ADR & Endoscopic Methods for DDD

Total disc arthroplasty

(a.k.a. TDR, ADR)

TDR & Endoscopic Methods for Degenerative Disc Disease Candidates

THIS PAGE PRESENTS INFORMATION COLLECTED DURING MY SEARCH FOR A SOLUTION TO ANASTASIA’S BACK PROBLEM. THE PRESENTATION HAS CHANGED CONSIDERABLY, OVER TIME, TO REFLECT OUR NEW UNDERSTANDINGS.

FOR EXAMPLE, THE LAY READER WILL LIKELY BE HEAVILY SWAYED TOWARD TDR, WHEN READING THE VARIOUS LITERATURES ON TDR VS. FUSION. THEY WILL SEE QUITE SOON, THAT TDR HAS BETTER OUTCOMES, SHORTER RECOVERY TIME, AND FEWER COMPLICATIONS. BUT THAT’S JUST THE BEGINNING OF THE STORY …



March 2005, Vienna	JUN 17, 2005 Dr. Anthony Yeung	SEP 20, 2005 Dr. Schubert
JAN-MAY: WORK ON PAIN MEDS	JUN-SEP: BED-RIDDEN, PAIN	SEP-DEC BED-RIDDEN, PAIN
Dr. Yeung, Phoenix, had recommended Dr. Bertagnoli or Dr. Michael Mayer in Munich, to do an eventual ADR.
SCHEDULED: Jan 13, 2006, Charite’ Dr. Zeegers MRT’s show Anastasia’s Facets are fine at this point.	Toft shaves perfectly healthy Patella, with No Chondromalacia, leaving Anastasia crippled for life. Said he would check for a torn meniscus. Toft knew she was in bed 6 months. This procedure was never discussed with us, and is totally inappropriate.	Maverick (May 4,) Cancelled Dr. Ritter-Lang
CANCELLED: AlphaKlinik reports that a Knee operation is URGENT	JAN-JUN BED-RIDDEN, PAIN ADD TO BACK, DESTROYED KNEE	Bad reports on Stenum

Prodisc, Oct 9 2006 Dr. Bertagnoli	10 Months Post-Prodisc. Anastasia lies in bed ALL day, in PAIN (except for 5 minute meals) Pro-Spine Staff does not answer our emails or return our images. Anastasia can not walk far due to the cartilage damage to her knee.	CONTRAINDICATIONS: Facets were arthritic Pre-Op Device is too large: 11mm vs 8mm. Device Lordotic Angle 14.7 vs 3. Disc space 1mm. (5mm min spec) Prolapse had disappeared! The biomechanics of an Oversized device + fused facets creates a condition of hyper-lordosis, which overloads the facets and compresses the nerve root.
http://www.geocities.com/javanoginn/sitebuilder/preview/NastyasFamily.htm

ANTI-FUSION on Spine-Health.com (5 Aug 2007 – THIS IS STILL THERE!)

In a review of 4,454 patients in 78 reports, Bono and Lee found the average fusion rate was 85%, and the average clinical success rate (pain reduction) was 75%. They also found that a successful spinal fusion takes a relatively long time (3-24 months, average 15 months) for healing and recuperation, and causes adverse effects on adjacent levels over time.

http://www.spine-health.com/research/discupdate/artificial/artificial01.html

QUESTIONS TO ANSWER: 80-93% Good Results ? 5%-20% Revision Rate ? 50% Average Pain Reduction ? 10 – 40 years Lifetime ? Adjacent Level Facet Arthrosis ?

PRO-ADR: CLINICAL SUCCESS RATES OF PRODISC 90-98.2%

European literature shows success rates of (See ADR Studies)

94% Smokers, 87% non-smokers: Bertagnoli (Germany) 104pts
93% Bertagnoli mulit-level 2005 (Germany)

94% Bertagnoli, Pts > 60yo, (Germany) 22pts

100% Bertagnoli/Kumar (Germany) 108pts 90.8% excellent, 7.4% good 1.8% fair

Wow. Smokers and people over 60yo have 94% success! Then obviously, a young woman with perfect health, perfect bone structure except 1 level of DDD, should be closer to 99%!

Hey, AND WE LIVE RIGHT NEXT DOOR! IT’S A MIRACLE!

Of course, we also live right next door to Zeegers and Ritter-Lang, so I did my due diligence, to compare the results of the three device types: charité , Maverick, Prodisc:

http://www.geocities.com/javanoginn/sitebuilder/preview/ADR_COMPARISON.htm

(Prodisc clearly wins on all counts except possibly longevity.)

FOUND AFTER THE SURGERY:

At a recent meeting of the American Orthopaedic Association, surgeons were asked what treatment they would prefer for themselves if they had unrelenting low back pain from a single degenerative disc.

Of the 133 surgeons surveyed(1), only 7 percent stated that they would choose disc replacement. So what would the surgeon's choose? About 47 percent said they would choose spinal fusion and close to 47 percent would choose chronic pain management.

http://www.centerforspinecare.com/approach/dynamicstabilization.html

Boden SD, Balderston RA, Heller JG, Edward N. Hanley, Jr., and Zigler JE. An AOA Critical Issue, Disc Replacements: This Time Will We Really Cure Low-Back and Neck Pain? Journal of Bone and Joint Surgery 2004; 86: 411-422.

Modern lumbar spinal fusion surgery utilizing minimally invasive techniques and BMP is very successful and predictable.

http://www.centerforspinecare.com/orthopedicsarticle/myths.html

FINAL CHAPTER: REVISION STRATEGIES

http://www.geocities.com/javanoginn/sitebuilder/preview/ADR_REVISION_STRATEGIES.htm

DOCTORS REFUSE TO TAKE THE DEVICE OUT AND FUSE ANTERIOR

UK Doctor volunteers to salvage! HooRah! Only costs from $50000-$100000.

Because of ProSpine Denials, we cant get a German Surgeon to approve a revision surgery.

Most surgeons ignore us, some state that they do not treat AMERICAN patients., one (the local Freising surgeon) even yelled at Anastasia saying he cant diagnose her without her MRIs (the one’s ProSpine has), and yells at her that its her fault she did all these surgeries.

TKK (German) insurance wont approve the surgery in the U.K. But, they MUST, by treaty and law, so long as a Germany Orthopaedic surgeon indicates it is necessary.

4 AUG 2007

SURGEON IN UK CANCELS!

TABLE OF CONTENTS. 2

CHRONOLOGY: 2

OVERVIEW: 2

ADR CLINICS, HOSPITALS. 3

ADR & ENDOSCOPIC SURGEONS. 3

ADR COMPANIES. 3

ADR DEVICES. 4

MOBILITY AND BIOMECHANICS. 5

MATERIALS & FAILURE. 5

SUPPORT GROUPS. 5

GENERAL ADR INFORMATION.. 6

ADR EVALUATIONS & TRIALS. 6

COMPLICATIONS, MORBIDITY.. 6

X-RAY RISK.. 7

INFECTION: 7

SUBSIDENCE. 7

ORTHOPEDIC GENERAL ORGS. 7

SPINE CONFERENCES. 8

INSURANCE REVIEWS. 9

CONSERVATIVE PT. 9

NATUROPATH TREATMENTS. 9

LITERATURE. 9

REFERENCES. 14

FUNNIES COMMENTS: 78

ARTHRODESIS RESEARCH (FUSION) 88

Note, information in this page here for our personal organizational and research needs. It is posted as a communications means from us to various doctors … generally to assist them in understanding our situation. Feel free to use it for a reference to resources. Any opinions stated in here are ours only, and are not to be construed as advice or medical fact … etc.

CHRONOLOGY:

A detailed timeline of the events, treatments leading to Anastasia’s ADR may be found here.

2004 Nov 25: Minor prolapse. Discomfort does not go away, but we have signed contracts to transfer to Germany

2005 Jan-Mar: Anastasia can not see a doctor, and must continue working, on pain meds, due to transfer contract

2005 Mar: Finally, an MRI. Anastasia has DDD at L4/5.

2005 May: Epidural shot hits nerve root (Dr. Jesses has 20 people sitting in the waiting room). Anastasia goes on medical leave.

2005 Jun: Although painful, Anastasia must fly back to the USA for a Visa fix. Luckily we find 3 open seats for her to lie on.

2005 Jun: We try the VaxD technique in Tucson. The machine yanks her apart. Apparently it was broken. Anastasia has a prolapse.

2005 Jun: We go to Phoenix (the drive is hell) to meet Dr. Anthony Yeung. He proscribes and does an Endoscopic Discectomy (SED).

2005 Jun: The SED puts a bigger 7mm hole in the disc, but does not remove the prolapse. Anastasia spends the next 4 weeks in a hotel.

2005 Jun: Return flight to Germany is hell. Anastasia is not able to walk 300m until September. She is trapped in our apartment.

2005 Sep: Finally, able to walk (painfully) across the street at least to the café, on 22 September Anastasia has a severe prolapse.

2005 Sep 23: Our doctor (Kroiss) is on vacation, so we go by ambulance to the AlphaKlinik in Munich. Dr. Schubert does a discectomy + abrasion.

2005 Sep:

OVERVIEW:

Anyone considering this MUST go through the testimonials and clinical trial reports. The overall 'very good' outcomes seem to be in the 85-90% range. Not the kind of statistical knife I want to put my wife under. But ...we really have little choice now.
Which is the only time I would consider ADR.

Take the Pain Test: http://www.chirogeek.com/001_Oswestry_20.htm

Dr. Stephen Hochschuler: www.texasback.com <http://www.texasback.com> (interview)
Dr. Zigler. http://www.touchbriefings.com/pdf/1680/zigler.pdf

Dr. Willem Zeegers: (www.alphaklinik.com)

AlphaKlinik, Effnerstr. 38, Munich Germany

Has done over 1200 Charite' ADRs,
Dr Zechel and Dr Ritter-Lang :

Stenum Hospital, Heilstaettenweg 1, 27777 Ganderkesee

http://www.stenum-adr.com/ http://www.getadr.com/ http://spinaloptions.com/

Has done 800 Charite's, and now 400 Mavericks (Bremen)

(Testimonial: http://communitytalk.rd.com/WebX?14@726.h3udaoitDto.2@.eff124d/19 )

Dr. Bertagnoli: http://www.pro-spine.com

Contact: Dr. Andrea Fenk-Mayer: fenk-mayer@pro-spine.com

Klinikum St. Elizabeth, Straubing Germany

MussinanStraBe 6, 94327 Bogen, 09422 8089-0

Two year study, Prodisk (link). Pay attention to the VAS & ODI charts.

ADR CLINICS, HOSPITALS

http://www.texasback.com/ Plano, TX, Stephen Hochschuller, MD

http://www.bitanmd.com/

http://www.pro-spine.com/ Bogen, Germany, Dr. Bertagnoli

www.alphaklinik.com Munich, Germany, Dr. Zeegers, 1200+ Charite’s since 1989

www.spineinstituteny.com

http://www.getadr.com/index.htm Stenum Hospital (http://spinaloptions.com/ )

Dr. Ritter-Lang, 1200 ADRs

Maverick disc procedure done in June 2004 in Austin, Texas

Flexicore in Sacramento (too big, bad reviews)

Flexicore: Dr. Zucherman of St. Mary’s Spine Center in San Francisco ++

http://www.nch-muenchen.de/kontakt.html Ingolstädter Str. 166, 80939 München,

Dr. Med. Johann Obermüller, Munich

Leon (North of Spain ) Clinic Nuestra Señora de la Regla"

Dr Antonio Mostaza.

Center For Spine Care, Dallas, Frisco, Peloza, He is also a Spine Scientific Advisory Board Member for Oratec Interventions, Inc. and Sulzer Spine Tech, Inc., and a consultant with Medtronic Sofamor Danek.

http://www.spine-surgery.com/ Indiana, Kentucky ( Unknown status )

Provides very good info on the Charite’.

ADR & ENDOSCOPIC SURGEONS

Dr. med. Univ. Rudolph Bertagnoli (PDN) ADR Overview

Dr. Rudolf Bertagnoli: www.pro-spine.com Prodisc® specialist (President of

James Yue, MD. http://info.med.yale.edu/ortho/clinical/yue.html Prodisc® Specialist

Dr. Willem Zeegers: www.alphaklinik.com (here)

Dr. Fabien Bitan: www.discreplacement.com

Dr. Karin Buettner-Janz: www.vivantes.de Inventor, Charite’

Dr. Stephen Hochschuler: www.texasback.com

Dr. John Regan: www.spinesource.com

Dr. Anthony Yeung: www.sciatica.com ( Selective Endoscopic Discectomy )

Prodisc Trial Doctors http://www.spineuniverse.com/displayarticle.php/article1707.html
Dr Zechel and Dr Ritter-Lang : (http://spinaloptions.com/ ) 800 disc replacements using the SB Charité III disc replacement.

U.S. ADR Doctors http://brain.hastypastry.net/forums/showthread.php?t=50125

ADR COMPANIES

SUMMARY OF ADR BUSINESS

http://www.medtronic.com, www.back.com : Maverick

http://www.charitedisc.com/charitedev/domestic/default.asp

http://www.charitedisc.com/charitedev/international/products.asp

Link (Charite'): www.linkspine.com http://www.charitedisc.com/

Charite’ : http://www.depuyaccromed.com/
Prodisc: Spine Solutions: www.spinesolutionsinc.com

http://www.synthes.com/html/ Synthes-Stratec acquisition of Spine-Solutions: http://www.vbllc.com/pr004.html
Flexicore Disc: www.spinecore.com

SaluDisc: http://www.spinemedica.com/

http://www.spinemedica.com/pdf/release.02.pdf
http://www.surgicaldynamics.com

http://www.synthes-stratec.com

http://www.codon.de

TDR Market Analysis: http://www.devicelink.com/mx/archive/05/01/viscogliosi.html

Musculoskeletal issues represents a market of 350 Billion annually

ADR DEVICES

CHARITE’ (Charity, French)

http://www.getadr.com/link.htm

http://www.spine-health.com/research/discupdate/artificial/artificial05.html 63%, 79%, 70%

http://www.charitedisc.com/charitedev/domestic/patients/about_whatisCHARITE.asp

www.depuyspine.com/about/about.press.060204.asp FDA Approval

http://www.spine-health.com/research/discupdate/artificial/artificial03.html PDN Disc Nucleus

Prospective study evaluating total disc replacement: preliminary results. (pubmed)

The mean VAS score improved 50.8% by the 6-week follow-up, … Oswestry score improved 38.7% at the 6-week follow-up

http://www.spine-surgery.com/386.htm All about Charite’

http://www.charitedisc.com/ (arguments to insurance companies)

Clinical outcomes are good or excellent in 90% of patients at 10-year follow-up

Over 90% of patients have returned to work

There have been no subluxation or core expulsions

The re-operation rate is only 5%, with a 2% rate of adjacent segment disc disease

http://www.healthpointcapital.com/research/2004/06/14/only_one_clinical_trial_counts_with_the_charite/index.php

two surgeons (with financial ties to Medtronic) gave public testimony at the Charité FDA Panel meeting that the Charité's revision surgeries were life threatening. The panel's own data showed that wear debris from the Charité's polymer insert was inflammatory. (Raising the risk of revisions?)

Back to the Evidence: Many mp3 of speeches.

http://www.spine.org/springbreak06_presentations.cfm

Preclinical Testing of Artificial Discs – Paul A. Anderson, MD      MP3 File
Clinical Outcomes of Lumbar Artificial Disc Replacement – Richard D. Guyer, MD      MP3 File
Surgery for Chronic Back Pain – Artificial Disc Replacement: Methodological Concerns – Sohail Mirza, MD      MP3 File
Summary & Discussion – All Faculty      MP3 File

MAVERICK

http://www.getadr.com/maverick.htm General overview of device, results

Clinical Results of Maverick Lumbar Total Disc Replacement: Two-Year Prospective Follow-up

http://www.getadr.com/ADR%20Study.htm

http://www.spine-health.com/research/discupdate/artificial/artificial051.html

http://www.centerforspinecare.com/maverick/index.html

http://www.centerforspinecare.com/maverick/maverickanimation.html

There are eighteen sizes of the superior component and six of the inferior.

http://www.centerforspinecare.com/orthopedicsarticle/myths.html (Comparison of ADR devices)

“studies report greater than 82% good/excellent results at two-year”

“Of all the disc replacements at this time, the Maverick will most likely have the best results and longevity.”

http://www.rmsas.com/3_maverick.html

Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. (pubmed)

The Oswestry score improved for 75% of patients. (What!? Improved 1% or 100%?)

http://www.neurochirurgie-zwolle.nl/ART_artificialdisc.html

Nice 15s mpg video of implanted Maverick

PRODISK

http://www.spine-health.com/research/discupdate/artificial/artificial04.html 92.7% ???

Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up. Pubmed Patient satisfaction rates were 86% at 24 months

http://www.healthpointcapital.com/research/2006/01/09/prodisc_moves_one_step_closer_to_us_launch/#comments

Patient satisfaction runs over 90% for ProDisc recipients, in contrast to 70% satisfaction among Charite recipients.

http://www.worldspine.org/wsIII/ws3_117.pdf

Lumbar Disc Replacement with Prodisc - 24 Monthds Results of a Prospective Randomized Comparision to Fusion

KINEFLEX

MOBILITY AND BIOMECHANICS

http://www.geocities.com/javanoginn/sitebuilder/preview/MOBILITY_AND_BIOMECHANICS.htm

MATERIALS & FAILURE

UHMWPE ( Plastic core of Charite, Prodisc)

http://www.uhmwpe.org/publications/index.php

Analysis of a Retrieved Total Disc Replacement Component

http://www.uhmwpe.org/publications/pub_each.php?pubID=93

http://www.exponent.com/leaders/bios/pdf/kurtz.pdf

Examining Failure Causation in Retrieved Implant Devices

http://www.devicelink.com/mddi/archive/06/01/005.html

SUPPORT GROUPS

http://brain.hastypastry.net/forums/showthread.php?t=1018 Huge list of links.

http://www.burtonreport.com/InfSpine/TheFailedBackSurgerySyndrome.htm

https://www.globalpatientnetwork.com/index.shtml Mark Mintzer has a great success story, and has excelled in assisting others understand ADR, the doctors involved, and the various device’s available. So, now we know Dr. Yeung, Dr. Schubert, Dr. Hochschuler, Dr. Zeegers through direct contacts.

http://www.centerforspinecare.com/testimonials/

http://www.backpainsupportgroup.com

http://www.spine-dr.com

http://www.healthboards.com/boards/forumdisplay.php?f=18

D.LYNN’s Excellent review of the technology: March 2006

http://www.healthboards.com/boards/showthread.php?t=365625&highlight=ADR+Stenum

http://www.back1.com/forum/messageview.cfm Testimonial from MrBee, ADR recipient, Stenum Hospital.

ADR Support forum: www.adrsupport.org (find the discussion forums.)

Braintalk Spinal Disorders Forum

www.spine-health.com: Artificial discs and disc replacement - patients' advice

http://www.spine-health.com/backtalk/res/btb_res_chronic.html MANY ADR Testimonials.

Select Comments/Testimonials

“It has since come to my attention that some patients have had to have their artificial discs extracted years afterwards when the Plastic Spacer has disintegrated.” – Chris, Plano TX

I participated in the final phase of the Charité artificial disc….after 6 months … begin playing tennis …

Maverick: http://www.healthboards.com/boards/showthread.php?t=218248

Charite’: The sciatic nerve will be stretched and pulled during surgery so it is logical that the inflammation will take time to settle. http://www.healthboards.com/boards/archive/index.php/t-17803.html

http://www.centerforspinecare.com/testimonials/read.php?id=MTExNzkwMDA1OA8

Dr. Peloza, Today, Karen says she feels great. She went home less than 24-hours after her surgery and was already walking. She now walks four miles a day and is back to doing yard work again. (Maverick)

http://www.centerforspinecare.com/testimonials/read.php?id=MTExNzkwMjU1Ng6

In March 2004, Dr. Peloza performed surgery and Pamela received her new Maverick artificial disc. She says she awoke from anesthesia "pain-free." The next day, she was sweeping her back porch and skimming her swimming pool. "I'm so happy! I feel great!" she says.

A post by a guy doing research on a competing disc – politics here:

“He has a pretty strong opinion: It does not make sense at all and he would never use them. You gain 3º which compared to a fusion is very short of nothing and simply for this reason it does not make sense to use them.
To achieve this you may face considerable difficulties (migration and potential damage to the vertebraes among the most important) which could create real problems later on. He is of the oppinion that the hype these artificial discs create are pure marketing gimmicks.” http://www.healthboards.com/boards/archive/index.php/t-17803.html lakezurich

I had a Pro Disc implanted between L4/5 in Jan 2003. After 4 days I felt a new pain in my lower back and a new x-ray showed that the top plate had dislodged. I went back into surgery, and woke up to be told that the whole prosthesis was faulty!! Judy Lou

( Probably the docs are blaming the disc, and not admitting insertion error )

Very informative article: Comparisons of ProDisc, Charite’

http://www.healthboards.com/ubb/Forum14/HTML/003602.html

Stenum Hospital Testimonials

http://www.geocities.com/jimjen7/JennysADR.html

http://www.neurosurgery.org/focus/aug02/13-2-10.pdf

http://www.artificialdisc.com

GENERAL ADR INFORMATION

http://www.spine-health.com

http://www.spine-health.com/research/discupdate/discupdate01.html

http://www.spineuniverse.com

Excellent overview on ADR: http://www.spineuniverse.com/displayarticle.php/article1245.html

Artificial Discs: Spine Experts Speak Out: http://www.spineuniverse.com/displayarticle.php/article2949.html

ADR Home Study Program: http://www.aorn.org/Journal/homestudy/aug05a.pdf

15 Pages – superb overview for the lay-person by an RN.

http://www.spinearthroplasty.org/ Hosts an annual SAS Summit.

www.artificialdisc.com

Spine Doctor
Facet Technologies

Arthroplasty in the Treatment of Chronic Low Back Pain.

http://www.spine.org/springbreak06/presentations/chronic_low_back_pain_operative_4.pdf

http://www.trans1inc.com/pdfs/newsroom/print/news_print_Medtech_insight.pdf

ADR EVALUATIONS & TRIALS

http://www.getadr.com/ADR%20Study.htm

http://www.spine-health.com/research/res01.html

http://www.regence.com/trgmedpol/surgery/sur127.html 63% Charite’

“There were four (from 272) cases of polyethylene core failure with two revisions and re-implantation of a new Charité artificial disc at 10 and 12 years respectively.”

Dr Zeegers … reckons that his success rate is approx 85% http://www.healthboards.com/boards/archive/index.php/t-17803.html

http://clinicaltrials.gov/ Search=

Arthroplasty OR Maverick OR Prodisc OR Charite OR Flexicore

http://www.centerwatch.com/

http://www.vbllc.com/pr004.html

The ProDisc®, which has been evaluated in a retrospective clinical study of 64 patients dating back more than 10 years with excellent follow-up results, has now been implanted in more than 2,300 patients worldwide.

ADR STUDIES : http://www.geocities.com/javanoginn/sitebuilder/preview/ADR_STUDIES.htm

COMPLICATIONS, MORBIDITY

FACET DEGENERATION:

Contraindication http://www.geocities.com/javanoginn/sitebuilder/preview/Contraindications_TDR.htm

Mechanics: http://www.geocities.com/javanoginn/sitebuilder/preview/Facet_Pathologies.htm

Allergic Reaction to Implant Hardware

http://www.emedicine.com/orthoped/topic615.htm

Immune Response to Implants: “up to 13% of people are sensitive to nickel, cobalt, or chromium”

“The development of metal sensitivity after implantation of orthopedic hardware is common”

“Metal sensitivity is also correlated with osteolysis and aseptic loosening of implanted metal hardware”

“metal sensitivity can be proven causative in less than 0.1% of cases in which sensitivity reactions exist”

“patients with metal hypersensitivity prior to implantation actually become desensitized and anergic after implantation”

“metal hypersensitivity may be associated with bone loss and aseptic loosening of implanted device”

“Traditionally, skin patch testing has been the standard screening test for metal hypersensitivity.”

A routine skin test reveals a prevalence of metal sensitivity of 0.2% for chromium, 1.3% for nickel, and 1.8% for cobalt. After placement of metal implants, sensitization (change from negative to positive) occurs in 2.7% for chromium, 3.8% for nickel, and 3.8% for cobalt. Desensitization (change from positive to negative) occurs in 0% for chromium, 2.1% for nickel, and 3.8% for cobalt

http://www.totaljoints.info/metal_allergy_details.htm#4_

Discussion:

http://adrsupport.org/eve/forums/a/tpc/f/7501036081/m/7321028402

http://adrsupport.org/eve/forums/a/tpc/f/7501036081/m/8961041281?r=9081009281#9081009281

X-RAY RISK

Radiation expert warns of danger from overuse of medical X-rays, claiming they're responsible for many cancer and heart disease deaths

http://www.berkeley.edu/news/media/releases/99legacy/11-16-1999b.html

“Gofman argues that the correlation implies that death rates for cancer and heart disease have gone up as the number of medical procedures requiring radiation has gone up. Specifically, the study concludes that over 50 percent of the death rate from cancer today, and over 60 percent of today's death rate from ischemic heart disease, are induced by X-rays in combination with other factors.”

http://www.phyast.pitt.edu/~blc/book/chapter5.html

“every person in the world is struck by about 15,000 of these particles of radiation every second of his or her life,² and this is true for every person who has ever lived and for every person who ever will live. These particles, totaling 500 billion per year, or 40 trillion in a lifetime, are from natural sources. In addition, our technology has introduced new sources of radiation like medical X-rays — a typical X-ray bombards us with over a trillion particles of radiation.” .. What saves us, rather, is that the probability for one of these particles to cause cancer is very low, about 1 chance in 30 quadrillion. … Only about 1% of fatal human cancers are caused by the 30 trillion particles of radiation that hit us over a lifetime”

Thus, 30x10¹⁴ = 1% risk. One X-Ray = 1x10¹⁴, or 1/30 * 1% added risk. Thus 30 X-Rays add 1% risk.

Hot topic - X-rays and cancer risk from radiation

http://www.bupa.co.uk/health_information/html/health_news/300104xray.html

“Fluoroscopy involves passing X-rays through an area of the body over a period of time to allow the flow of a dye to be followed. Because of this the radiation dose is larger and depends on the length of time the dye is followed for.”

Spine X-ray: Equivalent to a ‘few months to a year’ of Natural Background Radiation. Additional risk of cancer: 1/100000 to 1/10000.

INFECTION:

Diskitis is infection of the disk space that can occur postoperatively. Patients typically get better after disk surgery for 2-3 weeks, then become progressively worse as the infection expands. Generally, patients have back pain out of proportion to their physical examination findings. Fevers, chills, and night sweats may be present. Magnetic resonance imaging (MRI) will show increased signal change of the disks and adjacent vertebral bodies on T2-weighted images. Gadolinium is a useful adjunct to MRI to elucidate the diagnosis. The presence of epidural abscess must be ruled out.

http://adrsupport.org/eve/forums/a/tpc/f/7901036081/m/1841092391?r=1841092391#1841092391

SUBSIDENCE

Bone Density Scan ( to consider subsidence )

http://www.healthatoz.com/healthatoz/Atoz/ency/bone_density_test.jsp

ORTHOPEDIC GENERAL ORGS

http://www.orthoinfo.aaos.org/

http://www.eurospine.org/

http://www.spine.org/

http://www.spinejournal.com/

http://www.spinemedica.com/

http://www.swiss-spine.ch/

http://www.aaos.org/ American Academy of Orthopaedic Surgeons

http://www.worldspine.org/

http://www.ryortho.com/

http://www.theassr.org/ : American Society of Spine Radiology

http://www.ors.org/web/index.asp Orthopaedic Research Society

SPINE CONFERENCES

EuroSpine: http://www.eurospine2006.com/

FIRST RESULTS OF SPINE TANGO DATA M Melloh, Bern, Switzerland

North American Spine Society

Complete list of conferences: http://www.spine.org/calendar/nass_future_events.cfm

http://www.spine.org/06SprgBrk.cfm NASS 2006, Mar 8-11, San Diego

World Spine: http://www.worldspine.org

World Spine III, Rio, July 2005 http://www.worldspine.org/ws3_presentations_final.cfm (215 Presentations, pdf)

Effect of Artificial Disc Placement on Facet Loading: Mobile Core vs Fixed Core

Does the Lumbar Disc Prosthesis with a Fixed Axis of Rotation Affect the Instant Axis of Rotation (IAR) of the Lumbar Spine? – A Biomechanical Study in Cadaver Spine

Charité Artificial Disc: Three Year Follow-Up-Clinical and Surgical Experience in 215 Cases

Incidence of Contraindications to Total Disc Arthroplasty

Total Disc Replacement Using Prodisc: 24-Month Follow-Up Results of a Prospective, Randomized Comparison to Fusion

Two-Level Total Disc Replacement with Prodisc: Results and Comparison to One-Level Cases

Lumbar Total Disc Replacement: A 2 To 3 Year Report from the US Clinical Trial for the ProDisc-II Prosthesis

Artificial Disc Replacement as a Salvage Treatment for Failed Back Syndrome

Charité Lumbar Artificial Disc: Multiple Replacement Levels, Radiological Sagittal and Coronal Alignment and Complications. 3 Years Follow-Up

Wear Characterization of the Charité™ Artificial Disc Using ASTM Guidelines

Disc Height Restoration and its Effect on Range of Motion and Clinical Outcome after Semi-Constrained Lumbar Total Disc Replacement (ProDisc-II)

Biomechanical Evaluation of Kinematics of the Cadaver Lumbar Spine Following Disc Replacement with the Prodisc® Prosthesis

Biomechanics and Finite Element Analysis of Dynamic Lumbar Instrumentation

The Art of Lumbar Fusion and the Role of Arthroplasty

One To Two Years Results with the Kineflex (Centurion) Lumbar Disc Prosthesis

Treatment of Chronic Low Back Pain with Lumbar Prosthesis

Effect of Fusion vs Total Disc Replacement on the Facet Loading of Adjacent Segment: A Finite Element Analysis

Subsidence of Intervertebral Spacer Devices Due to Cyclic Loading

Spine Arthroplasty Society:

SAS5

https://www.blueskyz.com/SAS2005/program.asp Global Symposium on Motion Preservation Technology, May 4-7 2005, N.Y.

http://www.ryortho.com/newsletters/05_09_05_Volume1_Issue11.pdf Superb review of the conference. Tabulated results.

12th International Meeting on Advanced Spine Techniques

http://www.istreamplanet.com/srs/default.asp?np=media&conf=2&edi=6 ( play ppt presentations with sound )

Polyethylene Wear Analysis of Retrieved Total Disc Arthroplasty play4

Revisability of the Charité Artificial Disc Replacement - Analysis of 347 Patients Enrolled in the US IDE Study of the CHARITÉ Artificial Disc & Complications of Lumbar Artificial Disc Replacement vs. Fusion: Results from the Randomized, Multicenter play4

ProDisc Total Disc Replacement: Clinical results for a variety of indications in the lumbar and cervical spine play4

Spine Technology Summit, May 9 2006, Montreal Canana

http://www.ryortho.com/spine_conference/updates.html

CHARITE Richard Guyer, M.D, DEPUY SPINE

PRODISC-L Rudi Bertagnoli, M.D.SYNTHES SPINE

FLEXICORE J.P. Errico STRYKER SPINE

http://www.spine.org/springbreak06

http://www.spine.org/21AnnMtg.cfm

http://www.sas7berlin.com/ May 1-4, Berlin

INSURANCE REVIEWS

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0104_coveragepositioncriteria_intervebral_disc_prosthesis.pdf

http://www.bcbs.com/tec/Vol20/20_01.pdf Blue Cross Blue Shield, 2005

http://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=170

More here http://www.geocities.com/javanoginn/sitebuilder/preview/ADR_Business.htm#_Toc172940468

CONSERVATIVE PT

TENS:

An electro-stimulation of the areas between two sets of pads – typically placed about 3cm apart. This has a noticeably positive effect on cramped muscles and joints. Many people report significant pain reduction during its use.

Epidural steroid injections:

Experience – An injection was given by Dr. Jessel, Munich Airport Klinik. Such apparently relieves the pain for weeks for some, but in others it only exacerbates the condition. In our case, it induced excruciating pain, as if he had hit the nerve, and from then on, things got worse.

Electro-Magnetic:

G-ogo device: http://www.dr-goettfert-systems.de/

http://www.dr-goettfert-systems.de/www/gogosport.html This cost us 481 Euro for 2 months rent. To buy: 3000Euro.

Vax-D:

Basically a torture rack. You lie on a table, feet anchored and hands holding a pulley. They ‘gently’ pull your arms. This probably works well for people who weigh more than 120 lbs (50kg), otherwise, it can really screw you up.

http://www.vaxd.net/

http://www.vax-dmedicalgroup.com/ Anastasia received her torture here … which lead to the emergency surgery in Phoenix.

NATUROPATH TREATMENTS

Acupuncture

http://www.needleme.com/

LLLT: Low Level Laser Therapy:

Dr. Lutz Wilden http://www.dr-wilden.de/en/index.html

Conceptually (As I understand it), the laser operates at a frequency and intensity which allows maximal penetration into the body. The frequency is also chosen to stimulate certain structures in the cell, thus increasing production of ADP (the cell’s energy medium). Increased ADP stimulates increased cell activity.

We took 11 trips (from Freising to Bad Füssing) for treatment of LLLT to Anastasia’s inner ear (Menier’s).

The pre and post treatment audiograms showed significant improvement in the hearing quality.

The ‘therapy’ was also applied to her L4/5 disc area, in hopes that it would stimulate healing. No significant change noted.

Herbal/Natural Medicines:

Chaga:

Baikal Skullcap: Natural Anti-inflammatory http://www.nutricraze.com/Baikal-Skullcap-p-NJ-005.html

Glucosamine/Chondroitin http://adrsupport.org/eve/forums/a/tpc/f/7901036081/m/2181000181

LITERATURE

Back in Shape: A Back Owner's Manual

Treat Your Own Back

http://www.spine.org/Forms/techrecs_lda.pdf

Nonfusion Techniques for the Spine: Motion Preservation and Balance - James H. Maxwell, MD, FACS, Steven L. Griffith, PhD, and William C. Welch, MD, FACS, FICS - spine surgery books - medical books
Nonfusion Techniques for the Spine: Motion Preservation and Balance

Edited by James H. Maxwell, MD, FACS, Steven L. Griffith, PhD, and William C. Welch, MD, FACS, FICS

http://www.qmp.com/nonfusion_techniques_for_spine.html

$195

Spinal Arthroplasty: A New Era in Spine Care

Edited by Richard D. Guyer, M.D., Jack E. Zigler, M.D.

buy $150

http://www.us.elsevierhealth.com/product.jsp?isbn=9781416031253

Spinal Arthroplasty with DVD - The Preservation of Motion
By Alexander R. Vaccaro, MD, Stephen Papadopoulos, MD, Vincent Traynelis, MD, Regis Haid, Jr., MD and Rick Sasso, MD

448 pages 575 ills
Copyright 2007
$199.00, Hardcover, Reference

REFERENCES

See References List

Selected Articles, Titles & Excerpts

http://www.healthboards.com/ubb/Forum14/HTML/003602.html

Normal spine ranges of motion are:

Flexion - 10º
Extension - 5º
Lateral bending - +-5º

ProDisc ranges of motion are:

Flexion - 13º
Extension - 7º
Lateral bending - +- 10º

Extremely useful ... but high-level. I am looking for metabolic factors coincident between menieres, DDD and

http://www.emedicine.com/pmr/topic67.htm

... The nucleus pulposus may lose its normal water-imbibing abilities as a result of biochemical changes in aggregating proteoglycans.

Studies suggest proteoglycan destruction may result from an imbalance between the matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). This imbalance results in diminished capacity for imbibing water, causing loss of nuclear hydrostatic pressure and leading to buckling of the annular lamellae. This phenomenon leads to increased focal segmental mobility and shear stress to the annular wall. Delamination and fissuring within the annulus can result. Annular delamination has been shown to occur as a separate and distinct event from annular fissures.

http://www.menieresinfo.com/

http://www.healthy.net/scr/Article.asp?Id=1675

Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease in which cytokine production is increased. A recent study has reported that RMR is 12 percent higher in this disease than would be predicted. This is probably modulated by increased levels of IL-I beta and TNF-alpha. In contrast, TEA is much lower because general activity and certainly exercise is greatly decreased in patients with the disease.

http://www.hhi-kc.com/indications.htm

Auto Immune Related Disorders:

Lupus Rheumatoid Arthritis
Fibromyalgia Scelodrema
Chronic Fatigue Syndrome Guillain-Barre syndrome
Silicone induced disorders
- Speaks of Menier's and Lyme ... as treated by HBO

SELECT COMMUNICATIONS:

From: Dr. Kroiss,

*Städt. Krankenhaus München-Bogenhausen
Abt. für Physikalische Medizin und Medizinische Rehabilitation
Englschalkinger Str.77,81925 München*

*Sekretariat: Frau Bräu
Tel.: 089/9270-2401
Fax: 089/9270-2115
E-Mail: physmed@kh-bogenhausen.de <mailto:physmed@kh-bogenhausen.de>*

*ltd. OA Dr. med. **Anselm Reiners**
OA Dr. med. Fischbacher
OA Dr. med. Schröter OÄ Dr. med. Schröter-Morasch***

The Physiotherapy of the Klinik Bogenhausen is considered the best in Munich, and along with it they offer psychologic training against chronic pain within the concept of multimodal pain therapy.

Prosthetic Disc Nucleus

Dear Mr. and Mrs. Scott,

As to my knowledge, presently there is nobody in Germany who performs PDN - implantations. Since there have been some adverse events with the current product, a completely redesigned nucleus prosthesis is expected to be released very soon. Meanwhile we usually recommend total disc prostheses which provide excellent results - if the indication is correctly made. All I can offer you is to send me the images and reports of your wife for evaluation, which type of therapy will be the most promising one for her.

Depending on the result, I probably will be able to recommend a surgeon or center located close to you.

With best regards,

R. Schönmayr

Robert Schönmayr MD, PhD
Direktor der Klinik für Neurochirurgie
HSK - Wiesbaden
Telephone +49 611 43-3070
Fax +49 611 43-2739
e-Mail: r.schoenmayr@hsk-wiesbaden.de
Internet: www.neurochirurg.de

TRAVEL IN GERMANY:

http://www.bahn.de/

HOTELS IN GERMANY:

BREMEN

Best Western Hotel Schaper-Siedenburg 28195 Bremen, Bahnhofstr 8 (link)

STRAUBING:

HOSPITAL SEARCH IN GERMANY

http://www.surgicalexperts.de/ ( expensive !)

http://www.english.german-hospital-service.com/html/german_hospitals.html Also expensive

Disclaimer: This page is considered transitory and fluid. It is a sampling of the state of the science at the time of composition. It is provided for education and reference purposes only and is not intended to represent all of the information available on this topic or to imply endorsement of views therein expressed. Moreover, any or all of the conclusions reached by any or all of the authors and sites may be rendered obsolete or may need to be modified in light of discoveries or other developments arising after the date of writing.