Tim, I'm not sure about the "no bridges are burned" aspect of anything spine. I remember when the ADR doctors said... "sure, no problem, try ADR and if they don't work you can pop 'em out an fuse... no options lost".
I have spoken at length with several docs about the Fenix system. Looks good... looks minimally invasive. I guess you could say, 'no bridges burned' if you believe that the facets are already completely shot and are your pain generator.
At the conferences, everyone seems to understand that the facet repairs are going to pay off for the failed ADR patients. However, the product development process does not allow that to be the focus... only plain vanilla cases... all the talk about ADR revisions is pretty hushed. I think that the facet replacement and repair technology will be huge. The surgeons I know who are involved in the clinical trials seem to be pretty surprised at how well the patients recover. However, it's still early and we'll see about long-term when we get there.
I don't think that there is accepted protocol for ADR revision. Sadly, a substantial part of my business is dealing with failed ADR clients. (Even more sadly, most of them have problems that could have been avoided... some are just unlucky and their complications would have happened no matter what they did. But, I still see the lions share of problems being from poorly implanted devices or poor patient selection ... easy to say in hindsight.) I've taken the same clients to multiple surgeons and have listened to compelling reasons why one would absolutely explant the prosthesis, while the other would leave it in place and fuse behind. I have also seen posterior stabilization behind failed ADR and will see more soon. I have seen anterior ADR revisions both cervical and lumbar. I have seen lateral procedures, but not ADR revision. I will soon see lateral ADR repositioning... can't/won't give details until it's over.
The decision on how to remove the prosthesis will be impacted by what else needs to be done. If another total disc will be implanted (say between 2 ADR's), then you are already there for anterior surgery and an anterior access retrieval will make sense. Now, you can consider a lateral ADR, but I've only seen Pimenta talking about that. Each case is unique and revision strategies will not be consistent.
Rosadee... I'm so sorry to have watched you go through such difficult times and not finding relief with ADR. You are living the nightmare that we all feel. It's amazing to me how, as I deal with many difficult cases that span years, how the diagnoses change. A surgeon sees something that seems obvious, but he's missed it before and other surgeons have missed it before... then it turns out not to be the culprit???? Spine is so complex and many cases will never be understood. I don't think that means we should stop looking. But it does mean that Rosadee's caution is well placed. When we are desperate, we will do surgery based on wishful thinking. Some of us may be so desperate that that is not unreasonable. However, getting clear diagnoses... proving them out... will help increases our chance of success. Unfortunately, it's only an increase... nothing brings it close to being a sure bet. What I see is people having surgeries based on clear indications. It makes sense that when tests prove a pathology, when that pathology is certainly the most likely cause of your pain, give high confidence for a positive outcome. However, that does not mean that you don't have another generator for the same pain that will not be addressed when the obvious issue is dealt with.
I don't know how we are supposed to deal with this except by doing what we are doing. Expend the effort necessary to get as much information as possible so you can make an informed decision. Then proceed with the full understanding that 70, 80, 90% chance of success may sound good, but it's only good if you are not one of the unlucky ones.
All the best,
Mark
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