I opted to have a free review of my MRI done at the Celling Treatment Ceneters in the US.  Their head surgeon informed me that my disc isn’t really all in that bad of shape and that my best bet would be a minimally invasive laminectomy (removal of bone/tissue causing my stenosis).  The European surgeons I’ve spoken with have all recommended ADR.  I have no idea what the correct course of action is, but I think its good to get as many opinions as possible.

His take on my condition:

1. Disc is dehydrated.  It might help for him to inject it with some stem cells during the other procedure – but there is no garuntee it will help as stem cell therapies are in their infancy
2. Disc is now stiffer, not moving properly and has lost about 10% of its height
3. My facets at L4-5 are picking up the slack and being overloaded
4. They are hypertrophic at L4-5 and contributing to central canal stenosis and foraminal stenosis

None of this is news to me, as my MRI report indicates… BUT, where the ADR surgeons want to unload the facets through disc arthroplasty, he thinks my disc isn’t too bad and wants to shave down the points of impact on my nerve roots(2 surgeries).  From what I’ve read, this is minimally invasive, but there are 2 issues I can see developing:

1. Most people that have a laminectomy of this nature see a weakening of the facets to the point where a fusion is inevitable down the road
2. Increased risk of scar tissue forming between the shaved portions and your nerves – very bad

My big quesiton now is if the ADR surgeons really think the ADR can help with the stenosis.  I hope I’m not being lead astray because those are the only surgeries they specialize in.  Buyer beware!

I’m really looking forward to speaking with my local specialsts on the 8th to get their take.  I’ve also contacted Dr. Pimenta in Brazil to see if its possible for a review of my condition.  He is one of the pre-eminant spine surgeons world-wide (not just ADR) and the more opinions I have, the bigger the picture I’ll be able to see.  I’m still the most comfortable with Mr. Boeree’s assessment – but it’s my spine and my life we’re talking about here.   I’m approaching this situation as critically as I can… you only get one back.  It is the doctor’s job to provide me with options and my job as an informed patient to make the final decision.

-Brett

My wife is in Chicago this week.  I’m flying solo with a 20 month old, a cocker spaniel and a Jack Russell terrier.   LOTS of bending over so far and it’s only been a day!

The pain is constant and spikes as I tcb with the kid and dogs… but what can you do.

Caleo on the 8th, Palm Springs(vacation) on the 10th.  Still radio silence from the Mesoblast fda trial.

Enough snow already!  This is what shovelling the sidewalk feels like now.  😉

It has been a CRAZY winter.

-Brett

Well, kind of.  I stayed away from anything that might strain my back further.  The dune buggies looked like so much fun!  Too bad.  I must have seemed like a zombie to my coworkers though, while they danced and had fun and I sat there hopped up on pain killers and NSAID’s.

The NSAID’s have helped me to sleep a little better, but my old friend, back pain, is still here.

I’m waiting for my appointment here in Calgary, but I’m worried they’ll tell me to do nothing or more physio until my nerve roots are totally compromised and I have to get a fusion.  Not on my watch!

Discectomies, laminectomies and the like do nothing to treat the real issue… and will make more problems down the road from everything I’ve read.  Cutting pieces of the disc off will just make it weaker and I don’t want a full herniation in my future.

I’ve come to the conclusion that the disc either needs to be repaired or replaced.  This has to be done sooner than later to prevent nerve root damage and degeneration at adjacent levels.

2 weeks until Caleo, nothing back from the FDA trial and I can book a surgery 4 weeks out with Mr. Boeree in a worst case scenario.  The flight to the UK will be another story.

The supplements I’m taking have helped a little – I don’t have as much pain getting up and down.  The question is, which one is actually helping?!  🙂  The NSAID’s are far superior for killing the pain mind you… but they also kill my stomach.

-Brett

We’ll see how my back reacts to Vegas for a couple of days.  It’s going to be a nice break from the cold, but I’m worried about walking, moving around a lot, sitting and drinking.  I’ve pre-emptively began the NSAID’s today in hopes that they stave off my back getting mad at me.

The past few days have been tough – I’ve controlled the pain as much as I can with excercises, walking and supplements, but my right big toe decided to go numb two days ago.  The feeling is back today… but I really hope I’m not doing any permanent damage.  I’m almost to the point where I want to just bite the bullet and get the ADR done so I don’t damage my L5 nerve roots.

I emailed a number of people from Canada that made the trip to Stenum for ADR – not one of them regrets the experience and they’re all doing much better than they were before.  It’s pricey and it sounds like there is no chance of reimbursement, but you can write it off on your taxes.  Kick ass(sarcasm).

Still nothing from the FDA clinical trial.

I just exchanged some follow up emails with Mr. Boeree and he has adressed each and every one of my concerns.

1) He uses and occlusion barrier between the vessels and surgery to make a revision safer, if it is ever needed.

2) Infections are unusual but you can take prophylactic antibiotics if worried – very low risk.

3) Nerve injury is a risk, but it is predominantly related to surgical experience and careful technique.

4) Friction based prosthetics like the Prodisc will generally wear more than an M6-L – though no one has any long term data to back it up.

5) My pain appears to be related to the disc itself along with referred muscle/joint pain

6) Success is in the eye of the beholder.  He indicated that no one entering surgery can expect a “cure” and you’ll be disapointed if you do.  This is to reduce symptoms only and I’ll probably have residual symptoms (though not as bad).  ADR surgeries tend to have a higher satisfaction rates than their fusion counterparts.  Specifically, I’ll “have very good chance of a good outcome”.  He chooses his words well. 🙂  Also, he is true to his principles and would not recommend a surgery if unwarranted or too risky.

7) Hockey, and skiing should be alright by about 4 months… though he didn’t know enough about Ashtanga Yoga to make an informed decision.

Some big decisions ahead, for sure.  I will also add that Mr. Boeree is one of the most thorough and attentive doctors I’ve ever spoken with and I’m very confident in his abilities.

The consultation went very well!  Dr. Boeree was exceptionally thorough and was bang on with this analysis of my condition.  He could tell from the MRI/xrays where my pain and tingles show up and how they relate to the lateral recess and disc bulge compressing the L5 nerve roots.  The formaminal stenosis at L4 is showing some narrowing, but I’m not exhibiting any symptoms and he wasn’t too worried about it.  The Facets also show only minor wear and he has treated a number of people far worse off with great success.  As such, I’m a good candidate for an M6-L prosthetic disc… or a prodisc should I prefer that.  But, I’ll defer to his expertise if I choose the surgery route.

He also reiterated that there is no absolute indication for when spinal surgery should be undertaken.  It is up to the patient to decide.  Physically, I’d probably benefit from the ADR, but I ultimately have to make the call and front the cash! 😉

 My choices are as follows:

 1) Do Nothing: see what happens – will probably not show any improvement, but you never know.  This will increase the load on the facets and adjacent discs as L4-5 deteriorates

 2) Disc Replacement: this will restore proper facet and adjacent disc loads – But it is a pretty major surgery.  If he were in the same boat, he would choose the ADR.  He was also very transparent when indicating he has no vested interest in any ADR companies – just that he believes ADR is the way to go

 3) Fusion – He is not a fan of fusion, but it has its uses.  More adjacent level deterioration, but sometimes you have no choice with an unstable spine, or a complication during ADR surgery

 In terms of ADR risks:

 1) Subsidence – very low risk for a young, healthy and active person like myself.  The ADR should bond to the bone quickly and that will solidify in place.

 2) Migration – very low with the design of the M6.  It’s pretty rock solid upon implantation and by 3 months the bony overgrowth will cement it into place

 3) Autofusion – more of a cervical disc issue, though genetics do play a large part.  It can happen, but it is a low probability as well.

 We were having a great chat, but were both cut short by meetings.   I need to follow up with him on revision surgeries, infection rates, nerve decompression(likelihood of permanent damage) and sports participation after an ADR.  I also need to chat with him about the longevity of the device as it sounds like polymer breakdown can cause some very serious inflammation and complications down the road.  I’d also like to know how much height my L4-5 has actually lost and if a mechanical disk inteferes with the nutrition of the surrounding bone and adjascent discs.  Lastly, I’d like a number in percentage form of my chance of success given my physical shape, health, activity level and current degeneration level.

 In terms of booking an appointment, they need a lead time of 3-4 weeks and I could be back at work 3 weeks after the operation and residual pain/symptoms can take up to 3 months(sometimes longer) to disappear.

All in all, there was no pressure for me to proceed… just what he felt was best for the relief of my symptoms.  I should receive a quote for the procedure today.

I’ve still got my fingers crossed for the FDA stem cell trial!

Here’s a link to a couple of position papers on TDR.  Interestingly, the case for is written by Dr. Nick Boeree and the case against isn’t really about TDR specifically.  It’s more of a position paper against spine surgery for the most part… in favour of Physiotherapy.

Some more information on device longevity, mechanics and physics from a UBC engineering student.

Since switching over to the Animal flex in combination with the Collagen, I’ve noiced a difference in my fingernails of all places!  They are growing like crazy and are shiny and strong.  WTF!

I may have stumbled on a “secret” formula for ladies fingernails! 🙂

The inflamation seems to have gone down with the natural anti inflammatories in the Animal Flex and I’m having far less espisodes of tingles… still not much radicular pain, though that hasn’t been a problem since I first injured my back in the early 2000’s.

The pain is still centered in my back and I really feel it with any forward or backward flexion instantly.  I’m trying ot keep the the back as mobile as possible to encourage nutrient exchanges and still do the spinal stretch every night before bed.

Normally, I’d be walking like crazy outside, but our Calgary winter this year has been less than appealing.  It’s below -20 almost every day and it is far too miserable to go for walks… not to mention the hazardous ice patches I have to avoid like the plague.  I’ll stick to my yoga postures until the temp goes up a bit.

I’m still terrified of surgery and I don’t see that subsiding any time soon after an email from Stephanie.  The films say it all… 🙁  Good read for any prospective ADR patient.

I’m still hoping I succeed as a candidate for the stem cells.

-Brett

I  finally got my hands on one of the most highly regarded joint/cartilage support supplements available on the market:

Universal Animal Flex. Essentially, it’s got all of the things I have listed in my program (except the collagen) rolled into a single daily serving – with a few additions.   I will begin the supplementation tomorrow.

My phone consultation with Dr.  Boeree (UK) is booked for Monday afternoon.  I’ve heard great things about him and it will be nice to speak with an expert on ADR.  If it comes down to disc arthroplasty, he is the front runner, followed closely by Dr. Clavel (Spain).

I have yet to speak with anyone in Germany or my local specialists.

I’ve heard back from the fda clinical stem cell trial – I haven’t been ruled out yet, but it is not looking very promising due to my foraminal stenosis.  It is ironic though as I have learned the stenosis is a result of both disc space narrowing and the resulting facet overload that is inflaming and thickening the ligaments – causing the stenosis.  One could postulate that an increase in disc height/health should relieve both the facet overload and stenosis.   But I’m just an IT manager… what do I know.

Here is a quote I found particularly appropriate for my condition…

There is a precipice on either side of you — a precipice of caution and a precipice of over-daring.

-Sir Winston Churchill

I’m terrified of doing nothing and having my situation deteriorate further and at the same time, deathly afraid of surgery and all things medical.  Hell, I passed out at my last tetanus shot.

Also, I’d like to send a quick shout out to Stephanie for all of her help over the past week.  She’s the only canuck I’ve been able to exchange emails with that successfully went through and ADR here in Canada.  And, she’s a yoga instructor!  It would seem an ADR might do the trick for me.  Thanks for all of the info and I plan on finding a thai massage VERY soon!