I commented on another post but I had an artificial disc replacement surgery on C5-C6 in 2022. My surgeon had done the surgery many times already and he’s had years of experience. He did his fellowship at the texas back institute and I trust him 100%. I had the Mobi-c implanted and have not had any complications so far. His reasoning for choosing disc replacement over ACDF was that I was 33 at the time and still very young and he wanted to preserve segment motion. With that said I 100% respect your opinion on why you don’t do the surgery and had it been presented to me in that way I may have chose not to have it. You make some very valid points! You’re videos are very Informative and packed with a lot of knowledge the average person can understand. Thank you!
Thank you for your thoughtful comment. I agree that for the right patient TDR is an excellent procedure, and most patients do very well after this surgery. However, in rare cases when the TDR device doesn't work as expected (or promised), the resultant complications can be very difficult to treat surgically. The goal of my video is to help patients see both sides of the picture, so that they can make the right decision for themselves. Thank you for watching the channel, appreciate your kind words. Wishing you the best of health. Good luck! 👍
Thank you Dr. Khan for sharing this incredible insight into disc replacement. I’ve been very intrigued as I maybe in a position in future where I’ll need to decide between the two procedures. In a future video, could you share bit more insight on life post ACDF? There’s a lot of misinformation that claims Fusion surgeries ultimately fails for various reasons and extremely limits your mobility but never really explains why. I recently saw a popular professional wrestler podcast claiming he had a Fusion surgery in his lower back and his surgeon somehow didn’t tear through any back muscles and now after 18 months of rehab he’s better than ever taking huge bumps in wrestling ring as if he’s in his teens and I don’t see any scars in his low back. So I was bit puzzled at how he got the procedure without any tears, how is he still so flexible with Fusion hardware, how is he jumping 20ft in the air and landing on his back in a wrestling ring etc.
Thank you for your thoughts and questions, appreciate it. I hear you loud and clear. One of the things which is difficult for patients to understand is how aggressively surgical devices and techniques are marketed by companies and surgeons for financial gain. The simple fact is that new "cutting edge" technologies are more financially-lucrative/ profitable than boring "old" (but tried-and-true, reliable) technologies. This is the main driver of how information is presented to the general population. I am going to make a separate video about the range-of-motion concern that a lot of patients have when they consider ACDF/ disc-replacement. Stay tuned.
Why are fusions so common in the states when the risk of developing adjacent segment disease gets higher the more years pass by. It seems that more fusions are inevitable once a patient hopped on the fusion train.
What about disc replacements for the Lumbar Spine L4 L5 S1 Have long term bulging discs. and in 2017 had an extra foraminal decompression, laminotomy, and laminoplasty to clear space around bulging discs Recently had new pain down leg, burning etc. and some disfunction of right leg. I am athletic and want to continue that. Thank you!
There are a lot more surgeons doing cervical TDRs vs. lumbar TDRs: The lumbar spine has to bear more weight compared to the cervical spine. Therefore the failure rates are higher in the lumbar spine TDRs, so fewer surgeons are doing them.
That's a good question. In the U.S. the lumbar disc replacements have mostly fallen out of favor. For a variety of reasons, disc replacements in the lumbar spine have not been very successful. Cervical disc replacements, on the other hand, are much more promising.
ADR in lumbar have “fallen out of favor” because payors aren’t covering it - they’ve been relatively successful but pricey as compared to PLIF/ALIF/OLIF, etc. Payors would prefer to risk paying much less for lumbar fusion and then hope patient switches payors or gets discouraged and not want another subsequent surgery….much less hard dollar cost that way.
Still don't get why they can't go through the back. Clean up the spur and shave off the buldge. Even if it's dryed out. Seems like being young and a herniation is more advantageous for going through the back. No one knows how long the disk replacements will last.
Thank you for reaching out. This is a common question I get from patients. For anatomic reasons, surgery from the back of the neck is more painful, more likely to get infected, and the degenerated disc cannot be removed in its entirety. On the other hand surgery from the front of the neck is much less painful, much less likely to get infected, and it allows complete removal of the disc so that a spacer can be placed between the vertebrae (to keep the nerves open). Also, if you approach the disc from the back of the neck, the spinal-cord is directly in the way (very dangerous), and you can only remove a small part of the disc (not the whole disc). For all these reasons, surgery from the front of the neck is much easier and safer. Hope this helps. Cheers 👍
@@SpineSurgeonSpeaks had micro surgery from the back for a c4 c5 herniation and bone spur. 45 minutes 30 years ago. Surgeon said seven drops of blood. Had Minimal.pain. Instant results. Swollen incision site for about a week . Stitches taken out a week later No collar. I mean that's why Im perplexed about fusion. Yes my surgeons I have are saying say the same thing as you. Maybe I was a anomaly.
Yes, this happens, unfortunately. Here is a video of a similar case that I had to fix: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-HruYBwCekC0.html Hope you are doing better, wishing you the best of health 👍
My disc replacement at C6-7 would pop out of its divot all the time. Surgeon refused to believe me and said I’d be paralyzed. Liar. I got a new surgeon and had it removed and fused. It caused so much havoc and pain. I wished it would have worked better.
Sorry to hear about your experience, thank you for sharing. I hope you feel better now. I did a similar surgery, hope you find this video interesting: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-HruYBwCekC0.html Good luck to you 👍
Sue him. I am having problems now and he ran away when I complained to him after 3 months of rescuing symptoms…….these discs are lethal and not good…….they pop out and are hyper-mobile and can fuse and calcify like mine which is causing me massive facet joint pain and dizzyness
That's a good question. Arthritis develops in joints that are still moving. In a ACDF surgery the facet joints cannot develop arthritis because they are locked in place. On the other hand in a disc-replacement the facet joint is still moving so it is possible for it to develop arthritis. Hope this answers your question.
Thank you, Dr. I had replacement.and fusion (plating?) one week ago at C5-7. My spine was a mess. Surgeon took about 3 hours to complete. Im wondering now if replacement was the right choice because the thought of going back for another surgery flat out terrifies me almost as much as the thought of paralysis. Any thoughts?
Obviously I cannot comment on your particular condition since I don't know any of the facts, but most patients will do very well with either procedure. If you have any questions, make sure to get in touch with your surgeon and have an honest discussion about it. Good luck to you!
Thank you for reaching out. In general, I am *very* skeptical of any medical-device manufacturer who claims that their "new" device is superior to what is already available. Similar claims had been made for many devices which are now gone, no longer in use. Medical-marketing is just that... marketing. What matters is track-record.
That is a good question. For a variety of reasons disc replacements in the lumbar spine have not been very successful, so they have been mostly abandoned. Fusion is a better alternative compared to disc-replacement in the lumbar spine. Thank you for reaching out.
After 70 years and all the medical innovation, we are still fusing joints. It only has to move a couple degrees. SpaceX broke the mold in rockets and there are so many other mechanical innovations , and we are still here. I simply don’t understand why we aren’t in a different place. What bugs me is the surgeon wants to do a laminectomy. The only choice I have is to weaken my spine by risking possible instability long term. Oh well, I’m all for normalcy, but they can now replace heart valves without opening the chest and massive buildings that survive earthquakes … so what’s not happening here. Just venting - that’s all.
Thank you for your thoughts. I understand your frustration with the choices available as a patient. Our biology is more complicated than rocket-science, unfortunately, which is why our options are so limited.
That is a very good question. In order to adequately perform a posterior cervical foraminotomy, the inner 1/3rd of the facet-joint needs to be removed (so that the nerve can be successfully decompressed). The surgeon would have to carefully evaluate the facet joint to make sure that adequate amount of the joint remains, and also to make sure that the joint has not developed significant arthritis. Either one of these situations could cause problems if a disc-replacement is performed. You should discuss this matter with your surgeon carefully. Good luck 👍
Since I am not familiar with the details of your particular condition, I am unfortunately unable to diagnose it or make treatment recommendations. Having said that, adjacent-segment-degeneration is a well-known condition where the disc next to a surgical segment wears-out and may need surgery. If your consultation with the first surgeon has not provided you with a satisfying answer, it may be very reasonable for you to get a second opinion. Good luck to you!
