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!