Need advice on lumbar ADR surgeon

[Tableone]

Hi Everyone:

I'm in a different situation than others here because I've had Scoliosis surgery and already have fourteen levels of my spine fused, from T2-L3/4. Now, as a result of the horrible Scoliosis surgery, I have severe DDD at L-5 and L5- S1. Instead of getting the rest of my spine fused and having NO MOVEMENT in my spine at all, I am wanting ADR at L4-5 and L5- S1.

The ADR in me will be at a tremendous disadvantage because of the fusion on top, which will put constant pressure on the ADR. However, it's been done before in patients like me. If I didn't already have my entire spine fused, I would just fuse a few levels...but I NEED my remaining lumbar movement.

I don't want to reinvent the wheel here, so please everyone advise me as to what is the best lumbar disc that will take the most pressure and last the longest? What surgeon should I go to? Bertagnoli wouldn't answer my questions about patients like me, Zeeger wanted $1100 before he would talk to me...even the local surgeon I found did not tell me to get Osteoporosis tested or CT Scan/facet tested first...they just want your money? I only know to get tested for Osteoporosis and facet disease because Dr. Bitan in NYC told me to. However, I'm afraid I won't be able to afford a surgery in New York.

Is it true that if you get your surgery overseas and then need a revision that no US surgeon will touch you? And, if you don't have money for a revision, what happens? Do you go paralyized? If you need a fusion when the ADR breaks, will a US surgeon at least do that? Would insurance cover a post-ADR fusion even if they did not cover the ADR?

thanks for any advice. Everyone here is so nice!

Anne

[vnf]

Anne

I understand what you are saying and I wish in your case, your spine had started in the opposite direction of deterioration. Meaning, if your lumbar had gone first, then the fusions probably wouldn't have been that noticeable and as you worked your way up the spine towards the cervicals, then maybe the ADR's would have made a difference because you do notice the movement loss more in the uppers than the lowers. I hope that makes sense.
Unfortunately, in your case, it didn't work out that way.

The whole reason I didn't want a fusion in the first place is because you always read about it affecting the other levels around it. In my case, it was only one level and in the lumbar where you least notice it.
In your case, sounds like you've already been fused in the places where you'd notice the loss of motion.
Again, I know it sucks, but be open minded to the fact that ADR's for you might not be the answer. Only a true surgeon who cares can tell you this.
One who is willing to walk away from the money and tell you that you're not a candidate for an ADR.

That being said...here's what I've learned just from my readings on revisions and also Dr Zeegers.

The reason Zeegers likes the Active L is because of it's size.
When it comes to other discs, each has a disadvantage he doesn't care for.
He has had the most success with the Active L. To this day, he has never had an Active L need to be revised at his practice. I believe he said he's been doing ADR's since 1988. This is why he is considered to be one of the best ADR doctor's.

The Active L has these advantages that Dan shared on another forum.

Unique translational movement to avoid biomechanical stress at the facet joint
Unique translational movement for an effective protection of the the adjacent disc levels
Anterior and antero-lateral approach possible
Specific instrumentation for the antero-lateral approach
Design of prosthesis plates adapted to the anatomy of vertebral body endplates
Unique PE-Material (Inlay) to reduce wear rate to 12-17% of other lumbar prosthesis types
Specific prosthesis design treatement of L5-S1
Plasmapore coating for a fast and safe bony integration of the prosthesis plates to the vertebral body endplates
Spikes and/or Keels as primary stability structures. Can be used together in any combination.
Unique translational movement
Convex prosthesis plates
Anatomical adapted footprint
Smallest height with 8.5 mm
Instrumentation for the lateral approach
Free choice of direction of approach (angulation)
Revision instruments


This disc can be put in and if they don't like the look of it, they can take it back out and move it again.
When I was reading about what causes a revision many factors came up.
One being that, some of the discs are too big. If the space is tight, some of these doctor's hammer the disc into the space. This sometimes causes facet fractures which will be seen right away or it can be a very hairline fracture that will take time to show itself and thus the facet will degenerate and now the ADR is compromised.

Another reason that can cause ADR failure is the surgeon removing too much bone. When your collapsed disc is removed, there is now a hole in that space which is obviously where your new ADR is going to be placed.
But, the upper and lower bone needs to be flat. They use a dremel (drill) like tool and smooth that out until it feels straight. This way when the new ADR goes in, it must lay level against the bone. Your bone is hardest on the outside and gets softer towards the center. If they remove too much bone (the hardest outer layer) when the ADR is put in, it can cause subsistence where the ADR starts to migrate or sink into the bone. This can also happen if you have bad bone density (like osteoporosis, etc) and why a DEXA scan is usually ordered to see if your bones are good. Again, if that test comes back with a negative report, you are not an ADR candidate because the disc will eventually fail. I'm trying to say this is in layman's terms because I'm trying to repeat to you what many doctor's and articles have said to me.

This is why you will see people debate about which disc is best.
Keels or no keels? metal or plastic?
Again, this is where the surgeon must know his field and keep up to date as to what's happening with these discs when they are implanted. How are they holding up in the short term, in the long terms etc.
I think we are still in the learning stage with ADR's and there is no guarantees.

You said your doctor told you that your two discs have collapsed.
How did they see that? Did you have Xrays/MRI/CT scan ??
If you are in pain, normally the items ordered are physical therapy, steroid injections, facet blocks, rhizotomy, etc. which would be a pain management doctor. Some insurance's don't cover this or they have a limited time of which you can do it. For example, my insurance covered my rhizotomy but I can only have it done a maximum of 4 times. My insurance will cover 33 physical therapy treatments in a year. So, here is where the insurance starts to screw with your life. Depends on what you have and what they cover.

Zeegers ordered a Lyme Disease test for me because sometimes people have this for years and don't know it. It can also be a cause of what's making the bones degenerate. I am negative but Zeegers is the only doctor who thought to check me for this, just in case.

Also, Zeegers ordered a nuclear bone scan. This test is ordered:

if you have unexplained bone pain, a bone scan may help determine the cause. Images from bone scans can reveal bone abnormalities related to these conditions:

Fractures
Arthritis
Paget's disease of bone
Cancer originating in bone
Cancer that has spread (metastasized) to bone from a different primary site, such as the prostate, lung or breast
Infection of the joints, joint replacements or bones (osteomyelitis)
Fibrous dysplasia
Impaired blood supply to bones or death of bone tissue (avascular necrosis)


Again, Zeegers is the only doctor who ordered this to make sure there was no infections or something else going on in the bones.

I'm trying to answer all of the questions you left in your post.

When you come back to the US and you have trouble with the ADR, most US docs don't want to help you with it. First, I still think they are annoyed because you spent your money overseas and not with them (just my opinion), they don't want it on their record if the surgery doesn't have a good outcome and the US is lawsuit happy. If they try a revision and it doesn't go well, they don't want a lawsuit. Also, many doctor's won't do because they've never done an ADR revision! Many doctor's here haven't even put one in. You can't just go in there and pull it out like a sliver in your finger. They must know what they are doing and be familiar with the disc and it's components to remove it. I've talked to many doctors in the US who agreed that my disc needed to be removed but they weren't willing to do it.
I've only had two doctor's willing to take it out (and they have experience with revisions just not an M6). Now, I have to hope my Florida insurance will cover my out of state surgery. This doesn't seem to be a very successful submission.

Now that your two main arteries are at risk, you don't want just anyone removing that ADR, even if they are willing "to try it".
Experience matters here. Even Regan said that he would call overseas because he has done many revisions but not an M6 yet. He will call to see if they have any tips to share with him as to getting it out.
Regan is very respected, even overseas. Zeegers told me he is excellent.
Even with that skill, he has to get advise as to getting the M6 out.

You see where I'm headed here

I'm sorry this is such a long post but I'm trying to share what I've learned to keep you informed and try to get you to be open minded that an ADR for you might not be the best thing. Again, that's up to a doctor but it must be an honest one.

I hope that all helps you a bit.
I'm just trying to share what I've learned since I've been through the before ADR life and going through the removal of the ADR process.