Prodisc ADR fusing and not moving

[energyofhope]

I've had one Prodisc-L in my low back fuse about 18 months after insertion, and recently one Prodisc-C in my neck stopped moving and there is eveidence of fusion from the facets at that level. I suspect that my worsening neck pain is related to this latest "finding" on CT.

Has anyone here experienced a similar phenomenon with ADR fusing? If so, has this created a problem with pain, and what was your solution? Did you need to have a decompression surgery leaving ADR in place, or a complete removal of the prosthesis with "standard" fusion?

Thank you all!

[JKDE302]

that sounds scary...how could that happen ?

[Katie]

How in the *ell did that happen? I thought that with the movement and space between the levels that this would not be possible.

Where did you have the surgery, and what has your surgeon said? This is very worrisome for me...facing five levels of surgery.

[energyofhope]

Lumbar L4-L5 Prodisc-L in 2005 at UC San Francisco with Bradford (a heavy hitter)

Cervical 2 level Prodisc-C ADR in 2005 with Bertagnoli (top dog in Europe I was told)

If I had known about this fusing issue, I don't know if I would have done anything different at the time. The talk of "preventing adjacent level deterioration and preserving motion" was very seductive.

Now, I have been told by several consults that there are many people reporting this problem and that it is something like 5-10% of those who've had Prodisc or other ADR surgery in the previous 3-5 years.

[bootslamar]

I'm new here.
I'm one week post-op from a prodisc c at C5-6 and C6-7.
I did not seriously consider (or even hear about) future auto-fusion of this device.
scary.

[mmglobal]

Autofusion of ADR often generates a positive result. Obviously, we wish motion was preserved, but if autofusion causes the system to settle into a non-painful configuration, the clinical outcome can be very good.

IMHO, some times the presence of the autofusion process indicates that there is a problem and the body is trying take care of it. (See eddieG's story... I think it is possible that his pain is coming from the autofusing level, yet the surgeon did the revision on the disc that was not autofusing???)

Some surgeons have very high autofusion rates (google "heterotopic ossification cervical disc replacement" and you should see the articles"). Other surgeons have very low HO occurrences. I wonder about eoh's having autofusion in both cervcial and lumbar procedures? Do you have some reaction to the prosthesis? Do you have some propensity to grow bone where it shouldn't? I hope to learn more about this case.

All the best,

Mark

[energyofhope]

I doubt that this phenomenon has much to do with who the surgeon is. I was operated by different (top notch) surgeons. I strongly suspect it has to do with the patient anatomy of the facet joints going into the surgery. As our organic disks deteriorate, they often cause facet joint deterioration as well. I was considered a good candidate for ADR in my cervical and lumbar spine at the time of the insertion despite having some facet hypertrophy. Young, active, motivated to get better, etc.

It is clear that ADR accelerated facet joint deterioration greatly. I don't have any other joint problems in my body, and otherwise, I am very healthy, so we can't blame this problem on something systemic.

I suspect, it is better to do traditional fusion in cases like mine from the start because autofusion of ADR often leads to "incorrect" fusion with lots of overgrowth that causes huge problems in people like me. And, if ADR fuses soon after anyway, then there is no motion preservation argument that can be made. Besides, it is very possible to find a competent surgeon in the U.S. (where I reside) and have fusion covered by your insurance, instead of spending a fortune and traveling in pain abroad.

I think, ADR will become TJR (total joint replacement) in the future. When that day comes, it will be a much better solution (when they have a proven and reliable total joint replacement solution that will take care of both the disk and the facet joints)

But, hindsight is always 20/20... Anyway, I need to figure out at this point if my Prodiscs in the neck and in the back need to be taken out as part any future revision(s) and who is the best doctor for this...

[energyofhope]

Mark,

You wrote something that makes me worried: "IMHO, some times the presence of the autofusion process indicates that there is a problem and the body is trying take care of it. (See eddieG's story...) "

Can you please send me eddieG's information, I am new here and don't know how to find his story...

Thank you.

[Maria]

Energy,
I believe you're correct in terms of matters not who the surgeon is as much as the patients own anatomy or bodily response to the surgeries performed.

As for Dr.Bradford.. he was the surgeon first authorized to do my 2 level ADR back in '03 but the trial canceled out and even tho I finally ended up with an ADR at L4 and fusion at L5S1 being authorized I have done nothing further to date re my lumbar. Of all the surgeons I have seen I liked Dr.Bradford's bedside manner quite a bit. He actually looked at me and patted my knee and said "I'll try to make you better".. wish he could have done the surgery way back when. He was having shoulder probs at the time tho and I think he was retiring as well.

I too have some cervical issues going on now (disc bulge at C5/6 and DDD at 3 levels)... I'm told that it's more genetic/hereditary in terms of my DDD.

I'm pretty much believing anything can happen when there's surgical intervention of the spine.

Good luck with pain relief~ I think that's the most important thing as long as you've still got function going for you.

[mmglobal]

Eddie's story: http://www.ispine.org/forum/surgical...er-2006-a.html

Each failed spine surgery is unique. IMHO, SOME auto fusions are the bodies response to ongoing irritation at the level that is auto fusion is occurring.

[Katie]

Is there any chance that you are allergic to the various metals in the artificial discs? I am having blood work done before I have ADR or fusion as I have numerous allergies including one to nickel.

I'm finding out that most discs and the hardware for fusion contain at least minimal amounts of nickel, and the lab I contacted said that 60% of all failed surgeries for artificial products including knees and hips are caused by allergies to the appliance. The body starts to reject the new part.

While the blood test is not cheap, I am counting on it preventing problems six months or so down the road. Maybe this is something to investigate? I wish you well.

[energyofhope]

Interesting thought, Katie. Is there a specific blood test for nickel allergy?
How do you know about your allergy? From reaction to jewelry?

I don't have any known allergies, but that does not mean I am not allergic to something I don't know about (I am a guy, so I don't wear earrings, maybe if I did, I would discover a nickel allergy

They did all the standard blood work on me before every surgery and it was good enough to send me into space. I did ask them if the material in the Prodiscs may cause rejection or some reaction and they said "no," for whatever that is worth. My disks cemented themselves well and there were no issues with them sliding out, no infection, no excessive swelling, or other red flags, so I don't know what to think.

There may still be a subtle reaction that manifests itself as this fusing over but I have yet to see anything in scientific literature that would shed light on it.

I do know that I am not alone. As more ADR is done, there are more reports of autofusion happening. I, personally, still suspect facet joint hypertrophy as an under-appreciated predisposition for ADR problems down the road. IMHO, from what I've read by now, fusion is probably better than ADR in cases like this.

[mmglobal]

eOh, I don't think that pre-existing facet issues are under-appreciated as a source of post-adr problems. This is extensively discussed at every meeting and in most presentations about ADR. More severe facet issues are an absolute contra-indication for ADR.

Having said that, the discussions of facet issues also demonstrate the unpredictability of spine surgery. I've seen cases presented with grade III facets pre-pop in which the facets have recovered and improved in the years following ADR. (Facets are graded I to IV with grade III representing moderate to severe degeneration, IV being severe.). I have also seen cases presented where pre-op good facets go bad after ADR.

Some might make an assumption that the cases going bad after ADR would have been successful if a fusion was done instead of ADR. In the discussions we had regarding failed back surgery syndrome with Dr. Hochschuler of TBI at the GPN symposium, he reiterated what I hear at all the conferences. "A very high percentage of the patients that fail ADR would have likely failed with fusion as well." (<-- paraphrased by mmglobal) This is evidenced by the number of cases in which the patient has an apparently successful ADR surgery that they tolerate well and recover from well... they just do poorly on all clinical outcome measurements. This is followed by an apparent successful fusion that they tolerate well and recover from well... but they just to poorly on all clinical outcome measurements.

I have seen many successful fusions in the patient community... both as a first surgery and as a revision for failed ADR surgery. Yes, the facets are key players in many failed surgeries. I think that 2 things are very clear:

1. Either we don't yet understand the system well enough and there (currently) no way to effectively predict success/failure for any/most spine procedures... or:

2. There is a randomness of failures that will never be understood...

I have a theory that I've been discussing with the spine surgeons for years. Most of them will first laugh at it, then they will agree with it:

All major spine procedures come with a success rate that is at best, about 85%.As the technologies develop, we get improvements in the system and get better and better options. I believe that 15 years from now, what we do today will seem barbaric and outdated... but the success rates will still be 85%!

Mark

[Katie]

Energy, I got the information and hint of possible allergy problems from people on here and another board. Liz recommended I look up another person's post about her problems after ADR surgery, and it made a lot of sense to me.

Here's the link. Check out Carrie's post half way down the page. Her story carries on through several pages.
Lumbar L5/S1 - Surgery Failed, Advice Needed (carrief) - Page 2 - ADRSupport Community

Here is the email address to Rush University where I am getting the blood test. Just Google the information you find in Carrie's posts. Marco_Caicedo at rush.edu (Just change the @ sign and join things together )

Yes, I am allergic to most jewelery unfortunately. No dressing up for me

I've also developed quite a number of sensitivities to food and related chemicals (preservatives, etc.), plus environmental 'stuff' over the past year, which I think are related to the massive amounts of narcotics I am taking. My allergist thinks that my immune system has taken a tailspin. While I can't eat any grains, I've had all the testing and am not positive for Celiac disease. The reactions are bad enough that I need to use and carry two Epi-pens and have been in the hospital by ambulance three times.

Here's another thought about your problem. Would your surgeon have carved down the end face of the vertebrae to make room for the ADR? Maybe that could have promoted an accelerated bone growth?

I have very little medical training, just some health sciences stuff. Peanuts in the face of all this, so take this with a grain of salt. I have found the experiences of others to be a great tool for educating myself though.

Good luck with everything. When it comes to things like this, nothing is too weird to investigate

[energyofhope]

Thank you all for your input!

Katie, your information about Carrie is very interesting! Thank you.

I did not experience the symptoms Carrie described nor did I have any of the red flags that would point at a metal allergy after ADR implantation. But, never say never. I will definitely bring up metal allergy testing with my doctors.

I also need to find out if this test is covered by Medicare (in the U.S.)

Does anyone know?

[Katie]

Liz deserves all the credit She pointed out that thread to me, and brought the metal allergy question to the forefront. While I always had it in the back of my mind, since I have so many new allergies on top of nickel, she really made me take a hard look at it.

It is just 'pay it forward' time I really hope you get to the bottom of this soon.

[dshobbies]

Though I doubt this will work for metal allergies - a home remedy for indoor and outdoor allergies is a tablespoon of honey and applecider vineger daily. I've since forgotten what the applecider does but the honey contains small amounts of most allergens, slowly building up your own immunities.

I premix them, keep them in a jar in frig and add 2 tablespoons to a class of orange juice. Warning - this is a very slow process, taking about 1 year before you realize the benefit.

Dale