| Author
|
Topic:
Charite core popping out???? |
ADRJen
Bronze Member
Member # 477
|
 posted September 22, 2004 04:54 PM
    
I had a
former Stenum patient email me today with some questions. He
had the surgery in August with a group of 10 patients. He made
the following statement...
"One other fellow in our
group has had his core pop out. He has been in great pain. He
goes back next week for the revision surgery."
Has
anyone ever heard of this happening? I invited him to join the
group here. Hopefully he will and update us on
this.
Jenny
--------------------
ADR surgery
August, 2003 at Stenum Hospital, Germany
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Stormy
Gold Member
Member # 2298
|
posted September 22, 2004 05:43 PM
It seems
from their website that they seem to be going for a speed
record and are not paying enough attention to quality. I was
going to go there. I have put the breaks on that until this
either works out or Dr. Zeegers takes me. ![[Big Grin]](Back Pain Support Group Charite core popping out_files/biggrin.gif)
Hey Spotty14, can you pm me?
/hugs
Stormy
--------------------
"Hope
keeps us alive."
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Harrison
Silver Member
Member # 1578
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posted September 23, 2004 08:18 AM
This sounds
pretty scary, and I am sure those of us who have had ADR can
empathize for the patient(s). It does make me wonder a bit --
has anyone noticed the picture of the artificial disc on the
advertising banner at getadr.com? I am no expert, but it sure
looks like that disc is positioned to the anterior. I'd be
curious what others think. (Jeez, and this is their choice
XRAY to advertise?!)
As difficult as these discussions
are, they are enormously helpful and instructive to people
considering ADR. My thanks to folks herein who get these
issues out in the open; my thoughts and prayers go out to the
folks suffering from these
complications.
--------------------
richlongland@yahoo.com
Reborn
June 25th, 2004
L5-S1 ADR June 24th in Boston
Canceled
fusion April 6 2004
Fell on my *** winter 2003
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Rita
Bronze Member
Member # 1528
|
posted September 23, 2004 08:54 AM
Dr. Zechel
is VERY much a perfectionist. Anyone that has had surgery
there already knows that. I sure hate seeing "Stenum bashing"
over one patient's problems. Like my husband told me....." it
COULD have been a defective core. They won't know until they
get it out." The surgeons don't make the discs...just put them
in. The cause may not have been the surgeon's installation at
all!
I know Dr. Zechel, and Dr Ritter-Lang,as well. I
sure wouldn't jump to any conclusions. The are very
professional, and we hope the man getting the revision gets
the problem completely resolved. That's what's
important.
Stenum is a wonderful hospital.
Blessings
to all,
--------------------
Skeeter
Had 2
level ADR(L3/4 & L4/5)at Stenum on April 2,
2004.
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JustMe
Bronze Member
Member # 257
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posted September 23, 2004 09:19 AM
Yes, it was
over a year ago that my physiotherapist informed me of this
problem with the disc. She also spoke about the disc getting
encapsulated by scar tissue and inhibiting it's movement
factor. She said the disc didn't perform quite as well as it
was hoped.
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mmglobal
Gold Member
Member # 65
|
posted September 23, 2004 11:23 AM
I have seen
several filmsets of Charite patients with dislocated cores.
Many serious complications are presented at the spine
Arthroplasty Society meetings. I've attended them (and other
spine congresses) for the last 2 years.
I have never
heard of a defective core, although that doesn't mean that it
hasn't occurred. In all the cases I've seen, extreme anterior
placement was readily apparent in the interoperative x-rays.
ProDisc cores dislocate too. As with the Charite, it's
from a surgical error. ProDisc core disclocation occurs when
the core is not pushed all the way into the plate.
I
agree with Rita that people shouldn't jump to conclusions
based on one, or even several disasters. All surgeons have
them and anyone who claims they don't is probably not
following up on patients very thoroughly or is still talking
about small numbers of patients and has been lucky so far. In
the words of one of my orthopedic surgeons, commenting on some
outrageously high fusion statistics and 'never made anyone
worse', from another local surgeon, "Well those results sound
excellent. Unfortunately, they cannot be duplicated in the
real world."
Hopefully, some of these patients with
complications will come here and post their experiences.
Mark
[ September 23, 2004, 06:09 PM:
Message edited by: mmglobal ]
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ADR-Jim
Junior Member
Member # 1691
|
posted September 23, 2004 06:11 PM
Please
don't believe everything you hear, Fred's core did not "pop
out", the lower plate failed to adhear to his previously fused
vertebrea. A risk they knew of prior, he will have fusion at
that level and ADR above in Oct. Also it is my implant on
getadr.com and I am now 18 months with no pain, skiing,
tennis, soccer, lifting up to 80lbs, no
problems.
--------------------
Jim
ADR
4-6-03
jim@rideoneinc.com
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Rita
Bronze Member
Member # 1528
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posted September 23, 2004 09:21 PM
I'm glad
you posted, Jim and Mark. I hate seeing doctors get a bum rap,
un-necessarily. (Some deserve it, but some sure don't) I had a
feeling he might have had a previous fusion here in the
States, before the ADR surgery. I thought there MUST be a
previous problem, for something so severe. I'll be praying for
him.
Doctors make mistakes....even all of the best in
the world, including Zeegers,Zechel,and Bertinogli. They are
only human, and I'm sure they are all committed to do their
very best on every single patient they do. They wouldn't have
the reputations of being "the best in the world", if they
weren't completely dedicated to each and every patient they
care for. I don't think any of the surgical sites in Germany
are going for numbers, over quality. I just think through the
internet, more people are learning about ADR daily, don't want
a fusion....and making the choice, (if they financially can go
to Germany, or can work it out someway)....to not wait on the
FDA here.
Like others, I didn't make any trial studies
here. This was my only hope for becoming pain-free.
We
pray Fred gets this problem taken care of, and the next one
adhears, (if that's what they choose to do.) I imagine he's
returning to Stenum???
Thanks for the insight, Jim....on
the x-rays, and the patient! Thanks, Mark on the
clarifications as well.
Blessing to
all,
--------------------
Skeeter
Had 2 level
ADR(L3/4 & L4/5)at Stenum on April 2, 2004.
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mmglobal
Gold Member
Member # 65
|
posted September 23, 2004 10:29 PM
The center
of the vertebral body is made up of soft cancellous bone. As
you move towards the outer edges of the body, it becomes hard
cortical bone. The stated goal of “2mm posterior to the
midline” placement is for several reasons. First, the
prosthesis needs to be supported by the hard cortical bone, or
subsidence is more likely to occur. Second, the axis of
rotation of the prosthesis needs to be as close as possible to
match the natural axis of rotation that is best for the other
elements of the spine. Otherwise, the other elements are
taking unnatural and unnecessary loads and may be more likely
to have future problems. Also, an undersized prosthesis does
not have a big enough footprint to span as much cortical bone
as a right sized prosthesis.
There is a
disproportionate amount of weight supported by the posterior
portion of the column, compared to the anterior portion. So, a
prosthesis that is not located under the center of force will
not have the load distributed over its base. An anteriorly
located plate will have more force on its back edge, which is
located over the softer part of the vertebral body. Think
tidily-winks. What happens when you press on the edge of the
chip… the other end comes up. So, when one edge of the plate
is weighted and one edge is not, the interface between the
plate and the body, that should resist forces that may cause
migration of the plate, is tiny. It’s an edge, or a small
portion of the plate instead of the entire surface. One set of
cleats is doing nothing.
I have seen several sets of
dislocated core films. I have 3 sets, but I’m not sure if it’s
OK to post them, so I won’t. I will show them at the BBQ to
interested parties, but I will not distribute them. Before the
dislocation of the core, you can clearly see that the front
cleats aren’t seated. Dislocation of the core is accompanied
by migration of the plate. Call it migration of the plates,
subluxation of the core or the core ‘popping out’. In these
cases, it all means the same thing. None of the 3 that I’ve
seen has been in patients with fusion at adjacent levels.
Conversely, I know many patients with ADR adjacent to fusion,
who have right-sized, properly located prostheses with no
migration or subsidence. Jim, I can’t tell if your post is
intended to mean that there is something special about the
fusion that would keep the plate from adhering to the body.
Also, are there other cases of failure of the plate to adhere
adjacent to fusion? I don't understand the increased risk of
non-adhereance?
Getting an undersized, and/or
anteriorly located prosthesis does not mean that you will not
be a success. However, it does mean that your risk of
complication is higher. Fortunately, the body will harden the
bone under the plate and osteointegration will occur, so the
risk of these complications is reduced as you get further out,
post-op. These complications are typically seen in the first
few weeks or months after surgery. Even so, the anterior
location of the plate will still leave you with increased risk
of other problems. That doesn’t mean it’s guaranteed or even
most likely… just increased risk.
Sometimes, less than
optimum placement is the best the doctor can do. It’s
difficult, time consuming and sometimes impossible to get it
perfect. Sometimes there are more risks involved in getting
the disc that far back… other complications may occur. I
suggest that everyone who’s already had the surgery not amp
out over placement. Jim is a wonderful example… 1.5 years
post-op and playing soccer. That rocks! I wish I was playing
soccer, but my knee won’t let me.
Mark
[
September 23, 2004, 10:36 PM: Message edited by: mmglobal
]
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997 | From: Fountain Valley, CA |
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ADR-Jim
Junior Member
Member # 1691
|
posted September 23, 2004 10:45 PM
My
understanding was that the fused vertebrea was hardened in
this case, causing some fear of an inability to accept the
implant. My understanding is that it was decided to try it
anyway. The resulting second surgery will result in the fusion
plus ADR which was the only other option. This is the first I
have heard of this hardening issue. I will try to get more
information from the doctors. Yes, he will be going back to
Stenum, I'll bet they don't even charge him for it. Try that
over here!
Mark, thanks so much for that description of the
issue of placement. I will send you a picture on me and my lab
soon, she is having surgery tmo, saw yours, oh, I bought a
boat also!
Jim
--------------------
Jim
ADR
4-6-03
jim@rideoneinc.com
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mmglobal
Gold Member
Member # 65
|
posted September 24, 2004 12:37 AM
Jim, sorry
about your lab needing surgery. I hope he/she's OK.
Dive boat, ski boat??? Sounds like fun.
As our
discs dry out, they turn black on the MRI's. Later, we see
sclerotic endplates that appear white on the MRI's. They have
lost their porous nature and have hardened. I don't think that
has much to do with the fusion, but I could be wrong. I think
that is good for ADR because it will provide a more stable
platform, provided the disc is placed properly. Proper
placement will insure a distributed load that will exert
forces causing firm seating with minimum force trying to expel
the device. Anterior placement will cause the column to
squeeze the back portion of the prosthesis more than the front
portion. The forces exerted will be much like sqeezing the
back part of a grape... it'll extrude out the
front.
I'm a little confused about the revision plan
you mentioned. If his surgery was last month and the level
above the subluxated ADR was tested and deemed not to be a
pain generator, why will they be doing ADR on it 2 months
later? How has it changed?
If the endplates have not
been damaged by the migrating prosthesis, have they considered
replacing the prosthesis with one that is properly placed? I
have seen other cases of subluxated cores that have been
successfully revised to a proper ADR installation.
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997 | From: Fountain Valley, CA |
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Stormy
Gold Member
Member # 2298
|
posted September 24, 2004 08:34 AM
All I can
say is that I'm following this discussion very closely as I
was considering going to Stenum, and might yet, if they can
provide me with a reason why they are placing their
replacments so far to the rear. I've emailed them, and am
awaiting an answer. Hopefully, they will have something to say
that eases my nervousness. (Is that a word, or did I just make
one up??
lol.)
Stormy
--------------------
"Hope keeps
us alive."
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MrBee
Member
Member
# 1859
|
posted September 24, 2004 04:06 PM
Hello
All,
For those of you reading this forum regarding the
said Charite core popping out. I am the source of this
information. It is not a prior fusion below that caused this.
In spite of many posts supporting positive experiences at
Stenum, as in the subject of this post, the films which I have
personally seen show this ADR were placed in a forward
anterior placement. The front teeth are barely touching the
exterior hard bone of the vertebrae.
If this was due to
movement, which I have been told by an undisclosed Stenum
official that "end plates don't move" then what caused this?.
And with respect to this is the x-rays in question are the 7
day post op taken at Stenum, the question is: Why didn't
Stenum alert this patient to the obvious potential for a
disloded plate which in turn "pops" the core out. Were they to
busy with 10 Americans?
This is a very dangerous situation
and should be treated as an urgent matter. Critical blood
vessals are poised in front of this level. Which begs the
question, What has been done? Why did it take this much time
to do? And finally if this is being remedied by Stenum and is
clearly a techincal fault, why would they charge this patient
for another surgery at face value of 19k euro? Not to
disinform ADR-Jim, but this pateint was required to pay for
the entire second surgery
So, take your shots as you may, I
am the source and I know this person first hand and stay in
close contact daily. Indeed, as a former Stenum ADR 2 level
patient who believes that for placement or wrong size issues a
revision surgery is on the hospital not the patient. I hope
Stenum does the right thing for this person and for any future
mistakes that occur that require a return trip which not
everybody can afford. Of and back to ADR-Jim as not to be
redundent to someone already pointing out why is Stenum now
fusing this level and doing a new ADR above a fused joint?
Isn't this the hypothesis that caused it in the first place?
Won't this happen again? Or is it that Stenum knows what
happened and is hiding it? ADR-Jim let us out here know why
this patient is getting a new ADR above a new fused (failed
ADR) joint?
Sorry ,Rita, I had to ask these obvious
questions, and Yes, Dr. Zechel is a fine human being and many
of the staff at Stenum also. Doing the right thing when
someone is having to endure a harsch second ADR/fusion surgery
barely 6 weeks apart is more important then that they deserve
to be looked to as infalliable. If we make mistakes, then do
the right thing and correct it willingly without
rancor.
MrBee
Ps. ADR is a great hope for back pain
sufferers, sharing this info good or bad makes the entire ADR
community a better place for the future ADR patients. Soon it
will be approved in the USA. However, Europe will still
command it's share of this business as long as Euoprean
hospitals pay attention to American values that a bad rep can
kill your business. Integrity starts with doing the right
thing even if it hurts.
Posts:
42 | From: Calif | Registered: May
2004 | IP: Logged | | |
Rita
Bronze Member
Member # 1528
|
posted September 24, 2004 04:33 PM
McBee,
I
would sure HOPE that they correct this problem with no charge
to the patient! I agree with you...
I think Dr. Zechel is a
wonderful doctor, and as I said...also only human. BUT....with
that being said...I would think there would not be a charge
for fixing this problem. I just can't imagine they would
charge him. This IS very serious.
I also hope the right
thing is done, and he's given the help he needs and
deserves.
Thank you for posting, and clearing up any
questions. My prayers are with
him.
--------------------
Skeeter
Had 2 level
ADR(L3/4 & L4/5)at Stenum on April 2, 2004.
Posts:
102 | From: Midwest | Registered: Mar
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Stormy
Gold Member
Member # 2298
|
posted September 24, 2004 06:15 PM
I'd been
thinking about going there, and when I asked Stenum Hospital
about these issues that are popping up and out, so to speak,
all I got was a synopsis of this specific forum thread and
told not to panic. That really answered my questions. NOT.
Just another person treating me like I was some two year old,
who had no brain, and was something they stepped in on the way
to work this morning.
I also felt it to be rather
rude, uninformative, and done with a "lets sweep this all
under the rug" attitude. None of my questions were answered,
so as much as they have a nice glitzy website, sorry. I'm
going elsewhere. I find it outrageous they would make this man
pay for a second ADR. Over here in the USA we'd OWN them by
next Tuesday.
--------------------
"Hope keeps us
alive."
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