Saw my Dr. after my latest MRI today and he wants to replace the disc between L5/S1.  He said replacement success is very high but that some insurance companies are not covering it yet.  The other option is to fuse the 2 together, which I am strongly opposed to.

So this is what he said about it.  Disc replacement requires going in through an incision in the stomach and replacing the disc with minimal invasion and tearing up of the muscles.  Recovery is relatively short.

Fusion requires going into the back, through the back muscles.  Sixteen weeks of recovery then nearly two years of rehab and healing.

So has anyone here had the disc replacement and how were the results?  If my insurance will cover it then I think I will go that direction to be pain free and regain mobility.

The procedure is new so it will not be easy to find someone who has had it done. I know a surgeon who does them and he reports VERY good results.
Cervical (neck) procedure should be available in a year or so. That is what I am waiting for.

I don't know anyone who's had disk replacement, but I know several people who have had fusion done and most regret it. They said the pain has been worse since surgery.
 My docs were honest with me, and told me there was no chance of improving my condition with surgery. (Degenerative Disk Disease).

Anybody else?

this respons is for both GOGOP, and Dukota,

First, Dukota, I would ask if you have exhaustively tried every physical therapy option available, and STUCK WITH IT for 6-8 months at the full reccommended levels.  It takes a while.

I'm 34 with degenerative disc disease in 2 lower vertabrae, and while my back hasn't been the same since this developed, I find that with therapy, and without drugs, I'm 100 percent functional, if a bit stiff in the morning, in some pain upon waking.

Gogop, how has your condition progressed.  I've been dealing with this for over a year now.  I hear that it actually improves with age, like in 20 years, YAAAAY. god I sure hope so.

nothing to add but that I've been reading up on the procedure and am very interested in others' results as well.
I've got a ruptured L4/L5 and daily pain (amongst other injuries), but didn't want to go down the 'Microdiscectomy / Repeat / Fusion' pathway.



I've read that the disc replacement procedure is a couple years further along in Europe, you might want to seek a board related to there for some with experience in the procedure.

My replacement was for C4/C5. It helped  alot, and the procedure is different than yours.

Quoted: My replacement was for C4/C5. It helped  alot, and the procedure is different than yours.

When?
My Doc told me it was not available yet. Come on, tell us how it was!

I worked with these patients for a few years. Very good results from what I understand. Immediately post-op isn't very much fun with the abdominal involvement with the disc replacement. It is much more than an incision in the "stomach". Your guts are "unpacked" and it requires a general surgeon also.
Fusion should be out patient as far as I'm concerned.
Both work some of the time. Although in 10 years of nursing I've seen alot of back pain has psyco-somatic origins  (and some docs have wrote about it).
That being said, I cannot imagine the shape I would be in to have my back operated on......

L-4, L-5 here, and I refused the surgery because I have heard so many horror stories.  When my back is out, I cannot walk, I have to crawl everywhere making shrill screamy noises, but after 3 weeks, it seems to get easier.  Those two areas control feeling to some fairly important areas in the body, and if they mess up, well, I don't want to take any chances.  So until I cannot walk at all, I am toughing it out.

In Italy, they have Discosan. Ozone injections into the tissue surrounding the disc. A far better alternative than any  surgery. See if you can find someone to do that here in the states. It works with none of the risk of surgery and best of all, you won't have to go back for surgery again later.

I am an orthopedic surgeon who has done some back surgery in the past but now mainly does sports and trauma. The disc replacements do show very good promise, but I would personally wait as long as possible before undergoing this procedure. It is still relatively investigational in the US and not all the kinks are worked out. Some of the viable alternatives would be series of epidural steroid injections to shrink the herniated discs and provide an interim solution.

Regarding the procedure itself, the abdominal incision should be taken very seriously because of the added risks of bowel perforation, major blood vessel perforation, risk of adhesions in the future (can cause bowel obstruction), increased wound infection, and wound healing problems/hernias.

I wouldn't do the epidural steroid injections either. They degrade what disk you have left and are not good for bone density. In the long run, they make your back worse.

Only do it if the pain is intolerable.

There is another thread out there with this topic and lots of info. I'm due L5/S1 fusing and cant wait to get it over with. Sgtar15 may be able to shed some light on this and the link to the other thread.

cheers

Taffy

I need C3-4-5 fused, but my doc has been dangling the hope of disc replacement for 3+ years now....

If interested in more info on ADR go to http://www.adrsupport.org/content.asp?cid=168. It's a support site for people who have had a disc replaced.  The FDA has recently approved the CHARITÉ™ Artificial Disc, you would need to check with your HMO/Health provider to see if the procedure is covered.  Good luck finding a surgeon in your area that has actual experience in the procedure.  You can locate a "trained" CHARITE surgeon in your area at http://www.charitedisc.com/charitedev/domestic/locator/.  I recently went to a "trained" neurosurgeon for a degenerative disc at S1/L5 and he gave me 3 options.

1.  Physical Therapy
2.  Epidural Injections (Which he dosen't believe would help in my situation)
3.  Spine Fusion at S1/L5

At no time did he mention disc replacement even though he is "trained" in the procedure.

Quoted: If interested in more info on ADR go to http://www.adrsupport.org/content.asp?cid=168. It's a support site for people who have had a disc replaced.  The FDA has recently approved the CHARITÉ™ Artificial Disc, you would need to check with your HMO/Health provider to see if the procedure is covered.  Good luck finding a surgeon in your area that has actual experience in the procedure.  You can locate a "trained" CHARITE surgeon in your area at http://www.charitedisc.com/charitedev/domestic/locator/.  I recently went to a "trained" neurosurgeon for a degenerative disc at S1/L5 and he gave me 3 options. 1.  Physical Therapy 2.  Epidural Injections (Which he dosen't believe would help in my situation) 3.  Spine Fusion at S1/L5 At no time did he mention disc replacement even though he is "trained" in the procedure.

I looked at that site....my doc is the chair of neurosurgery department at GW University and he's not on the list...one of his "underlings" is.

Quoted: Quoted: My replacement was for C4/C5. It helped  alot, and the procedure is different than yours. When? My Doc told me it was not available yet. Come on, tell us how it was!

Last year.
I don't know if the procedure your doc is talking about is different than the one I went through. There were some rough days right afterwards; in my case, they went through the front of the neck. Nice scare that has faded with time. I have heard various horror stories from other folks under-going similar surgery, but luckily my doc seemed to know what he was doing. I have had soem other recent back problems at the OTHER end of my spine, but they couldn't find anything wrong on the X rays.
To the guy who crawld around his house screaming in pain: man, get the repairs made. If you are worried about the procedure, find a reputable doc before the procedure is done. You are talking some serious  quality of life issues if you lose mobility for weeks at a time.In my case, if I had had a slip and fall on ice without going through the procedure, I could have wound up in a wheelchair. The procedure beat the alternative.

Good luck to each and every one of you who are thinking about any surgical procedure,and thank God we live in the era we do when this stuff is  at least treatable.

Other places you can look for "specialists" are http://www.back.com/findadoctor.html, http://www.spine-health.com/find/fi01.html, http://www.spineuniverse.com/spumd_search.php.  You will be lucky to find a Doctor listed in all three sites.

I had C6/C7 fused in my neck on 12/27/04, I was home the next day and on disablitiy for 2 months (could have gone back to work after 2-3 weeks but I was leaving the job in 4/05 anyhow).  The operation took about a hour, I did hurt a lot that day and for about 3-4 days but after that everything was fine I cant tell any lose of movment in my neck at all.  I know longer have major pains in my arm and should or numbness in my fingers.  If you can find a surgeon that knows what he is doing with replacing the disc go fo it other wise fuse it.  A single fusion wont/shouldnt cuase you lost in movment,  but this is a different location than mine.


Now on to today.  I currently need to get another MRI as I have lower back problems with pains going down the back of my legs in to my knees.  I might be in the same boat as you with another spine operation.  

Quoted: I wouldn't do the epidural steroid injections either. They degrade what disk you have left and are not good for bone density. In the long run, they make your back worse. Only do it if the pain is intolerable.

Prolonged  exposure to systemic steriods degrade bone density. Epidural steriod injections don't have that effect. The degradation of cartilage by steriods is applicable to articular cartilage, which is a different type anyway.

Quoted: I am an orthopedic surgeon who has done some back surgery in the past but now mainly does sports and trauma. The disc replacements do show very good promise, but I would personally wait as long as possible before undergoing this procedure. It is still relatively investigational in the US and not all the kinks are worked out. Some of the viable alternatives would be series of epidural steroid injections to shrink the herniated discs and provide an interim solution. Regarding the procedure itself, the abdominal incision should be taken very seriously because of the added risks of bowel perforation, major blood vessel perforation, risk of adhesions in the future (can cause bowel obstruction), increased wound infection, and wound healing problems/hernias.

Don't mean to put you in the spot, and putting any professional bias aside.  For back problems/possible surgery would you recommend a neuro surgeon or a orthopedic surgeon.  The reason I ask is because my primary physician first sent me to a neuro surgeon.  I want a second oppinion and he is now sending me to an orthopedic surgeon.

Quoted: Quoted: I am an orthopedic surgeon who has done some back surgery in the past but now mainly does sports and trauma. The disc replacements do show very good promise, but I would personally wait as long as possible before undergoing this procedure. It is still relatively investigational in the US and not all the kinks are worked out. Some of the viable alternatives would be series of epidural steroid injections to shrink the herniated discs and provide an interim solution. Regarding the procedure itself, the abdominal incision should be taken very seriously because of the added risks of bowel perforation, major blood vessel perforation, risk of adhesions in the future (can cause bowel obstruction), increased wound infection, and wound healing problems/hernias. Don't mean to put you in the spot, and putting any professional bias aside.  For back problems/possible surgery would you recommend a neuro surgeon or a orthopedic surgeon.  The reason I ask is because my primary physician first sent me to a neuro surgeon.  I want a second oppinion and he is now sending me to an orthopedic surgeon.

Both neurosurgeons and orthopedic spine surgeons are commonly  trained at the same institutions. Most in the field will tell you that orthopods would have better training for fusion work, while neuros might be better at decompression (nerve) work. I think the generalization may not be true anymore.

Beware there are many bad back surgeons in general. In Houston there are only about 3-4 guys I would trust to touch my back, and I know them all. Best bet is to ask some local operating room nurses and other local orthopedic surgeons on who is good or not. The internists, family practicioners and patients usually have no real idea if the surgeon is any good or not. Do not confuse a likeable doctor as being an excellent surgeon. There is not much correlation.

I herniated a disc in my lower back about 16 years ago. At the time the doctor told me my options were spinal fusion, surgery to "trim" the bulge, or physical therepy. He told me there was a chance I could "stretch" my spinal cord to correspond with the bulge in my disc. I was active duty army at the time. There was one other guy in my unit that had the same problem and he opted for the spinal fusion. He was back to running PT a couple of weeks after the procedure.

After about 6 months on profile doing a lot of stretching and walking excercises I was back to running PT with the unit. I retired from the military about 11 years ago and I still get back aches every now and then from work, but other than that, I can still function pretty much as I always have. I stll do stretching excercises on a fairly regular basis.

HTH.

Quoted: L-4, L-5 here, and I refused the surgery because I have heard so many horror stories.  When my back is out, I cannot walk, I have to crawl everywhere making shrill screamy noises, but after 3 weeks, it seems to get easier.  Those two areas control feeling to some fairly important areas in the body, and if they mess up, well, I don't want to take any chances.  So until I cannot walk at all, I am toughing it out.

I can fully relate to the crawling everywhere.  I've been ther a few times.

Quoted: I am an orthopedic surgeon who has done some back surgery in the past but now mainly does sports and trauma. The disc replacements do show very good promise, but I would personally wait as long as possible before undergoing this procedure. It is still relatively investigational in the US and not all the kinks are worked out. Some of the viable alternatives would be series of epidural steroid injections to shrink the herniated discs and provide an interim solution. .

Ive had the epidural injections.  Five in all over a 2 year period.  First series of three worked fine for a year, the second series of 2 didn't do anything.

Yeah...I had a double level fussion (old style disk fix) and my doctor also told me the success rate was high.

Well, if the success rate is so high then why did it fail on me and why did they come out with a new proceedure?


I have heard alot of good things about these new "disks" but they have yet to have a long enough track history for me to give my full opinion on them.  And Doctors RARELY tell you the whole truth about new things, they just like to try new things.

And if I were you I wouldn't have surgery over 1 disk because the scar tissue as the result of the surgery is gonna cause you more problems then the disk will.

Just learn to take care of your back.

SGatr15

Quoted: this respons is for both GOGOP, and Dukota, First, Dukota, I would ask if you have exhaustively tried every physical therapy option available, and STUCK WITH IT for 6-8 months at the full reccommended levels.  It takes a while. I'm 34 with degenerative disc disease in 2 lower vertabrae, and while my back hasn't been the same since this developed, I find that with therapy, and without drugs, I'm 100 percent functional, if a bit stiff in the morning, in some pain upon waking. Gogop, how has your condition progressed.  I've been dealing with this for over a year now.  I hear that it actually improves with age, like in 20 years, YAAAAY. god I sure hope so.

Mine started in 1991, and has gotten progressively worse, at a very slow pace. I kept working until 2002, when I could no longer do it. The pain got too bad, along with the weakness/numbness in my leg. I'm on disability because of it, and most of my movement is with eith a scooter or wheelchair, with short distances using a cane or crutches. (Like getting into my Ranger after loading the scooter in the back).
  Knowing what the word "Degenerative" means, I'm not sure why someone told you it would get better, but it obviously hasn't gotten better for me. I've been through therapy/pain management, but all that ever did was increase the pain and decrease mobility temporarily. One example is the Lumbar Facet(sp) they did, which is injecting steroids into the area causing the pain. For two weeks the back pain spread out over a larger area, and the part of my left leg that's normally partially numb was in constant pain. All the PT, TENS Unit, etc. ever did was make it worse, and I kept at it until they told me there was nothing else they could do.  
 The surgeons and neurologists said there was nothing they could do to reverse what I have, and that any surgery on my back would cause more pain and possible paralysis. They said eventually I'll lose everything from the waist down, but that surgery could bring it about faster.
  The Myelogram and MRIs show that the worst areas are 4 disks in the Thoracic area and 4 in the Lumber area. The Thoracic ones look the worst, a couple of them pushing against the spinal cord, but most of the pain is Lumbar. (On my left side, right over the SI joint).
  I don't normally even type answers this long because it takes away the support of my arms which increases the pain of trying to hold myself upright. That's why I do more reading than posting.

Not being a whiner, just answering the question the best I can.


EDIT-------The only medication I've found that takes away the pain is two 50mg tabs of Ultram. It also makes sleep, or so loopy that I'm staring at the cieling, so I rarely take it. I don't want to get used to them where they won't work anymore.