. I'm having my surgery at Brigham & Women's/Harvard in Boston, and they will do a 2 level ADR (as will Mass General, which is where my neurologist is). 

    Also risk of non-fusion was considered in all of the studies, although I am going with an autograph rather than an allograph (my own bone vs. cadaver bone) which also helps with faster fusion. The recovery time statistically is 7 days less for an ADR. 

    GL!

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