Mark:
Excellent, steady response as always. As one can glean from your signature: when the questions of efficacy and outcome are raised in relation to ADR you literally "walk the walk". You have more than a dilettante's interest in these questions and so far, in your experience, ADR has represented the salvation of a life: yours! You and the other successful ADR/spineys are to be congratulated. It's your Christmas present for this year and many more to come.
Glad the pressure of your escort duties is over, I assume till after Christmas 2006.
In your next post I hope you touch on some of the points mentioned below.
It should be pointed out that the study referred to is of Cervical not Lumbar ADR outcomes.
It seems that the essence of your post is that the surgeon is THE pivotal variable. You've pointed this out before.
What needs clarifying, besides the surgeon variable, across the Cervical (not Lumbar) ADR patient population is are these results: prosthesis specific, due to poor patient selection, a function of the degree of disease progression, patient age, other pathology related, etc..
Clarification Please:
"HO has only been an issue in extreme cases and for the most part, it's in people that [[[[should be fusing and autofusing represents a good result]]]]."
I'm acquainted with your oft cited observation that a single level cervical fusion is the "gold standard" of care in treating cervical DDD (DDD = all spine disease appropriately treated w/fusion), etc..
However I'm unclear about your statement: "should be fusing and autofusing". Is this observation based on the idea that: auto-fusing is a desirable outcome in DDD and further that if it's the end state of an ADR implantation it's desirable because auto-fusion in the presence of an ADR is preferable to auto-fusion as the result of "natural" end state HO, or some other explanation?
As other's have observed: auto-fusion as an outcome, is counterintuitive to the premise of ADR: motion preservation. This is esp. the case for multi-level cervical spine disease where 3+ levels of fusion leaves the patient w/greatly reduced ROM and in all probability significant chronic pain requiring constant medication for "life" is it possibility. Might it be posited that in cases where central spinal cord stenosis is the main concern, if auto-fusion is highly probable regardless of the surgical treatment applied, that low impact posterior approaches, e.g. split laminectomy, could ultimately be just as effective as ADR: esp. reduced the financial impact on the patient as well as elimination of the additional trauma, for some patients, of going to a foreign land for treatment, assuming split lami for example is in fact available in the US.
What, if you will, is the cost benefit equation in cases of probable HO of: ADR versus the best "traditional" treatments?
If you have the opportunity, enlargement on these aspects and others of auto-fusion would be appreciated.
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Happy Holidays to you and all my fellow spineys. May we all have at least a brief respite from from the pains, fears, and the angst that all to often is the spiney's lot.
Good luck to us all!
