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.

-Brett

A must read for any prospective ADR recipient.

Courtesy of Harrison at the ADR Support Forums:

Link is here.

However:

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.

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 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.

-Brett

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)

Undecided:

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.

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.

Look what I just found…

http://www.clinicaltrial.gov/ct2/show/NCT01124006?term=the+spine+institute&rank=11

I’m burning my scans and will put my name forward ASAP.

I also might try to get into the Mesoblast trial in another location – but that might be a little too sneaky on my part. 🙂

My right toe isn’t going as numb or numb as often as it has before – I think the bulge might be working back into place.  The back and shin pain is still there all the time though.  I’m only 3 treatments in, we will see where I’m at in another week or two.

I’m waiting to hear back from Dr. Pimenta, The Specialist Referral Center (Canada) and I plan on booking another appointment at Caleo to inquire about post surgical care as I get everything in order for a foreign surgery if needed.

I’ll be speaking with Mr. Boeree tomorrow to finalize my concerns regarding:

• Facets – I think mine will be fine
• Severing of the Anterior Longitudinal Ligament – does he attempt to re-attach?
• More information on the longevity/durability of the device – some people are questioning how tough it is
• Strength of the bony ingrowth to prevent subsidence and prolapse when I take up sports again
• Does he use a transperitoneal or retroperitoneal approach (the latter takes longer, but is less risky
• Will I have to take any weird precautions in the future because I have prosthetic disc?  ie. Antibiotics at the dentist, infection risks, xrays, mri’s, scuba diving etc.

I’ve also contacted the VP of Product Development at ISTO Tech and have arranged for a short phone call on Friday to discuss NuQu – if and when they will ever have another trial.

For any of you out there on the cusp of needing ADR… stem cells will be where it is at.  Mesoblast and ISTO Tech will revolutionize back pain treatment if they ever make it to market.  Hold out for as long as you can because fusions and ADR will only be for EXTREME cases.   Hell, 5 years from now, they’ll be just making you a replacement disc from your own cells!

Looking back – I can’t believe I’ve gone 8 months like this.  People are a lot tougher than I thought they were!  Though I can’t really bend or twist anymore, I’m finding a way to make it work.  It’s not very much fun, but I am living ok and still helping out a little around the house.  I could go another 8 for sure if there was a stem cell garuntee – but there isn’t and I’m worried about my facets shouldering the load.

-Brett

Why can’t I be having back issues 5 years from now!

First up – ISTO – they will be competing with Mesoblast.

NuQu, a cell-based therapy derived from ISTO’s platform technology for cartilage regeneration, is intended as an early intervention treatment for patients suffering from low back pain by potentially repairing, regenerating and restoring function to the disc. In preclinical studies, the juvenile chondrocytes used in the NuQu program have shown to have far greater regenerative potential than adult cartilage cells in both in vitro and in vivo environments.

Next up is Cornell Univeristy engineering new invertebral discs.  Dr. Hartl is about 5 years away from a clinical application and this sounds VERY promising.  I’m guessing they will also have to sever the ALL in the installation mind you.  An ounce of prevention…

I’m going to inquire about the NUQU clinical trial.

-Brett