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Cervical disc replacement after previous fusion?

From: TLB - on 07/04/2010 9:05pm

I had C5/C6 fused seven years ago and am very close to needing a second surgery for the adjacent level. C6/C7 started to be symptomatic about 5 years after the first surgery; I've had four epidurals, physical therapy and massage, but the disc is now winning . My surgeon says my only surgical option is another fusion, but I am afraid of loss of range of motion and additional stress on the adjacent discs (c4/c5 is also bulging and causing some symptoms, but has been stable for two years).

Is disc replacement really not an option for me? If not, do you know the reason? I I am 41 and in otherwise good shape.

Thanks in advance.

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on 07/18/2010 3:23pm

I had a successful C5/C6 fusion in 2007 for severe arthritis and abnormal neck curvature due to excessive bone growth. I too, was asymptomatic after surgery and had no problems with recovery or fusion (I was 39 at the time). In September of 2009, I began to have arm and neck pain.
An MRI showed a severe C6/C7 herniation. Physical therapy and other treatments were ineffective. My doctor and I discussed the possiblility of using an artificial disc instead of a fusion to replace the disc "off label", because at this time the FDA has not approved artificial cervical disc replacement after prior neck surgeries. The FDA is currently in the process of reviewing and may possibly approve the use of certain artificial discs after prior neck surgery. The doctor said that I was a good candidate for the artificial disc because my C6/C7 vertebrae and disc space is large and well above my shoulders and because I do not have significant cervical arthritis. So, if all other conditions are right, you could probably get the artificial disc with a surgeon who is willing to do it "off label" or wait for the FDA to approve it (I"m not sure where they are with that at this point--European surgeons have been doing artificial disc replacements after fusions for a few years). The artificial disc surgery had a slightly shorter recovery time overall than the fusion, and fewer restrictions on activities. I was back to work in two weeks and did not have to wear the collar at all. It has been about 3 months since the surgery and I am totally pain free!

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on 07/19/2010 8:13pm

Thank you for the report on your successful procedure. Your outcome is exactly what I'm hoping for. I will discuss this with my surgeon and seek out others who might be willing to go off-label if the FDA doesn't approve this soon enough. Did your insurance give you any trouble with a non-FDA procedure?

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on 07/19/2010 8:33pm

TLB,

there in lies the problem...Insurance companies are not reimbursing a whole lot of Artificial Discs to begin with and one that is off label is sure to be a no go and you could be slapped with that bill. The implant alone is not cheap so do some research. ACDF's are the standard practice for this though and everyone has to worry about adjacent levels over time. The Good news is you got some time out of the first surgery and hopefully will get more with whatever you decide to do. Best of Luck.

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