7 replies to this topic

[mikeinnaples]

The current gold standard in the United States for herniated discs where there is no response to non-surgical intervention (traction, chiro, epidural injections, physical therapy) or where the cord is compromised due to disc/osteophyte caused spinal stenosis is spinal fusion. For single level, the FDA approved artifical disc replacement for a couple of implants, but half the insurance companies will not cover it. Multi level disc replacement or hybrid fusion/disc replacement surgery is considered experimental in the United States despite surgeries such as this being done in Europe for over a decade with great success.

This is a personal matter to me as I have c3-c7 herniations with a compromised cord on two levels. See the attached photo for the MRI read.

With that said, surgery has been recommended by two different neurosurgeons, both of which are among the best in the business. Here are my options:

1. 4 level spinal fusion - Completely covered by insurance.

2. Single or two level fusion (depending if c3-c4 can be left as is) and an artifical disc implant (prodisc-c) above and below the fused levels to reduce stress on adjacent levels and provide more mobility than a full fusion. Insurance would pay for the fusion, the rest would be out of pocket.

3. 4 level artifical disc implants outside of the united states. 100% out of pocket and possibly out my affordability range.

Obviously I am doing everything I can to avoid the first option because of my active lifestyle. I am a gym junkie, runner, surfer, paintballer, and play league softball/flag football. 36 y/o is too young to be face with this kind of surgery, but there is little I can do about it.. I am thinking #2 would be the best choice for me because #3 may be financially impossible and too risky long term.

So with all of that said, I have done my research on current treatments, but really have had difficulty with finding information on possible treatments coming down the pipeline in the future. For example, I would want to avoid fusion at ALL costs if I would be able to get some sort of stem cell treatment to regrow my own discs in the near future. Does anyone have any insight or thoughts on my situation? I hate to make a post like this, but I really feel backed into a corner on this and thought I would reach out to the community.

Thanks guys.

[mikeinnaples]

Just a quick update. After more diagnostics to see how my vertebrae/discs/osteophytes/cord in different states of flexion and extension, my surgeon believes that fixing c5-c6, where my cord is compromised and most of my symptoms are coming from, will allow me the best outcome for now. He thinks there is some chance that I may get symptoms on my left side post op on c6-c7, but that the chance is small because I am currently asymptomatic at that level. Luckily my insurance company was recently forced to cover single level artifical disc implants, so I will be getting this surgery done in Jan. I must say that I am extremely happy about this as it will allow me to retain my range of motion fully and remove the risk of permanent paralysis. In addition, my expected recovery time will be 6-8 weeks compared to 9-12 months for a multi level fusion.

With that said, I am still interested about any personal information anyone may have about this kind of surgery. In addition, since the life of the hardware is roughly 10 years, I am still interested about any information on insight that anyone in the community may have about possible new treatments (stem cell therapy, etc.) that may be coming down the pipe over the next decade.

Thanks

[niner]

Mike, I'm glad to hear that you've got this covered. It sounds like a good choice. I know a guy who'd had some fusions done, and aside from the onerous recovery (he had to wear a cage around his head), I was impressed at how well it turned out. He continued an active lifestyle (did a lot of mountain biking) and seemed pretty happy. I have two cervical discs that were wrecked in an injury, and will probably have to do something about it someday, but at the moment they're stable, though slightly dysfunctional. I don't have any good information on stem cell treatments, but regenerative medicine continues to advance. I figure it's just a matter of time, but I don't know how much. I wish you the best of luck on this; keep us posted on it.

[mikeinnaples]

Mike, I'm glad to hear that you've got this covered. It sounds like a good choice. I know a guy who'd had some fusions done, and aside from the onerous recovery (he had to wear a cage around his head), I was impressed at how well it turned out. He continued an active lifestyle (did a lot of mountain biking) and seemed pretty happy. I have two cervical discs that were wrecked in an injury, and will probably have to do something about it someday, but at the moment they're stable, though slightly dysfunctional. I don't have any good information on stem cell treatments, but regenerative medicine continues to advance. I figure it's just a matter of time, but I don't know how much. I wish you the best of luck on this; keep us posted on it.

Just an update on my status:

On January 31st I went to Health Central Hospital at 6:30am to have spinal reconstruction surgery consisting of a c5/c6 discectomy and a prodisc-c cervical implant. Dr. Masson was my surgeon (and as I type this, the irony is that his advertisement is in the googlead banner at the top of this page... heh). I arrived at the hospital at 6:30 am and by 8 am I was in the operating room. What is normally a 20-30 minute surgery after the initial incision, took Dr. Masson a little shy of two hours to complete due to the care he had to take to remove the blown disc material that was jammed into my spinal cord and nerve running into my right arm at the root.

Here is how my recovery has gone so far:

4 hours later: I was walking aroung the hospital without assistance! I had to drag my IV stand with me everywhere. Two days after the surgery I walked 4 miles outside with my wife. 10 days after the surgery I returned to the gym, lightly lifting weights (no overhead lifting) and walking uphill on the treadmill for several miles. 2 weeks after surgery I was bench pressing 135lbs pain free for 3 sets of 12 (so much improvement in so little time). Three weeks after the surgery I was able to swim for 30 minutes freestyle in a pool, leg press 400lbs pain free, and start to lightly do overhead presses and pulldowns. I have most pain free, full range of motion in my neck.

My recovery plan includes physical therapy (heat/stim/massage) and SLOWLY easing back into activity. In two weeks I have another follow up with my surgeon's PA. I expect at that time I will be allowed to return to heavy lifting, surfing, and running. As it stands my PT can hardly believe I had spine surgery a scant 3 weeks ago because I have complete and total pain free range of motion already.

Hopefully this gives some hope for some of you with disc issues whether degenerative or trauma related (mine was initially trauma that caused degeneration over time). Dr. Masson and his staff is top notch and the hospital staff where I had my surgery were outstanding. The hardware is expected to last between 12-17 years (more than I initially thought!), so hopefully by the time I need to readdress this, there will be other options available via stem cells / growing discs from my own cells / etc.

Edited by mikeinnaples, 23 February 2012 - 01:50 PM.

[nowayout]

Hopefully this gives some hope for some of you with disc issues whether degenerative or trauma related (mine was initially trauma that caused degeneration over time).

Glad it went so well, but your story is not typical. Of course neuro- and orthopedic surgeons are going to be biased in favor of surgery more often than not, but several studies have shown that there is no difference on average between surgery outcomes and conservative treatment for most degenerative spine problems after one year (yes, none at all), and in many cases surgery may actually be worse because of secondary effects. Of course there are exceptions and I don't presume to be able to judge your injury or suitability for surgery, but most people should avoid spine surgery. Anecdotally, I have spoken to several people who told me that having spine surgery was their biggest regret.

[mikeinnaples]

Hopefully this gives some hope for some of you with disc issues whether degenerative or trauma related (mine was initially trauma that caused degeneration over time).

Glad it went so well, but your story is not typical. Of course neuro- and orthopedic surgeons are going to be biased in favor of surgery more often than not, but several studies have shown that there is no difference on average between surgery outcomes and conservative treatment for most degenerative spine problems after one year (yes, none at all), and in many cases surgery may actually be worse because of secondary effects. Of course there are exceptions and I don't presume to be able to judge your injury or suitability for surgery, but most people should avoid spine surgery. Anecdotally, I have spoken to several people who told me that having spine surgery was their biggest regret.

I had military related spinal trauma in 1997 that cause degeneration over the next decade. In 2007/2008 the degeneration finally caught up with me and started severely affecting my life. After three neurosurgeon consults (initial opinion, then a second, and third), I opted to go with a combination of epidural cortizone injections into 3 levels and aggressive traction therapy. This mostly kept me going pain free for the next 4 years, able to perform at 95-99% outside of a few eposidic moments (a day or three here and there where it would bother me). Last year, it caught back up with me. Most of the levels looked about the same as my previous MRI 4 years prior, except for C5/6. It had moved into my spinal cord (the jaged edge of the disc/ostephyte material pressed into my cord was enough to make a seasoned surgeon cringe) and was also severely affecting my right arm. At this point I had no choice BUT surgery, unless I wanted to live in pain with the constant risk of permanent injury hanging over my head. I am an athelete, I surf, play sports, lift weights, and run.

The common misconception when citing studies is that all spine surgeries are created equal. Most of the research and studies you will find through searches on the internet compare fusion to conservative treatment. Alot of the problems generated from fusion is due to the loss of range of motion and the additional instability it causes on the level above and below (eventually resulting in further fusions years later). Not to mention recovery time. In a multi level fusion, recovery can be anywhere from 9 to 12 months. Disc replacements and fusions are vastly different when it comes to outcome and recovery. Full recovery from a disc replacement is 6 to 8 weeks, allow the patient to regain full range of motion, AND it doesnt cause instability and additional stress at the levels above and below. Most of the pain associated with the surgery is referral pain from restoring disc height and most of the post operative physical therapy revolves around resolving the resulting soft tissue problems.

Edited by mikeinnaples, 23 February 2012 - 05:56 PM.

[niner]

Three weeks after the surgery I was able to swim for 30 minutes freestyle in a pool, leg press 400lbs pain free, and start to lightly do overhead presses and pulldowns. I have most pain free, full range of motion in my neck.

Wow Mike, that is a spectacular result. I'm glad to hear that it worked out so well. I hope that you'll ease back into things and not hurt yourself with too much too soon. I can't blame you for being anxious to get back to your previous lifestyle, but be careful. Good luck with the rehab.

[mikeinnaples]

Thanks Niner. I am being very careful to walk up to the edge of the cliff without falling off in regards to getting back to normal.