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Back Problems Message Board


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As someone who has read a great deal about disc replacement surgery and is about to have one, I'd like to address a few of the issues raised on this thread thus far:

MelissaMay's post entitled "failed disc replacement" or something like that seems to refer to a failed nucleus replacement. I hope you will clarify this, Melissa, because it is very important to distinguish between nucleus replacement and artificial disc replacement, lest people become confused about the two procedures. I don't know much about nucleus replacement except that I believe that it is relatively new and untested in comparison to ADR. I'm not entirely sure why someone would opt for nucleus replacement rather than complete ADR. Seems to me that most of us with herniated and degenerated discs have an annulus that is pretty severely compromised. Replacing only the nucleus would not really help matters much. I would be curious to hear Melissa's thoughts about why she opted for this approach. Melissa?

ADR has been performed in Europe for over 18 years now and more than 10,000 patients have received Charite and Prodiscs. In all of these cases, there has NEVER and I repeat NEVER been a single instance of a prosthesis failure. I believe there have been some cases in which osteopenia was not properly diagnosed and that, after the ADR was installed, the patient's facet began to decay (they call this subsidence). This was detected via x-ray and the artificial disc was removed and the patient fused. This is not a failure of the disc, but rather a failure to effectively select out a patient who should not have had the surgery. The situation that Melissa described (where the prosthesis had become dislodged) simply has not happened with ADR. I am assuming that she had a nucleus replacement because she used the term "partial" disc replacement. I think it's not too hard to see how an artificial nucleus could, under sufficient pressure, "pop" out of a torn, compromised annulus. In contrast, artificial discs have fairly deep teeth that are embedded into the facet joints and then the bone adheres to the metal endplates over time, creating a very secure hold.

Someone else asked about the projected lifetime of the artificial disc. The discs are theoretically supposed to last at least 40 years. That is, the materials that were selected and the laboratory stress tests all indicate that this is a reasonable expectation. The longest a person has had one in their body is 18 years. No one has ever had to have one removed because the disc was prematurely wearing. But we won't know how long they last for sure until we follow patients for another 20 years or so. The hope is that, because ADRs do not restrict range of motion like fusion does, patients will be able to avoid the increased risk for premature degeneration of adjacent discs that is seen with fusion. Now, it is also important to state that not everyone who has fusion will have premature degeneration of adjacent disc. It just means that fusion increases the risk for this. It is too early to say whether or not ADR will protect patients from this negative consequence, but the hope is that it will.

Moonlight: There is a real “buzz” about ADR because it is clearly the most important advance in spine surgery since perhaps micro surgeries were introduced. People for whom fusion was the only surgical option (not all of them, but many) now have much better odds for an excellent outcome. It might ease your mind to know that every single surgeon I have consulted with, whether ADR was in their repertoire or not, strongly advised me to avoid surgery if, and this is the clincher, “I could live with it.” I lived with it as long as I could and when I knew I could no longer, I went ahead with plans for ADR surgery.

--tennisnut

**************************************
2002: Gradual onset lower back pain.
DDD w/ full-thickness radial annulus tear @ L5/S1. 60% loss of disc height.
2003: Multiple ESI fail, PT makes pain worse.
Unable to sit for >10 min for the past 15 months.
Meds: 160mg oxycontin, 3600 mg Neurontin
Try IDET (11/03). No benefit.
Having artificial disc replacement (Prodisc) in 2-3 months.





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