Revision ADR to ADR, L4-L5-S1 explantation anterior and posterior surgery!

[mmglobal]

I'm still here in Straubing with a series of clients. Earlier this week, one of them had a VERY interesting surgery. With his permission, I'll provide you with and overview. I'll leave it up to him to provide the level of detail that he feels appropriate.

This man had a 2-level Charite (L4-S1) done in early 2005. The surgery was an early success, but after about a year, his leg pain and back pain returned. With the Charite's highly mobile core, something that allows or causes the core to be pushed to one side, is amplified... as the core is pushed off center, it increases the force, essentially trapping the core in an off center position. It's even more of a problem in multi-level configurations, as one core can go one way and the other core can go the other way, forcing the vertebral body in the middle to tilt. Sadly, I've seen this many times in single, double and triple level systems.

The patient had a 2-level Dynesys procedure done in an effort to address the tilt and stabilize the system. Not only did that not work, but he wound up with a broken screw to add to his problems.

The revision surgery to remove both Charite's and implant 2 ProDiscs in their place, plus removal of the Dynesys hardware lasted over 11 hours. The repeat anterior approach was very difficult and tedious. With the formation of adhesions and scar tissue from the prior surgery, each step went very slowly. It was tough enough getting to L5-S1, but remobilizing the great vessels at L4-5 was even more difficult. This surgery is not for the average surgeon and I see why.

The first travel client of mine (Mr. B) had a Charite explanted and a new one reimplanted at L3-4. Since I was so early in my career, I still didn't know what I was looking at. Now, with 4 more years, a dozen conferences and hundreds more surgeries obsevered I am better equipped to absorb so much more information. I've been paying attention to tool sets and retractor systems. With spine, everything is a trade-off. Some retractor systems make things easier for the surgeon and allow smaller access for the original surgery, but make things much more difficult for revisions. Seeing these types of issues play out in the OR in cases that I'm intimately familiar with is incredibly interesting.

Again, I'll leave it up to my client to determine the level of detail that he'd like to include in the story. All I can say is that Bertagnoli is truly amazing and they way he handled so many difficulties with such skill and determination was something to behold. I've seen so many unbelivably complex surgeries and revisions that I can say this was the top, but it certainly is up there in the top few! Utterly amazing!

All the best,

Mark

[ans]

Ooh, the first case seems exceptionally gnarly. I hope he will do much better - in the long run. Same for the other patient.

[mmglobal]

Just to be clear... the first case was 4 years ago... Mr. Bee 2004 in Stenum. I'm only talking about 1 new case here.


Nothing but good news from Straubing. Karl walked 45 minutes this morning... something he says he has not done in more than a decade because uptime became more and more painful. Now it's OK.

In the afternoon, we had the obligatory iced cafe in the town square:

[Maria]

What a number of surgeries to go thru and come out on top! My best wishes to Karl in continuing to recover at this rate as a 45 minute walk and sit in a cafe so soon post op surgery of this magnitude sounds just incredible!

Does Dr.B design his own surgical instruments by any chance? It is a very good point to consider the instruments being utilized plus techniques in terms of potentially how this can figure into the patient's outcome.

[mmglobal]

Thursday in Munich... 3 clients done, one to go. I can't wait to get home! Niether could Karl. We didn't know what to expect and knew his surgery was going to be large, so he was scheduled to return home at 2 weeks post-op. Yesterday, day 8, he returned home to the west coast. Amazing.

Again, we don't know the outcome yet... time has to tell us that... but it looks good so far!

Mark

PS. Maria, yes Bertagnoli designs some of his own 'gadget tools' and also is a key designer for many of the new technologies I've seen that have emerged through the years that I've been observing. But, what I was referring to in the post above does not refer to tools that he's designed. I'm just noting that there are many, many trade-offs and issues that we'll never understand. Even with 'standard' surgeries, there can still be a big difference from one surgeon to the next. We can't even anticipate which side of the trade-off will be important to us.

[ans]

Fantastic news.

Please ask Dr. B. if he wouldn't mind taking a temporary transfer to LA CO-USC's Hospital Spine Unit (and bring some Cortoss on the side). Thank you. - ans

[nomorepain]

i am amazed at how far you have come with your observations of the many many surgeries your are allowed to sit in on! what an amazing experience it must be.
when i had my first laminectomy way back in 1979, i didn't learn of what my surgeon did till months and months afterward, as i didn't even want to know, the thought of it made me sick to my stomach, but through the years of chronic pain, and what they actually did do, or screw up, it made me realize how much more informed i needed to be if i were to have any kind of surgery in the future. and on a side note, after my Pro-disc surgery, a Doctor friend of mine told me for my records to get the surgery notes from the hospital, and the nurses notes on after-care, which i have and are extremely interesting, and i encourage all of you to do the same! not sure it's the same practice out of the states. but maybe a valuable tool for any future care to know what difficulties you may have gone through while under the knife.