Looking for Cervical ADR or ACD Experiences

[KL Aguilar]

I have a bulge at C3-4 and bone spurs pushing into my spinal cord and my esophagus at C5-6 and 6-7. My spinal cord is narrowed to .8 mm at C5-6 and .9 mm at C6-7.

I have seen three surgeons and gotten three different recommendations. Surgeon 1 recommends a four-level fusion with a plate. Surgeon 2 recommends a two-level artificial disc replacement (ADR) at C5-6 and 6-7. Surgeon 3 recommends a anterior cervical discectomy (ACD) without fusion at C5-6 and 6-7 and a cervical endoscopic discectomy in which only the bulging part of the disc is removed (CED) at 3-4.

Surgeon 1 is the local worker's comp surgeon. Surgeons 2 and 3 are very experienced, respected surgeons who try to avoid fusions.

I would like to hear from cervies who have either ADR or ACD.

[fortitudine]

Hi KL

Your surgical recommendations are almost identical to mine! I have cord compression at c3/4 and 4/5. Surgeon #1 - the local guy, which means 'free' here in Canada - wants to do a posterior (ouch!) plated 3-level fusion (including c2/3 since 'the level above usually goes and it would be easier to do it now'). He had no ADR experience at the time, in fact the first 25-person trial for the Bryan was just starting here.

Surgeon #2 (USA) offered ACD at 3/4 and ACDF at 4/5 as there is a possible instability there. (Different radiologists disagree)

Surgeon #3 (Europe) offered 2-level ADR with slight possibility of having to fuse 4/5.

Surgeon #4 was a sort of half-baked consult and he offered 1 level ADR and one level ACDF if I remember correctly

I'm guessing that your surgeon #2 might be the one I consulted in California, He is in his early 60s. When I called his assistant to say I wasn't going ahead with him, he called me himself to warn me away from ADR.

In any case, that was early 2005, and a year and a half later I have done nothing, although I had decided to go with ADR and surgeon #3. Circumstances have forced me to reschedule or cancel 4 or 5 times!

Meanwhile there is a neurosurgeon in Canada who has collaborated with surgeon #3 on papers, and is doing 2-level cervical ADR ( five or six to date). I sent him my films for a consult months ago. Perhaps by the time he looks at them I will be able to get ADR for free in Canada!

[KL Aguilar]

Hi Fortitudine,

Surgeon 3 is in California, and is probably the same person you saw. I know he is an excellent surgeon and I have a lot of respect for him, but I don't know about a two-level ACD without fusion. As for your option of a free ADR in Canada, hmmm. It might be cheaper in the long run to have ADR with a much more experienced surgeon. There is a surgeon in Santa Monica, Dr. Rick Delamarter, who is cutting through the vertebrae, removing spurs, and closing the vertabrae with some kind of brace, but leaving a bigger space for the spinal cord. I am going to research this option more.

[fortitudine]

Is Dr. Delamarter doing some kind of laminectomy? Or something new? Can you let us know when you learn more?

There's something called an open door laminectomy where they make a sort of hinge out of the bone around the spinous process, I think.

[KL Aguilar]

Dr. Delamarter's surgery:

http://www.laspineinstitute.com/Laminoplasty.htm

[fortitudine]

I don't know that any form of laminectomy is a really great option. There seem to be a lot of people who had multi-level lami's years ago who are now dealing with instability, and the resulting problems.

The lami is an old surgery- although this 'open-door' that Dr. Delamarter does is farily new - and it cuts through the neck muscles at the back, as far as I understand it, so while it doesn't involve fusion, it has its own challenges.

[necknose]

Check out:

Split laminectomy. It's not your Dad's lami. There have been posts elsewhere about this. I suggest you check them out. If there is a lami that's viable this is it.

Contact Dr. Frederik Pennings, Spine Surgeon, UC Davis Spine Clinic, Sacto CA.

[KL Aguilar]

I googled Dr. Frederik Pennings and found nothing. Where is Sacto? I am in California and have never heard of Sacto.

[necknose]

Originally Posted by KL Aguilar

I googled Dr. Frederik Pennings and found nothing. Where is Sacto? I am in California and have never heard of Sacto.

Sacto = Sacramento

http://www.worldspine.org/ws3_presentations_final.cfm

search for: split laminectomy.

dbl-click to open as .PDF.

Document contains a summary of techniques and pros/cons split laminectomy.

It appears to be an excellent procedure when posterior aprroach surgery is indicated.

Note: this technique has been represented as superior to any of the "standard" lami's. Laminectomy, laminoplasty, back-door laminectomy, etc.. The reason being: these procedures involve varying degrees of muscle resection/cutting. This is damaging and in some cases leaves the patient with both muscular related incapacitation as well as chronic pain.

A split laminectomy (posterior surgery) is indicated when there is multi-level spine disease, and in the case of the cervical spine, no indication of kyphosis "swan" neck/negative cervical lordosis. This is because the alternative, fusion, when applied at multiple levels results in reduced ROM and possible adjacent segment degeneration.

Of course TDR/ADR is best when the pathology of the spine is anterior, in front of the cord, and completely accessiblee for removal by the attending surgeon. This is not always the case.

As other posters on the forum say: I'm just another spiney, my posts aren't any better informed than yours. I'm not a medical expert and the foregoing is just what I've "gleaned" as a motivated spiney.

Good luck!