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Author Topic: Charite core popping out????
ADRJen
Bronze Member
Member # 477

Icon 1 posted September 22, 2004 04:54 PM      Profile for ADRJen   Email ADRJen   Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 22, 2004 05:43 PM      Profile for Stormy     Send New Private Message       Edit/Delete Post   Reply With Quote 
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]

Hey Spotty14, can you pm me?

/hugs

Stormy

--------------------
"Hope keeps us alive."

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Harrison
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Icon 1 posted September 23, 2004 08:18 AM      Profile for Harrison   Email Harrison   Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 23, 2004 08:54 AM      Profile for Rita   Email Rita   Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 23, 2004 09:19 AM      Profile for JustMe         Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 23, 2004 11:23 AM      Profile for mmglobal     Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 23, 2004 06:11 PM      Profile for ADR-Jim   Email ADR-Jim   Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 23, 2004 09:21 PM      Profile for Rita   Email Rita   Send New Private Message       Edit/Delete Post   Reply With Quote 
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

Icon 1 posted September 23, 2004 10:29 PM      Profile for mmglobal     Send New Private Message       Edit/Delete Post   Reply With Quote 
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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ADR-Jim
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Icon 1 posted September 23, 2004 10:45 PM      Profile for ADR-Jim   Email ADR-Jim   Send New Private Message       Edit/Delete Post   Reply With Quote 
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

Icon 1 posted September 24, 2004 12:37 AM      Profile for mmglobal     Send New Private Message       Edit/Delete Post   Reply With Quote 
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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Stormy
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Icon 1 posted September 24, 2004 08:34 AM      Profile for Stormy     Send New Private Message       Edit/Delete Post   Reply With Quote 
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
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Icon 1 posted September 24, 2004 04:06 PM      Profile for MrBee   Email MrBee   Send New Private Message       Edit/Delete Post   Reply With Quote 
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.

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Rita
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Member # 1528

Icon 1 posted September 24, 2004 04:33 PM      Profile for Rita   Email Rita   Send New Private Message       Edit/Delete Post   Reply With Quote 
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.

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Stormy
Gold Member
Member # 2298

Icon 1 posted September 24, 2004 06:15 PM      Profile for Stormy     Send New Private Message       Edit/Delete Post   Reply With Quote 
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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