Disc Fusion Or Total Artificial Disc Replacement

[Who, me ?]

Hi there....

I might be in need of a surgery, as I experience severe pains caused by a herniated disc (L5-S1), especially at night.

The doctor I met and who diagnosed this (based on MRI) told me that I need a surgery, and he recommend a disc fusion. I am not excited by this, as I also read some good reviews about "total artificial disc replacement" . I wish to avoid a surgery, but if in worst case scenario I really need one, I'd like to make the right choice

Has anyone of you guys got some experience with these methods ? Can you please advise, according to your own experience ?

Thanks

[sleepyjohn]

Did he tell you why a microdiscectomy was not enough?

[Fore Man]

There is no such thing as a disk fusion...it is the adjacent vertebral segments that are fused using a mending plate. To maintain the interstitial gap between segments, surgeons typically use either your own bone tissue extracted from your hip (a very painful process that often causes more post-op problems than the spinal work) or they can use cadaver bone tissue that has been specially sterilized to eliminate any possibility of rejection or viral infection.

I have heard about the new disk replacements, but it would seem to me that the post-op results would be about the same. Fusion at the level you refer to will cause some impairment in trunk flexibility but in time it is not a problem after it all knits together. I had a hemilaminectomy done of the L1-L2 disk in 1990, but the surgeons accidentally nicked my spinal cord and created a very slow CSF leak...they weren't aware of it at the time and after I returned home and began experiencing terrible pains at the site did they make the diagnosis. In repairing that CSF leak, I contracted a bacterial infection of the spinal canal that laid me up for 4 months and required me to learn how to walk again, because my supporting muscles had atrophied. I was 44 and in very excellent shape when this happened. Other than irreparable damage to the inner ears and kidneys caused by the oto- and nephrotoxic antibiotics used to defeat the infection, I am none the worse today and lead a normal life.

In 2001 I underwent a 3-level fusion in my cervical spine...which went well and there were no ill after effects. The (San Diego) doctor gave me the choice of using native bone or cadaverous tissue and recommended strongly that I accept the latter option. I definitely have no regrets.

I tell you this medical history so you can understand the tremendous risks inherent in invasive surgical techniques.

I would suggest that you investigate arthroscopic surgery of the spine as a very worthy and creditable alternative. This is done in the West as an inpatient procedure, but the patient normally returns home the same day or the next and heals back to normal extremely quickly as there is no invasive wound nor trauma to the muscles and underlying tissue at the surgical site. I have heard but not confirmed that the only place in Thailand to have this done is at Bamrumgrad. I do not know how many such procedures they have done nor their success rate. You owe it to yourself to thoroughly check this out...or consider going to the USA or Europe to have it done. You didn't cite your age, but believe me, most of us do not need a major invasive surgery done with all of its possible complications and heavy use of antibiotics and anti-infammatory medications. These drugs are extremely toxic to your system, especially your kidneys, and your renal function once damaged cannot regenerate itself. After invasive surgery you will also require physical therapy to restore range of motion and speed up healing.

There is another possibility involving the use of a special laser-like probe that literally dries up the inpinging disk tissue, relieving pressure at that nerve root and easing of symptoms.

I have sciatica symptoms from time to time now, 18 years after my original disk surgery. They just started cropping up late in 2008 for the first time. Probably caused by overexertion and excessive swinging when I play golf. If I had to have another surgery done, it definitely would not be an invasive procedure.

You should also exhaust all forms of therapy and bedrest before moving to the next step. Most neurosurgeons will tell you that they are paid to cut, not to prevent. Seek qualified therapeutic advice.

I'm well-educated in spinal surgeries, was once a pre-med student, and my son is also a doctor, but am by no means an expert. You need to learn all you can and compare your understanding with what doctors will tell you.

Good luck!

Edited January 12, 2009 by Fore Man

[pumpuiman]

From what I've read of artificial replacement discs, you should be a young man to be considered..20-35 years old.

Also, being a fairly new procedure, the long term effects are not known.

Other problems include increased danger of serious complications if ever the artificial disc need be replaced or repaired.

I'm contemplating a two level fusion myself, and after discussing artificial discs with my surgeon at Massachusetts General Hospital ...I'd say no.

You should seek two or three opinions, many doctors are more conservative and a fusion may not be necessary. I've spent two years trying alternate therapies... none have worked.....but I'm glad I tried.

Good luck

[samtam]

Fore Man's advice is the best. Explore the options very thoroughly, and have a number of opinions. Surgery should be your very last option.

[Lefty]

For a well educated second opinion you might try the Spine Center at BNH Hospital.

Lefty

[Sheryl]

They are using the artificail disk at BNH and there has been some positive feedback from at least 1 TV member. However, it is very costly (cost of the device itself, which is additional to cost of the surgery) and the main advantage, preservation of mobility of the spine, is more of a concern when multiple fusions are involved than when just one is done.

In any case, depending on how long you have had the pain and also whether it is "just" a herniation or there are degeneratiove changes, it may be premature to think of surgery. Have you had a course of physical therapy? That is normally tried first.

2 spinal surgeons who have been recommended by numerous TV members are:

Dr. Nanthadej Hiranyasthiti at Bumrungrad

Dr. Wicharn at BNH

[Who, me ?]

Thank you all for your answers

I went to the BNH yesterday, and had a very long meeting with the Doctor, K.Eakpatipan

He made an examination, and studied the XRay and MRI I brought with me. His comment is very clear

- An operation is highly recommended. The disc has slipped out of the space between L5-S1, and has migrated downwards. There is no chance for the disc to come back in its normal position. The pain can only be treated by pain killer, and my condition my deteriorate if the disc presses more on the nerve (numbness, weakness, loss of control of bladder and bowels, ....)

- I am an active person, and this situation effects my mobility, my sleep, and I do need to take a lot of pills not to suffer

- I am not a good candidate for the total artificial disc replacement, even if would like this method

- The option the doctor recommends is an operation to remove the disc, and to screw 2 titanium pins to bridge L5-S1. No bone graf in this case.

I have to say that the meeting at the BNH was quite good, quite professional. The Doctor answered all my questions, spent a long time with me, and gave me clear and detailed explanations

Don't know yet what I'm going to do...My physical therapy, and oral medicine did not improve my condition at all

Thanks again for your comments

Cheers

[Kuedech]

Hi there....

I might be in need of a surgery, as I experience severe pains caused by a herniated disc (L5-S1), especially at night.

The doctor I met and who diagnosed this (based on MRI) told me that I need a surgery, and he recommend a disc fusion. I am not excited by this, as I also read some good reviews about "total artificial disc replacement" . I wish to avoid a surgery, but if in worst case scenario I really need one, I'd like to make the right choice

Has anyone of you guys got some experience with these methods ? Can you please advise, according to your own experience ?

Thanks

Hi

Just read your post and I'm not sure if I manage it to get it out.

Try to get in contact with Dr. Dhanit or Dr. Paisan in Bumrungrad , new wing, 16th floor. I have had a herniated disc in Nairobi and after 18 days in Hospital there,I decided to fly to Bangkok for treatment. Dr. Dhanit was not very keen to operate immediately as he wanted to do the Therapy first. But after 4 weeks, we came to the conclusion, that an operation could not be avoided.

They did it an early morning and the next day I was on my feets and no pain.

This happend in April/May 2004, I stayed 38 days in Bumrungrad and paid for the whole Threatment / Operation, Medication and Accommodation in a single room USD 12'000.- only.The same amount I paid in Nairobi for 18 days without operation.

Dr. Dhanit told me afterwards, that my operation was his 2nd most difficult he had done in the last 20 years !

I wish you good luck and I hope, you get an equal good Treatment as I received it. But lets face it - either it goes well or one may/can end up in a wheelchair as well.

Best regards

[Who, me ?]

Hi there....

I might be in need of a surgery, as I experience severe pains caused by a herniated disc (L5-S1), especially at night.

The doctor I met and who diagnosed this (based on MRI) told me that I need a surgery, and he recommend a disc fusion. I am not excited by this, as I also read some good reviews about "total artificial disc replacement" . I wish to avoid a surgery, but if in worst case scenario I really need one, I'd like to make the right choice

Has anyone of you guys got some experience with these methods ? Can you please advise, according to your own experience ?

Thanks

Hi

Just read your post and I'm not sure if I manage it to get it out.

Try to get in contact with Dr. Dhanit or Dr. Paisan in Bumrungrad , new wing, 16th floor. I have had a herniated disc in Nairobi and after 18 days in Hospital there,I decided to fly to Bangkok for treatment. Dr. Dhanit was not very keen to operate immediately as he wanted to do the Therapy first. But after 4 weeks, we came to the conclusion, that an operation could not be avoided.

They did it an early morning and the next day I was on my feets and no pain.

This happend in April/May 2004, I stayed 38 days in Bumrungrad and paid for the whole Threatment / Operation, Medication and Accommodation in a single room USD 12'000.- only.The same amount I paid in Nairobi for 18 days without operation.

Dr. Dhanit told me afterwards, that my operation was his 2nd most difficult he had done in the last 20 years !

I wish you good luck and I hope, you get an equal good Treatment as I received it. But lets face it - either it goes well or one may/can end up in a wheelchair as well.

Best regards

Thanks for the comment...will check this one too

[RobMason]

I had a 2 level ADR (artificial disc replacement) performed by Dr. Wicharn 3 years ago. At the time he was the most experienced ADR surgeon in southeast asia. I was 59. The outcome was favorable, tho I still have other issues related to spinal stenosis at another level and facet arthritis/arthrosis caused by 5 years of abnormal spinal dynamics related to disc disease. A percutaneous lumbar discectomy will remove the extruded fragment but will not repair the damaged disc, and ultimately that disc will degenerate further. The statistics of ADR vs fusion has show in varying studies increased satisfaction of ADR over fusion, but one needs to fulfill certain criteria to be a candidate for this procedure. Recovery from ADR is much faster than fusion.

The diagnosis, treatment and management of spine/disc related back pain and nerve symptoms is not to be taken lightly, one must educate oneself and get multiple opinions. There is web site ADR support dot org, that is very informative, also chirogeek dot com, for loads of information.

The decision to get surgery should be made after conservative treatment measures have failed, the usual time frame being 6 months. If nerve related symptoms of numbness, muscle weakness, bladder or bowel problems are present, that will make the decision more urgent.

Some of the most experienced spine surgeons are in Germany, Dr Rudolf Bertagnoli (www dot pro-spine dot com), and Dr. Willem Zeegers being the most prominent. Many have gone there, some from Thailand to Germany. I myself flew to Germany soon after my surgery for Bertagnoli to inject a bone hardening agent in 2 vertebrae to prevent subsidence (sinking of prosthesis) into the vertebrae.

Good luck friend.

Edited February 5, 2009 by RobMason

[Who, me ?]

I had a 2 level ADR (artificial disc replacement) performed by Dr. Wicharn 3 years ago. At the time he was the most experienced ADR surgeon in southeast asia. I was 59. The outcome was favorable, tho I still have other issues related to spinal stenosis at another level and facet arthritis/arthrosis caused by 5 years of abnormal spinal dynamics related to disc disease. A percutaneous lumbar discectomy will remove the extruded fragment but will not repair the damaged disc, and ultimately that disc will degenerate further. The statistics of ADR vs fusion has show in varying studies increased satisfaction of ADR over fusion, but one needs to fulfilled certain criteria to be a candidate for this procedure. Recovery from ADR is much faster than fusion.

The diagnosis, treatment and management of spine/disc related back pain and nerve symptoms is not to be taken lightly, one must educate oneself and get multiple opinions. There is web site ADR support dot org, that is very informative, also chirogeek dot com, for loads of information.

The decision to get surgery should be made after conservative treatment measures have failed, the usual time frame being 6 months. If nerve related symptoms of numbness, muscle weakness, bladder or bowel problems are present, that will make the decision more urgent.

Some of the most experienced spine surgeons are in Germany, Dr Rudolf Bertagnoli, and Dr. Willem Zeegers being the most prominent. Many have gone there, some from Thailand to Germany. I myself flew to Germany soon after my surgery for Bertagnoli to inject a bone hardening agent in 2 vertebrae to prevent subsidence (sinking of prosthesis) into the vertebrae.

Good luck friend.

Thanks a lot

I experienced severe pain, numbness from thigh to foot, weakness. I had a surgery at the BNH on 26 January 09.

Performed by Dr Eakpatipan, and Dr Wicharn. I was not a good candidate for artificial disc, so I had a fusion . I am now in recovery process: I walk fairly well, I sit (not too long) , and my overall feeling is rather good.

Cheers

[RobMason]

Thanks a lot

I experienced severe pain, numbness from thigh to foot, weakness. I had a surgery at the BNH on 26 January 09.

Performed by Dr Eakpatipan, and Dr Wicharn. I was not a good candidate for artificial disc, so I had a fusion . I am now in recovery process: I walk fairly well, I sit (not too long) , and my overall feeling is rather good.

Cheers

You have had experienced Surgeons do your procedure. Fusion at L5-S1 is not as bad as having it higher up, as there is less motion there than L1-L5. Be aware that fusion at 1 level moves the motion to next level up and often results in faster degeneration of the adjacent disc level some years down the line. But this by no means is a given. In 3 months you should feel a lot better, and in 6 months usually all restrictions of activity are removed.

[Who, me ?]

Thanks a lot

I experienced severe pain, numbness from thigh to foot, weakness. I had a surgery at the BNH on 26 January 09.

Performed by Dr Eakpatipan, and Dr Wicharn. I was not a good candidate for artificial disc, so I had a fusion . I am now in recovery process: I walk fairly well, I sit (not too long) , and my overall feeling is rather good.

Cheers

You have had experienced Surgeons do your procedure. Fusion at L5-S1 is not as bad as having it higher up, as there is less motion there than L1-L5. Be aware that fusion at 1 level moves the motion to next level up and often results in faster degeneration of the adjacent disc level some years down the line. But this by no means is a given. In 3 months you should feel a lot better, and in 6 months usually all restrictions of activity are removed.

Thanks a lot for your information. Dr Eakpatipan has clearly mentioned the "risk" on other levels. He encouraged me to loose weight, and to start exercise (as soon as he will give the green light). He also mentioned a 3 to 6 month time frame for a full recovery...Also said that I can live "almost normally" after a couple of weeks, as long as I don't rush things. And yes, I am aware that those two surgeons are experienced. I can warmly recommend them , and the BNH Hospital. I have been taken care much better than I ever had, and this is not only from Doctors or nurses. Every one involved is dedicated to the patient !

[chiang mai]

I was three days away from having a discectomy in the UK after having seen a range of orthopedic surgeons and having undergone months of alternate therapy, the medical profession had consulted the MRI scans and determined it had to be done. By chance I received a call from a chiropractor I had visited years early who was checking up on past patients and no doubt touting for business. When I told him my story and that I was preparing myself for the op he reminded me that, "you cannot unoperate". He referred me to another Chiropractor very near to where I lived at the time and I duly went to see him - I walked into his offices doubled over in pain and half an hour later I walked out, upright and free of all pain, I have never had a back problem ever since. All of this was over fifteen years ago.

Edited February 5, 2009 by chiang mai

[Who, me ?]

I was three days away from having a discectomy in the UK after having seen a range of orthopedic surgeons and having undergone months of alternate therapy, the medical profession had consulted the MRI scans and determined it had to be done. By chance I received a call from a chiropractor I had visited years early who was checking up on past patients and no doubt touting for business. When I told him my story and that I was preparing myself for the op he reminded me that, "you cannot unoperate". He referred me to another Chiropractor very near to where I lived at the time and I duly went to see him - I walked into his offices doubled over in pain and half an hour later I walked out, upright and free of all pain, I have never had a back problem ever since. All of this was over fifteen years ago.

Wow, really great that you could avoid the operation. It is much better this way, I'd love to do the same...But unfortunately, it was not an option for me..

I wish you good

[onomataho]

I had three spine surgeries in the past (in America), and I am very active now (lots of travel, swimming, scuba, etc). Two years ago, I had a bad injury when a chair leg broke and my back was hurt bad. I went to both BNH and Bumrungrad for exams and opinions on my injury. IMHO, Both are very good.

I would definitely consult with Dr. Nanthadej Hiranyasthiti at Bumrungrad (aka Dr. Golf) before moving to any conclusion. He is a very, very competent doctor and I would not think of seeing anyone else for a final opinion if faced with a serious spine condition that might require surgery.

Also, fyi, I've had two surgeries at Bumrungrad (knee and shoulder by Dr. Panya), and I can say that both of these experiences were very positive.