Arthroplasty in the military: a preliminary experience

The introduction of cervical and lumbar arthroplasty has allowed for management of cervical radiculopathy and lumbar degenerative disease in patients with the preservation of motion at the affected segment. While the early clinical outcomes of this technology appear promising, it remains unclear what activity limitations should be imposed after surgery in patients with these implants. This is of particular interest in military personnel, who may be required to return to a rigorous level of activity after surgery. The goals of the FDA trials evaluating various disc arthroplasty devices were to establish safety, efficacy, and equivalency to arthrodesis. Information regarding the level of physical performance attained and restrictions or limitations is lacking, as these were outside the objectives of these trials. Nevertheless, there data are essential for the military surgeon, who is tasked with guiding the postoperative management of patients treated with arthroplasty and returning them to full duty. While there is a single report of clinical results of lumbar arthroplasty in athletes, at this writing, there are no reports of either cervical or lumbar arthroplasty in active duty military personnel

Read more here

The most interesting part is that some of the patients in this study were Marines and Navy Seals.  If a Seal can return to active duty, one could assume a civilian should be able to golf.

Probably Bad

But, single malt scotch seems to be the best pain killer so far.  None of the stomach issues like the NSAID’s and it only takes a little.  Sipping a nice Highland Park lifts my spirits too.  Highly recommended! 🙂


Surgery – Should I Choose it

It will come out of pocket as Alberta Health will not cover the cost. 🙁

If I choose to have an artificial disc implanted, I’m looking at a time frame of July (Pre-baby) or October (Post-baby).  The reasoning being that I should be well enough to help out with the new kid by September.  This doesn’t account for any complications that can arise from such a complex surgery.  Expensive and risky.  Two dates are open in July and any time in October – the ball is in my court.  One happens to be June 29th… My late grandpa’s birthday and a very special day for me.  June 29th.  A sign perhaps?

I’m still plugging away with my physio/chiro and will make a follow up appointment at Caleo this week if I can.  I need to give the triage doc the grills over his assessment of my condition.  8 months of walking and lying on the couch have been pretty boring/painful, and I haven’t seen ANY improvement… :/

I’ve had a couple of acquaintances go for ADR surgery in England over the past few weeks and they seem to have good results so far.  Time will tell.

Hurry up and release your stem cells, Mesoblast!

DEXA scan is scheduled for Friday.




As analyzed in this report, emerging markets such as annulus repair and nucleus repair/replacement could begin to limit the growth of artificial discs towards the end of the forecast period. Annulus repair, which can be used as a simple adjunct to discectomy, will see rapid adoption through 2013, particularly among newer surgeons. The market for nucleus replacement products, which should see some steady growth after 2010, is expected to grow substantially after the introduction of biological repair products, which could occur as early as 2012. By reducing the need for total disc replacement, these technologies will contribute to slower growth in the market for artificial discs after 2013.

You can read more here.

Maybe I should be waiting!  I just don’t know if my facets can take it.

Chiro Update

My range of motion is increasing, but my pain level hasn’t changed much.  We were able to determine that the dull ache I feel most of the time is probably the disc and the sharp pains I feel in flexion/extension/twists are my facets.  The disc pain might subside as the bulge is cannibalized by my body and begins to shrink, but the facet pain will increase as I lose more height and lordosis.   I cannot see my condition improving without some kind of intervention.  At least I have established that.

As for prolonging surgery:  Sure, I may be able to avoid surgery for a while yet… but I think it will bite me in the ass facet-wise years down the road.  I think some thing should be done sooner than later.

Back Update

Back pain is still pretty constant and still spikes with extension, flexion and rotation.  I’m working the core every night and walking close to 5K with hills.

I’m swimming ~once a week and seeing a chiro 2-3 times a week for traction and extension excercises to pump some nutrients into the disc.  My back is usually quite sore after Chrio, but my right toe has been less numb.  Shins & ankles and now calfs ache.

Overall, I’m no better off than I was last October, but I’m still trying.  My active life of a year ago is still a long ways off.


Score Update

For Surgery:

1) Boeree – M6 & Decompression (UK)

2) Clavel – M6 & Decompression (SPAIN)

3) Ritter Lang – M6 & Decompression (GERMANY)

4) Flood – Mulitple Laminectomies and stem cell disc injections (US)

5) Pimenta – Fusion via XLIF or ADR via lateral XL-TDR (BRAZIL)

6) Specialist Referral Centre/Cambie – Microdiscectomy for my leg pain only.  They cannot help with the back pain nor do they offer artificial discs (CANADA)

7) Dr. Zigler at the Texas Back Institute.  Prodisc and decompression (US)

8 ) LA Spine Institute.   They would like to enroll me in the Axiomed Freedom Disc trial (US)

9) Parkway Health.  Dynamic stabilization (Singapore)

Against Surgery:

1) Caleo – Core work.  ADR probably contraindicated by facets and short pedicles but I have an appointment in June 2013 to speak with a Surgeon  (CANADA)

2) Physio – Core work, swimming & thai chi (CANADA)


1) Chiro – Flexion/Extension and traction as allowed.  Offered discogram, steroid injections and thinks I should get some second opinions regarding a microdiscectomy (Canada)

Clinical trials: Mesoblast and DePuy are bust until Phase III.  Nuqu is bunk.

My big question is whether or not the pain will get better after 8 months (where I’m at currently).  So far, no luck.

Mr. Boeree is Great

He phoned me for a quick 20 minute follow-up to go over my facet concerns and a few other things.  He is a very understanding and compassoinate individual.  I can’t even get a surgical referral in Canada!

1) My facets are on the big side of normal and still have 2 visible layers of articular cartilage on them.  My facet size is not uncommon for someone 6 feet tall.

2) My ligamentum flavum is not thickening, rather it is bulging/buckling from the redundancy resulting from the 2mm loss of disc height.  This is contributing to the mild central canal stenosis and left lateral recess stenosis.  Proper disc height will fix this.

3) The ALL is divided and no effort is usually made to fix it, because it will turn into scar tissue with no benefit to the rest of the spine.  This was an issue in older model devices as they were unconstrained, so they had to keep part of the original annulus in place to prevent pop-outs of the prodisc and charite in extension.  The annulus of the M6 makes the ALL redundant and flexion/extension are not an issue.  He did offer to stitch it up for me if I would prefer!

4) He reiterated that my surgery is fairly straighforward and I have a good chance of a good outcome and like every major surgery, there is always a chance of a bad outcome.  That’s the nature of the business.

5) If I run into any issues with follow-up care in Canada, he will gladly review my scans if I pdf or email them over to him.

6) L3/4 and L5/S1 have big facets too – my big problem is the bulge.

The long short is that the M6 should work and make me active again, but there is a small chance it will mess me up further.  Ultimately, it’s a gamble.  Han shot first and made it out alive, right?

I’m really hoping I can get some stem cells or genetically engineered protein in this disc before I have to roll the dice on surgery.  If/When that fails, I’m now comfortable with the device and my surgeon.  I have no reservations about the device or his recommendations and expertise.  I can stop researching now! 🙂  Realistically, this is my best chance at a decent outcome as of today.