Artificial Disc Replacement Removal and Revision to XLIF Fusion + PLIF

mark-Perth · 08-29-2009, 09:19 AM

Hi

I finally had my Maverick ADR removed and fused and thought it best to start a new post to explain how I got it out.

I travelled to Brasil to have surgery with Dr Luiz Pimenta at the Santa Rita hospital in Sao Paulo at the end of July 2009. Dr Pimenta was unlike any other surgeon I dealt with in the way he treated me with his willingness to talk to me on the phone and email me directly. He was the only surgeon to give me any confidence that he could remove the disc for me and also had experience with ADR removals. It really was extremely comforting with all I was going thru.

The surgery consisted of a lateral(XLIF) approach to the disc space which was thru a horizontal cut about 2inches long a few inches above my hip.

A hemi-corpectomy (partial verebra removal) was done to remove a section of Spine vertebra the same shape of the bottom keel of the ADR to expose the keel fully. With my case the top keel was on the angle and the bottom disc was resonably level so the approach was much easier with the bottom keel so the bottom vertebra was cut instead of the top one.

OUCH!

With the bone out the keel can be accessed without having to distract the vertbra again. The Maverick ADR also has 2 small holes on each plate which enabled him to screw a small screw into 1 of the holes to have something to grab onto to pull the endplate out.

With the bottom plate out there is enough room for the top keel to be grabbed onto to remove thru the gap. (If only it was that simple

)

By cuting a decent section of bone out neatly, the bone can also be put back inplace after to fuse as well, keeping the strength in the vertebra. Usually this is held in place with a small screw but mine didnt need one. By removing a decent section it also saves cracking the vertebra which can happen if they dont cut enough away.

I then had an XLIF fusion cage implanted to fuse the anterior section of the spine.

Cause of the Scoliosis I also needed to have a minimally invassive PLIF as well. Sometimes the revisions can be done with a XLIF plate and pedicle screws which go thru the same incision thru the side instead of having to cut the back muscles with a PLIF which would be alot less painful.

The PLIF was done thru a 2inch and 3 inch incision's. He had to cut one side longer due to the scholiosis to straighten it up.

The lateral approach goes straight thru the Psoas muscle which is probably the biggest risk with the lateral operation as there are alot of nerves in there. Just the dilation of the Psoas muscle often causes leg weakness and nerve irritation. During the surgery they were guided by Nuvasive EMG nerve monitoring so I had alot of shaven areas all over my body from the sensors.

I am unsure which nerve was disturbed with mine as the area's affected are very close to each other but I have some parasthesia at the top of the inside of my left leg. Luckily it doesnt effect my leg movement, just feeling. It doesnt cause pain but it also doesnt feel good when touched. It was something I was well aware of and prepared for so dont mind it at all. Its not something that is of concern and I have been told that no nerves were touched so the parasthesia should resolve itself with time.

The resulting fusion has straightened my spine and corrected the scholiosis and also restored the correct lordosis which was great to see. As soon as I was up walking the morning after surgery I felt much taller and straighter and was amazed to see the difference in the mirror. I was even more excited to see the xrays a few days later.

I spent 3 days in hospital after surgery which was shorter than I immagined, especially after what was done and was able to start reducing my opiates within a week of the surgery.

This is definately a much more difficult and dangerous surgery than puting an ADR in and should be thought about prior to ADR surgery. I wish I had gone straight to a fusion instead of thinking I could always have it fused later if the ADR failed. What a mistake that turned out to be. ADRs are designed not to come out easily and I definately found that out the hard way.

I hope some people are helped by this.

Mark

March 26, 2009

July 2009 Revision

**Keano16** · 08-29-2009, 10:58 AM

Good luck in your recovery, good experience for the others too !

**daveinaustin** · 08-29-2009, 11:46 AM

Mark,

I hope many people find your write-up to be informative and helpful.

You've gone through an incredibly difficult challenge with a high level of pain for many years. It is amazing how you've kept your optimism through it all, and it is incredible how much and how quickly you've benefitted from the revision procedure.

You are truly an inspiration on the importance of optimism and research for each of us, as we each travel through our own journies.

-Dave

**Justin** · 08-29-2009, 12:30 PM

Mark,

Thank you for sharing the details of your Maverick Artificial Disc Replacement revision surgery. Dr. Pimenta is hands down one of the best neurosurgeons in the world. I have read extensively about his research and how he is truly a pioneer in spine surgery.

You have been through incredible pain and struggles. However, you have handled it with such optimism (as Dave mentioned above) and with the ability to see the "big picture" with unique clarity. We have become very good friends over the last year and I am honored for your willingness to share your experience with me.

Your personal struggle with artificial disc-induced scoliosis should be a "wake up" call for Spine Patients around the world and reminds us that artificial disc replacement surgery is not necessarily a "fix-all" or a benign surgical procedure -- it is major spine surgery with inherent risks and uncertain outcomes.

I know that by sharing your experience with the Spine Patients that frequent this Forum from all around the world, they will become more informed patients and will view any spine surgery with refined respect.

It is absolutely amazing that your recovery has gone so well. To cut down from >500 mg of morphine a day (not counting the other medications you are on) to < 200 milligrams a day in less than a month, is absolutely mind-blowing and a testament to Dr. Pimenta's skill and ability to correct such a difficult situation.

I am excited to follow your recovery and I know that you will be living your life to the fullest in good time. Hang in there and heal well mate.

**KBear** · 08-29-2009, 01:56 PM

Mark, Thank you for sharing your story. I know many have benefitted from it and many more will. I hope and pray that all spine patients considering surgery will become informed of the seriousness of it and that revision is a major thing!

**treefrog** · 08-29-2009, 06:28 PM

Mark, thanks for sharing your story, and describing everything that went into your surgery. I'm sure that your words will be helpful to all spine patients becoming better educated about all the risks of spine surgery.

Good luck healing. I am so glad to hear that you already see and feel some improvement. You have been through so much. I wish you all the best.

mark-Perth · 08-31-2009, 05:53 AM

Originally Posted by Justin

Mark,

Your personal struggle with artificial disc-induced scoliosis should be a "wake up" call for Spine Patients around the world and reminds us that artificial disc replacement surgery is not necessarily a "fix-all" or a benign surgical procedure -- it is major spine surgery with inherent risks and uncertain outcomes.

Hi Justin

Your quote above is very true. I Think a lumbar ADR removal would have to be one of the hardest and most difficult operations that anyone will encounter but I think it will be happening alot more over the next decade as they get inplanted more and more older ones fail. There arent many surgeons removing them at all, most just want to fuse it inplace as they know the dangers and risks of trying to remove it.

I do think I am one very lucky man for what was done to correct my spine and think my result is probably as good as it gets. If an ADR fails the chance of having a good result are very slim, its not a simple matter to fix. In most papers a successful revision is classed as a >25 % reduction of pain. Considering most people with a failed ADR are in pretty severe pain a 25% reduction of pain may only drop them to a pain score of 6 or 7/10 and thats classed as successful apparently. That still would restrict your life drastically and I really dont think those people would be counting there result as successful. I dont think too many of them would have still be wanting an ADR again.

I know fusions are not perfect either and have there own problems but the correct surgery needs to be based upon whats best for U and not what U want as the surgeon knows what they R capable of and get results with.

I had only one surgeon say to me that he would have both a fusion cage and ADR hardware available and once I was open he would decide what was best based upon my anatomy and what fit in best but would try for an ADR if possible. As I didnt want a fusion this scared me totally and made me choose another surgeon who was certain he could get an ADR in. I should have gone with the first surgeon as it turned. Each case is different and should be looked at seperately, not based upon whats helped others but whats best for U, even if it does mean a fusion.

I honestly dont think ADRs are any more sucessful than fusions anymore. They both seem to fail just as much but unfortunately a failed ADR is much worse than a failed fusion. Only time will show as more people speak up about the troubles they cause and long term reports R published will we be aware of how great they really are or aren't.

Mark

mark-Perth · 08-31-2009, 05:56 AM

Originally Posted by daveinaustin

Mark,

I hope many people find your write-up to be informative and helpful.

You've gone through an incredibly difficult challenge with a high level of pain for many years. It is amazing how you've kept your optimism through it all, and it is incredible how much and how quickly you've benefitted from the revision procedure.

You are truly an inspiration on the importance of optimism and research for each of us, as we each travel through our own journies.

-Dave

Thanks Dave

Hope the SCS is just as sucessful for U

Mark

mark-Perth · 08-31-2009, 05:57 AM

Originally Posted by treefrog

Mark, thanks for sharing your story, and describing everything that went into your surgery. I'm sure that your words will be helpful to all spine patients becoming better educated about all the risks of spine surgery.

Good luck healing. I am so glad to hear that you already see and feel some improvement. You have been through so much. I wish you all the best.

Thanks Cathy

Hope your recovery is coming along good

Mark

mark-Perth · 08-31-2009, 06:00 AM

Originally Posted by KBear

Mark, Thank you for sharing your story. I know many have benefitted from it and many more will. I hope and pray that all spine patients considering surgery will become informed of the seriousness of it and that revision is a major thing!

Thanks Kathy

Hopefully people will start to realise the seriousness of a revision OP as 2 many people think its just a simple case of fusing it and the pain is gone.
IF ONLY