Prestige ST c5/6

[sahuaro]

Just wanted to post that I had Prestige ST implanted at c5/6 after discectomy and extensive foraminotomy by Dr. John Regan. I am doing remarkably well and require minimal pain meds. Mark was able to observe my surgery and noted that they were doing EMG monitoring to look for spinal cord injury during the surgery; apparently, there was an improvement in my EMG after the decompression. I probably wouldn't have known anything about the EMG if Mark hadn't been there and I hope Mark will post with further thoughts and observations. BTW, my surgery was just hours before Mark tripped and had a flare-up of cervical symptoms...not suggesting there was a connection but just glad he didn't trip in the OR...

[ans]

Very happy for you B. and great that Mark could be there for you.

Best Wishes - Allan

[mmglobal]

It was very interesting to see Suhuaro's surgery. I've seen many dozens of cervical ADR's implanted, including ProDisc-C, Mobi-C, and PCM; but this was my first Prestige experience. Regan is an excellent surgeon and it's always a pleasure to watch him work. He uses a microscope for the decompression step. This allows him to to do very careful and accurate work when working in the canal area.

The Prestige-ST disc is one of 2 cervical discs that started US clinical trials in 2002. Until ProDisc-C approval last December, the Prestige-ST and the Bryan were the only 2 cervical disc repleacements FDA approved. It's a ball and trough design, slightly different from the ball and socket of the ProDisc-C. Implantation is similar to the other discs I've watched.... access, discectomy, decompression, preparation of the endplates, trial implants, fine-tuning, insertion of the device, control xrays, close. The instrumentation was quite different. (My perceptions about the differences will contain too much speculation, so I won't write about these differences here.)

During the surgery, I went to the neurologist who was doing the interoperative monitoring and asked if he could see the nerve release occur on the electrophysiologic testing. "That's very interesting.. I'm not usually looking for that. Let me see", he said. A few clicks and key strokes later, he brough up the baseline emg's done as the surgery was just getting started, then overlayed the current values. "Here... her ulnar nerve was released."

It's so nice to see the pathology that was causing pain and to see validation that they are working in the right area. Based on her reductions in arm/hand symptoms, she has every reason to expect improvements. I look forward to hearing of her success.

All the best,

Mark

[sahuaro]

Mark:
You've piqued my curiosity about the difference in instrumentation...

The EMG findings are indeed exciting and important given the background to the decision to have surgery: I've been sitting on the fence, dealing with these cervical issues for just about 7 years, but what pushed the issue was having a repeat EMG a year ago which showed changes from prior studies and definitely demonstrated radiculopathy for the first time. But then the neurologist who did the pre-surgery EMG's insisted that the nerve damage was permanent and therefore I should not have surgery. I decided to go ahead with the surgery anyway and it looks like I made the right decision--I don't have the complete EMG report from the surgery so there may indeed be at least some permanent damage but it looks like at least some damage was indeed reversible.

I think this is an important and hopeful piece of information for others who are also on the fence and/or having neurologists claiming to knowledge they may not really have.

[Maria]

So glad to hear that this has gone so well for you. I was impressed with Dr.Regan when I had a consultation w/him that Mark was good enough to get me squeezed into after seeing Dr.Delamarter.

Imagine where Mark may have landed if he tripped during your surgery while observing! Softer landing perhaps but better timing where it happened (tho sorry that it happened at all Mark)~

take care and continue to heal well~ Maria

[nopain]

I know this thread is a couple months old but I'm hoping you can advise me on a couple of things.

1. You can have MRI after a Prestige but it leaves an artifact?
2. The reason for only approving a single level with Prestige is the Design which takes up too much space for multi level?
3. Any idea what you were billed for the device itself? Not the Doctor or the hospital, just the actual cost of the device?

Any help would be appreciated. I have a consult soon for the possibility of the Prestige.

[sahuaro]

nopain:
I am not sure about the quality of MRI after implantation of the Prestige ST. The article posted by Fortitudine studied the Prestige LP, which appears to allow for good visualization. So far, my post-surgery studies have involved flexion/extension X-rays.

The Prestige ST has a flange which apparently rules out two levels. Since I do have a bulge at C6/7, there is a question of possibly needing a second level but Dr. Regan indicated he could implant the Prestige LP if necessary (LP stands for Low Profile). To my knowledge, the LP has not yet received FDA approval.

Since I paid out-of-pocket (thanks to HealthNet), I was just quoted a lump sum for the surgery and for the hospital. The hospital fees included the device but were not broken down. Therefore, I don't know the cost of the device.