HELP: Desperately Need a Maverick ADR Removed

[mark-perth]

Hi,
I have had a Maverick ADR put in at L3/4 that was placed way to far off centre to the left. It has caused my spine to curve which is getting worse quickly. After my last Xray when my surgeon saw it he insisted that I have a Posterior fusion and leave the disc in place ASAP. He even said that he doesnt think it will help with the pain but didnt want to remove the disc as he was concerned with the risks. I saw him again last week after I had a new MRI Scan and he agreed to remove the disc if the posterior fusion doesnt help. I dont know if that is even possible after a posterior fusion. The disc was put in mid november 2008. I have yet to find a doctor in Australia that is prepared to remove the disc as they prefer to just fuse at the rear and leave the disc alone. I have read most of the papers regarding the revision operations and they mostly recommend removal of the disc for the best result and not many say a good result is achieved from a PLIF. I am only 33 yrs old, have suffered in pain for over 12 yrs and dont really want to be in pain for the rest of my life. I am needing huge doses of medications which barely take the edge off the pain. If anyone has any advice regarding what is the best approach to take that would be appreciated, especially from anyone that has had a revision operation. Your advice is appreciated.

Mark

[mmglobal]

Mark, I hope that since your surgery was 2008 that you have the a-mav... the version with the shorter keel. I have many clients with ADR revisions... not only with different ADR types, but different revision types. I've seen both successful and unsuccessful revisions in many different combinations.

The Maverick presents special issues in revision as compared to the devices with the poly core. The poly core can be removed independently, providing a great deal of extra room to remove the plates separately. You only need enough distraction to clear one keel if you wish to remove it via an oblique or lateral approach. Getting enough room to take it straight out the front requires substantial remobilization of the great vessels... hence all the discussion about risks involved in ADR revisions.

All the papers about ADR revisions are interesting, but with such varied success, both with removal of the prosthesis and revision leaving the prosthesis as an interbody spacer... I'd consider each case to be unique.

Please take everything I say with a HUGE grain of salt... while I've observed hundreds of ADR surgeries including more than a dozen revisions, I am not a doctor.

Good luck... please keep us posted on your research and progress. All the best,

Mark

[dshobbies]

Mark,

Welcome to the forum. Your situation sounds difficult. Revision without removal won't alleviate your pain? Did I read that correctly? I don't care what your age, living the rest of your life in pain doesn't sound acceptable.

Are you able to travel for this surgery or are you limited re financial issues, etc. Dr. Regan in Los Angeles has done revision surgeries and or course, there's Dr. B in Germany. You can have an internet consult with both going through GPN, ( the Mark above) globalpatientnetwork.com

Good luck to you, Dale

[runner]

Mark,

I am sorry you are in so much pain.
I know in an earlier post I asked if you have seen Matthew Scott-Young, the Australian doctor that does ADRs? I believe he is in Queensland? I do not know if he does revisions but he does seem to be one of the top docs and he is in your country.

I read up a little bit on revisions when Phylly was going to get one done and I sent her a paper on revisions that you can probably get from her.
Like the other Mark said, from what I have read Maverick revisions which involve taking out the disc are more complicated than a ProDisc or Charite revision.

Personally, I would not take the chance of having my disc taken out. I would do the posterior fusion. I am a nurse and I think the risks are too high.
But that is me.
I wholeheartedly supported Phylly when she decided to have her ProDiscs taken out and to have fusion after. She has been through it, so if I was you I might contact her if you haven't already.

That's all I know. I feel for you because you already went through a major surgery and now are facing more.
It shows that no surgery is a guarantee of relieving your pain and every surgery is a risk.
I will be praying for you and I hope all goes well.

Runner

[Michelle Maree]

Hi Mark,

My heart goes out to you. I live in Melbourne and would like to have ADR in Germany. My concern is that if it doesnt go as planned there are very few experienced ADR surgeons in Australia to do a revision. So I would probably have to go back to Germany.
We are really behind the eight ball here down under and it is very frustrating that we are so conservative with our medical care.So that surgeons arent given the chance to really develop their skills in thes new technologies. Personally if I had the money I would go to Germany or USA for revision surgery or bar that have posterior fusion by a good surgeon here.
Can i ask who did your surgery? And do you know how many they have put in?
I think if they cant remove them they shouldnt be implanting them.
I really feel for you and hope you find a solution soon.
Michelle.

[runner]

Mark,

Not to confuse you, but I realized that I was seeing you on that other forum. i hope MSY, if he can help you, does.
Yes, I agree with you getting and finding the best surgeon for you is what is really important.
I hope people on this forum can help you.
I will keep praying for you.

[mark-perth]

Hi Mark

Thanks for the reply, I have the A-mav disc thankfully but have not had the patch put between the great vessels. Its such a hard decision. My biggest concern is whether the disc could be removed after a Posterior fusion is done as obviously the safest way would be best but not at the expense of loosing available options. Hope your necks going well.

Thanks for the advice

Mark

Ive attached a pic scan of my back 4 days post ADR and at the end of march 2009.

[mark-perth]

Hi Dale
Thanks for the reply. Yes most of the reports say the results for ADR revisions get better results with the disc removed than just fused in place. It is a much more dangerous and difficult operation but I would happily take that choice if it means less pain. From what I understand there is only a very slim chance that either will help totally but slightly better results are achieved from removal. I really dont ever expect to be anywhere near painfree but just want to be the best possible under the circumstances. Hopefully I can atleast not have to live on opiates for the rest of my life.

Thanks for your message,

Mark

[mark-perth]

Hi Runner
Thanks for the kind words and support.
I would be happy to have a posterior fusion if I felt there was a bigger chance of success but I am extremely doubtfull especially when my surgeon doubted whether it would help.
I also am concerned that if it doesnt work I may not be able to get the disc out at all then. Thats probably why I would rather take a bigger risk in the hope of a better outcome. I really dont want to live a life with a morphine pump. Thanks for your help and ill keep you informed how I go with the docs.

Thanks for your help
Mark

[Michelle Maree]

Hi Mark,

I am sorry to be pessimistic, i guess I tell things the way I see them. But looking at your scans.How could they straighten the bones up for fusion if the disc is keeping the vertebra off centre? Wouldnt you need to remove the implant first to realign the vertabra?

[mark-perth]

Hi Michelle

Thanks for your message. I hope you have better luck if you decide to have an ADR than me, Just make sure U understand that it is damn hard to have it removed and alot more costly. I too was originally thinking about going to Germany but was talked out of it.
I dont wish to name my surgeon as I hold no grudge against him, He isnt in your state though. There is always a risk with any surgery unfortunately and even the best have results like mine. My surgeon has stuck by me and is wanting to continue helping me which I really appreciate and I still have the highest respect for him. My surgery took 7hrs so it was not an easy operation. He had done more than 100 lumbar ADR's plus many more cervical ADR's.
The biggest concern I have is that im not too keen on a posterior fusion especially as it may not help and dont wish to be stuck in pain with a crooked disc stuck in me. That will mean I need to have another operation which I really arent keen on. You can see the Xray doesnt look very good and I agree with you about whether a posterior fusion would work. I think that it may be able to straighten up the spine at that level but I cant see there being equal pressure on the ADR for it to be used as an interbody device supporting the spine and not cause any pain. My surgeon has said he will do another anterior operation to remove the disc if the posterior fusion doesnt work and has done 1 Maverick removal but has done many repeat anterior operations which helps. I agree that noone should ever put something in someone if they arent able to remove it. The reason my surgeon doesnt want to do an anterior operation first is because of the huge risk involved which is understandable. My only concern I have with my surgeon is that he isnt able to do a lateral operation if a repeat anterior operation failed, otherwise I would happily have him operate again.
Its impossible to know what to do.
Thanks for the reply and best of luck,

Mark

[mmglobal]

Michelle,

Keep in mind that people can have tilted vertebral bodies without off-center ADR. I've seen several cases of tilted vertebral bodies with on-center ADR. (Even more cases of tilted vertebral bodies with off-center ADR because of the obvious balance issues with the center of the joint that us not under the center of load.)

Also keep in mind that many people have posterior or posterolateral fusions without touching the collapsed disc space. You can have forces acting on the off-center ADR that are completely overridden by the stabilizing forces that may come from a nicely done fusion or posterior stabilization system installed behind the ADR. I've seen successful and unsuccessful fusions leaving the ADR in place. I've seen successful and unsuccessful fusions following explantation of poorly done ADR. I've seen successful and unsuccessful dynamic stabilization behind ADR with Dynesys, DSS and Coflex.

Each case is unique and depends upon what the true pain generators are and how successful the surgery is at correcting the structural issues associated with the poor configuration.

Note that it's possible that the obvious structural issues associated with the tilted vertebra may not be the pain generator or may not be the only pain generator.

mmglobal (it's too confusing having 2 mark's here. Mark, Mark... sounds like a hair-lipped dog barking.)

[mark-perth]

Hi Everyone,
Thanks for all the replys, they have definhately been helpful. I have plenty of Xrays and other scans from prior to the ADR that show a straight spine. The curve developed after the ADR. I have 3 Xrays after the ADR and it shows the curve getting worse around the disc with a very minor curve 4 days after the ADR. I also have a posterior stabilization device still in place. That being the Diam which I do understand is not as good as a DSS system or a Corflex but surely that would help a little. I obvoiusly would like to have the symplist and safest operation, as long as it doesnt burn any bridges if it doesnt work. So if a posterior fusion doesnt remove the options of a disc removal at a later date then to me that would be the wisest option. But that being said I dont want to have 3 or 4 major operations if it can be done in 1 and from the medical papers I have regarding ADR revisions fusion while leaving the disc in often isnt as good as removing the disc. Also listening to Mark (MMGlobal) it obviously isnt something that has been perfected and there is obviously alot of debate about the correct procceedure to correct a failed ADR as there have been possitive and negative results from all attempted ways. I have heard of too many problems with a DSS system to consider that especially as my disc is so far misplaced and feel that way would definately mean an extra operation or 2. From what ive read the best option is usually removal with a 360 fusion to fully stabilize the area. Hopefully I can find a surgeon before problems occur to other areas. Please continue to give me your thoughts as your advice so far has been exremely benificial.
Thanks,
Mark

[Hucky :)]

Hi Mark,

I'm from Sydney and I saw a guy at Westmead Private. I haven't been operated on but saw him for a consult for ADR/fusion.

If you want his name I can give it to you, I don't know if he does ADR revisions though.

There is a neuro in South Australia that has a good reputation for taking on very difficult fusion revisions, but can't think of his name, if you would like, I can ring someone who was revised by him and get back to you.

The other thought I had is to ask your neurosurgeon who HE thinks is the best for revision surgery. As someone suggested, Matthew Scott-Young has a pretty good reputation, but he is in Queensland.

If it were me in this situation, I would be trying to see the guys in Germany. They are the best of the best. It would cost a lot more than being done here, but if you can afford it, it might be the safest and best outcome for you.

Take care

Hucky

[mark-perth]

Hey Hucky,

Thanks for the reply. That would be very much appreciated if you could get the name of the neuro in SA. I have contacted at least 50 surgeons in Aus so far and none are willing to look at removing the disc. I am happy to travel anywhere to get the best treatment as a life in pain is not my idea of fun. Hopefully I can have it in Aus and I still have a few surgeons to wait for a reply from but it doesnt look great. The problem is more to do with them having not done it before and I really dont wamt to be there first. I think it would be better to have someone experienced with it so I hopefully get a good result.
I hope you have a better experience than mine. Dont let mine put you off, just understand the dangers if it doesnt work. Have you seen my scans from earlier in the post? Failures can also happen with fusion as well which is the scary thing. Good luck with your choice.

Thanks,
Mark

[Hucky :)]

Hi again,


Sorry I haven't got back to you, I can't seem to contact this lady I know who had the revision fusion surgery in SA.

I've been trolling old posts on various boards but can't find his name. Hopefully, she'll ring me soon, unless her phone number has changed

Hucky

[mark-perth]

Hi Hucky

Cheers for that, dont stress about it 2 much, whenever you find out thats fine with me. Id say I will have another few weeks before I get answers from the surgeons ive contacted anyways.

thanks,

Mark

[Michelle Maree]

Hi Mark

It is my understanding that Dr Bertagnoli in Germany has the most ADR experience in the world. Particularily dealing with difficult cases that no one else will attempt. I understand that financial and insurance issues are extremely important.
But this is your spine and you only get one and it has to last the rest of your life. It couldnt hurt at least to get an opinion from him and see what he says.
The other Mark can help you with this or you can contact Dr.B through his own website.

Go Freeo!

Michelle.

[Michelle Maree]

From what I have read Mathew Scott -Young is Australias most experienced ADR sugeon and he has performed just over 300 of them. Where as Dr Bertagnoli in Germany has performed over 3000. Its not a garantee but it sure tips the odds in your favour.

Or are you an Eagles fan?

Michelle.

[mark-perth]

Thanks for the msgs. Ive sent all my scans off to MSY and another doc in near you on the NSW border and are just waiting for a reply, hopefully soon, its killing me all this waiting. I just want to be in less pain. Im unsure if MSY removes discs or just fuses them in place. Im unaware of any doctors in AUS that has experience with the Lateral approach which is helpfull to remove the disc. MSY seems to have the most experience with ADR in AUS but mainly uses Charite but that doesnt matter as I dont want another ADR in there. I think he has put in some mavericks as well but mainly uses Charite. I have contacted Dr B as well. They have been absolutely amazing with the speed of there contact with Tim answering emails within a day. They have given me several options in how to deal with the problem which is very reasureing. Im really at a point where I dont know what is the best option. It makes it extremely hard when there arent many papers regarding removal of maverick ADR's although a prodisc is similar with the keel

Thanks

Mark

No way no Eagle in my house

[Hucky :)]

Hi Mark,

I'm sorry, I tried that phone number several times, and I guess they have either changed it or moved

I saw Andrew Kam at Westmead Private Hospital for a consult several years ago. He was a very professional easy person to talk to and was not one to push you into surgery - in fact he said to wait as long as possible in my case.

I was just reading his web site and it says he prefers to "focus on complex spinal issues" - whether the removal of an ADR would be in that category, I don't know, but I would certainly consider contacting him. He certainly has a good reputation as far as other professionals are concerned.

Here is the link with his details.

Westmead, NSW Neurosurgeon - Dr. Andrew C Kam MD - Spine Treatment

Hucky

[mark-perth]

Hi Hucky

Cheers thanks anyway for that. Im going to contact your surgeon as well, thanks for that, it cant hurt to ask what he thinks.
Thanks.
Mark

[mmglobal]

NDM, thanks for posting the great news.

Dr. Pimenta is amazing. I'm so glad that Mark did enough research go be confident enough to follow through as he did.

Congrats Mark... please come and post an update when you feel up to it!

Mark

[Maria]

That's a wonderful youtube message Mark! so glad to hear the surgery with Dr.Pimenta was successful and that you can sit again, have that much less pain that shortly after surgery and decrease your pain med that drastically!

This news seriously ROCKS! so glad this youtube link was posted as well as update on Mark