"Too tall" ADR implants????

[fortitudine]

I wonder if any docs are doing research on this phenomenon of supposedly too tall ADR implants, leaving patients in pain, which have been the subject of some posts on various forums. I wonder if restoring a degenerated level to its original, youthful height is a mistake?

Mark, do you know of any discussion taking place in the surgical community about this?

And Happy New Year, all.

[Maria]

I've long wondered this as well considering I've had a 20 plus year lumbar back history and DDD noted back in early '90s when post second surgical MRIs done more regularly.

If the ligaments and musculature (any other structures) have adapted to the progressive degerative spine over time or maybe just shortened/contracted~ then hypothetically could restoring disc space to normal height be potentially problematic for longer term spine patients.

It would be cool if there were a measuring device that could approximate what an idividual could tolerate in terms of disc space height and then like that type of mattress that could be pumped up, be pumped up in terms of tolerace. Sort of like recreating pain with discogram but more like measurements that fall between the fine line of creating pain and alleviating pain.

I wonder about fusing L5S1 ~ restoring L4 and then what will happen with my anular tear L3. Will it like the work done on the other two discs or will it rage against it. That's if my facets are even still good enough for any disc replacement and/or bone density willing still in this country (w/o vertebroplasty)!

[fuzzy]

My disc space was collapsed for a decade or more deterioating every since. Now my back feels "fixed" it has not felt like this in a long time if not ever. My low back "works" again. I am sure the restored disc space has something to do with it. There are healing and distraction pain, probably due to the stretching but time will more often then not heal those pains. I am very hopeful (but impatient) here.

[johnb]

The designers of the Activ-L saw fit offer a shorter prosthesis size if warranted. http://www.backup-spine.com/doc/doc_...CER_AUTOLINK&&

Also, Zeegers site makes mention of it too. http://www.medkiozk.com/

If I was working with low disc height, the active l seems like a logical choice.

johnb

[martyusa]

Ever since I have started having problems I have face this dilemma.

We know that DDD will usually, eventually cause the disc to collapse if those who have the problem lead active lifestyles. Whether it be work or athletics. And yes, some modifications need to be taken into consideration when these disc bulge, herniate or are just ready to go in time.

With a condition of a herniated/bulging disc with DDD and a mild thinning with mild loss of signal, why would we not go right in and fix the problem. Instead of a temporary patch. Most of us know our bodies and the limitations that we have. And it is a catch 22.

Your whole body adjust and realign it's self when a disc collapses, right? Then the body will have to readjust itself when the ADR is put it, right? The height changes. So if we know it's going to collapse eventually, why don't we just fix it while the disc height is still normal.

Now granted, not everyone fits this billet. Some people have a laminectomy or discectomy and their fine forever. We have the technology to do it right the first time. Sometimes I feel like an insurance Guinea Pig...try this, now try this. Take this drug, now this drug. When for the most part, none of this has helped the majority with the problem.

Like I said, most of us know our bodies and it's limitations. I'm the very active athletic dad that is always playing some type of competitive sport. OK, herniated disc with mild DDD and annular tear. We're gonna patch it and HOPEFULLY the laminectomy will work. But if it doesn't an ADR is out of the question down the road.

Don't plug the tire and wait for the plug to fail. Don't let it go flat and ride on the rim. Change the damn thing. Give me a new tire so I don;t have to worry about these things down the road. Give me 10, 15 or possible 20 years. Not 2-4, or maybe less.

Sorry, kind got on a rant there. But you see my point.

[B13s]

Regarding tire thing - did you see tire that lasts 20 years ? Once you back is screwed-up - there is no way to make it whole again - you can only try to delay complete destruction with ADR(s), PT, medications etc. and hope that you prolong it until your death

[martyusa]

Originally Posted by B13s

Regarding tire thing - did you see tire that lasts 20 years ? Once you back is screwed-up - there is no way to make it whole again - you can only try to delay complete destruction with ADR(s), PT, medications etc. and hope that you prolong it until your death

LOL, that's the funny thing. Years of MMA and no problems. I though the tire was doing just fine. Then BLAM, a blowout.

[mmglobal]

Fortitudine,

This is a great question. It's a concept that is grossly misunderstood by the patient community (and by a large part of the doctor community too.) I often hear doctors and patients say, "Oh that disc (ADR) is too tall." Yes, there is much discussion in the surgical community about it.

The patient community has embraced the term "distraction pain". You don't hear me reference it unless I'm talking about what someone else is saying. I don't call it distraction pain, I call it "surgery induced leg pain" (or any other radicular symptom.) Some doctors call it "stretch neuropraxia"... I think that is a misnomer as well because often times the surgery induced leg pain has NOTHING to do with distraction, over distraction, restoring disc height, etc. It's just surgery induced leg pain and may be caused by many things. Even without restoration of anywhere close to normal disc height, fusion patients may experience this. (Although I do believe that it is more common in ADR patients, but there are many other factors besides distraction... like continued motion.)

You will see discs that may appear to be too tall in patients who have cores implanted that are larger than the smallest available. That is not necessarily because the surgeon didn't know his own strength and overdistracted the system when he squeezed on the distraction tool. Remember that tension on the system is required for it to have structural integrity. If they disctract the disc space and put in the shortest prosthesis available, the system may be too loose... possibly resulting in instability or greater chance of migration. The height of the disc should be determined by the surgeon distracting the disc space to the appropriate tension and seeing what size trial implant best fits the space. She will not necessarily choose the shortest one... it's best fit... not smallest possible.

Marty, I don't think that you need to be active to have your discs continue to break down. It's a degenerative process that afflicts inactive people the same way it does active people. The active people may even have an advantage because they maintain core fitness and strength.

Mark

PS. I have retreads on my 740... they seem to work fine unless I go over 140 mph. Then they require replacement.

[fuzzy]

Mark: retreads?? You cant even buy something like that in Germany! You would have to have a big sticker on your windshield saying "speedlimit 120"kmh (your car!). A BMW limited to 120, nobody wants that there ;-{)}}}

Restored diskheight: Before the surgery I had all kinds of pain problems in my WHOLE spine! My lumbar area would play ping pong with my mid back. I would have severe pain episodes in my midback and my lumbar would feel ok and then bang the lumbar was back and midback was fine. My whole spine would hurt after 3 hours in bed. Everything would hurt! I knew after a while it must all be coming from just that one place L4 and below. Chiropractor pushed down on my midback and BANG!!!, severe L4/5 pain.

Fast forward. 3 days after surgery I knew these problems were GONE, no more pain anywhere up my spine I layed in that bed for 3 days, could have never done that before and there hasnt been one tiniest shred of pain in my upper back since. I am sure that fixing the aligment in my spine including restoring the disc height must have something to do with this. I am sure it is a good idea to fix a flat!!! And not wait too long either . I now feel I waited too long as have the feeling I would have less foot problems if I would have done this earlier.

[Maria]

I just have to say that I've spoken with many persons that have not had surgery but have DDD and or previous spine problems and almost had surgery (discectomies first step usually).

For whatever reason, these persons got better without any surgical involvement, without pain medication, and most likely or definately with continuing degeneration in their spine.

In my own case I had gotten relief for about a year that was outstanding compared to what I had been for the prior 13 years at least. Yes, on pain meds, yes ESIs up to that year so I cannot say that "I'm better" only that I was functioning better.

Now I'm having cervical probs related to DDD and bulging disc and I think I'd tackle this as soon as it would be recommended for me re disc replacement as the pain meds don't touch how this affects me.

The flat tires I deal with in the lumbar spine are still annoying, still give me grief and still limit me however I still function better than I did several years ago.

I'll have a bone mineral density test done this spring and see where I'm at with that and what I feel like doing as to date WC is still on the books to pay for a 2 level surgery. Hoping I'm not pushing this to involve 3 levels and only with fusion left as option and if so, I'd have take out a loan, get bucks and go abroad as I don't want a 3 level lumbar fusion. I've been hoping that sooner than later the use of vertebroplasty might become FDA approved for persons with low bone density or at least have it on hand to use if need be..

There are so many more surgical options out there now and so much more access to differing options as to where to go to do what. For this I'm extremely thankful as having access to even learning about options gives so much more hope that one day I may decide to deal with my flat arse lumbar tires.