I am now 8 weeks post op from lumbar disc replacement

Specialties Orthopaedic

Published

Thank you to all those who answered my questions about lumbar disc replacement. I am now 8 weeks post op and am thrilled with the results. I have gone from 20mg of morpine every 2 hrs to 2 paracetamol per day.:) I had L4/5 and S1 discs replaced using Charite II prothesis' via an anterior approach.

The operation was less painful than a laparoscopy I had years ago, thanks to a morphine infusion for 24 hours then oral narcotic pain relief for 4 weeks. I was discharged 4 days post op, but was ready for home on day 3.

I have spent the last week gardening and packing up my house to move, not something I would have dreamed of previously.

Anyone contemplating this procedure should go for it, I am now looking forward to a new start and getting back to work.

Julie

Tassie Nurse

Specializes in MICU, neuro, orthotrauma.

All about the Charité artificial disc: now approved for use in the U.S.

The Charité artificial disc

On October 26, 2004 the U.S. Food and Drug Administration (FDA) approved the Charité™ artificial disc for use in the US. This device treats severe, chronic low back pain by replacing the damaged or worn out spinal disc in the lower back with an artificial disc. The device is made by DePuy Spine, a division of Johnson and Johnson, Inc. The Charité artificial disc is also currently used in disc replacement surgery in more than 30 countries throughout Europe, Asia, North America, Africa and Latin America.

The Charité artificial disc is a sophisticated implant made of two metallic endplates and a plastic center that is designed to help align the spine and maintain the spine's natural flexibility. This means that the artificial disc mimics the role of a natural spinal disc--both in maintaining the normal position of the spine and allowing the spine to bend and twist. See Figure 1.

The artificial disc has been created as an alternative to the current surgical treatment for treating chronic low back pain from degenerative disc disease - lumbar spinal fusion surgery. In spine fusion, the surgery is designed to stop motion at the painful level of the spine. Usually, implants are used to help provide initial fixation, such as metal screws and rods and/or cages that are inserted between the vertebrae. Because the fusion eliminates the motion in the lumbar spinal segment, the pain caused by the motion is reduced or eliminated. When done correctly for the right indications, a fusion has a high success rate in reducing or eliminating the patient's pain. However, because it limits range of motion it may transfer extra stress to discs above and below the fusion site. Because the artificial disc allows continued motion in the spinal segment, it is theorized that this may be a preferable alternative to spinal fusion surgery for patients with the right indications.

The Charité disc has been approved for use in patients who have severe lower back pain caused by degenerative disc disease and have obtained little or no pain relief after at least six months of non-surgical treatments, such as pain medications, physical therapy, injections, and/or manipulation. The FDA clearance for disc replacement is for one level of the lower spine, and it must be done at one of the two lowest levels of the spine (L4-L5 or L5-S1).

Charité artificial disc study results

The objective of the US FDA clinical trial on the Charité artificial disc was to determine whether the Charité artificial disc was any less safe and effective than the currently available spinal fusion surgery with a cage and bone graft, called an anterior lumbar interbody fusion.

The study involved a total of 375 patients enrolled in 15 spine centers located across the U.S. The initial five patients treated with an artificial disc at most centers (71 patients) were considered training cases and were not included in the results of the study. During the randomized study, 205 patients received the Charité lumbar artificial disc and 99 patients received the control surgery (anterior lumbar interbody fusion). Both operations require a similar incision in the belly. Patients were not told which type of surgery they were going to have--the fusion surgery or the artificial disc--before the surgery.

After two years of follow-up on the 304 patients in the randomized study, patients who received the Charité artificial disc did no worse than patients treated with anterior lumbar interbody fusion. The rates of adverse events from use of the artificial disc were similar to those from treatment with fusion. Based on these results, the FDA approved the Charité for commercial use in the U.S.

At the annual meeting of The Spine Arthroplasty Society, the Texas Back Institute, the principal spine center investigating the device, presented an overview of the study results. Several measures were used to determine outcomes of the study, including a 0 to 10 scale to assess pain intensity, a report by patients about their daily activities (using the Oswestry Low Back Pain Disability Questionnaire). In both the artificial disc replacement and the fusion patient groups, it was found that both the patients' pain and functional scores improved significantly after surgery.

Cindee. . .

I am currently appealing with BC of CA regarding coverage for disc replacement also with Dr. Delamarter. Did you have to appeal? How are you doing? Do you recommend the surgery and this surgeon. I am sooooooo nervous. Please help. Does anyone have any information on getting insurance coverage for the disc replacement and does one level vs. two make a difference. Any help would be greatly appreciated

Tass: I am scheduled for the disc on March 4, 2004. It will be installed in Dallas, Texas at the Back Institute, by Dr. Richard Guyer.

Later

DT

Hey How are you,

My name is victor castagneto. I also suffer from damage to L4/L5 & S1 disc herniation. I see you're from Louisiana. I also live in new orleans, La. I was wondering if you could share with me your experience with disc replacement. I see you were to go to texas for yours. If you can give me any information on where I can contact a doctor able to perform this procedure I would greatly appreciate the information. Please pm me w/info.

Thank you much,

Victor castagneto

Cindee. . .

I am currently appealing with BC of CA regarding coverage for disc replacement also with Dr. Delamarter. Did you have to appeal? How are you doing? Do you recommend the surgery and this surgeon. I am sooooooo nervous. Please help. Does anyone have any information on getting insurance coverage for the disc replacement and does one level vs. two make a difference. Any help would be greatly appreciated

Dear Healing Mom,

I just got a rejection for the ADR (Charite) from BC. I am going to appeal their decision. I am 45 yrs old and have 3 children. My quality of life is greatly declined. I take pain meds around the clock just so that I can straighten up and do light work around the house. I have 2 discs that need replacement - one is completely gone and the other is on its way. I have been suffering for over 2 yrs. I finally faced the fact that I am going to need surgery only to find out that my insurance won't cover it. I am beside myself. However, I have to have something done because I am building a tolerance to the pain meds and they are messing up my system. If I have to I will pay for the surgery myself, but I find that option to be, quite frankly, absurd. What luck have you had with your appeal? Also, how are you managing with your symptoms and your daily life? I look forward to talking with you as I feel so awful and now depressed after the rejection. Thank you!

Thank you to all those who answered my questions about lumbar disc replacement. I am now 8 weeks post op and am thrilled with the results. I have gone from 20mg of morpine every 2 hrs to 2 paracetamol per day.:) I had L4/5 and S1 discs replaced using Charite II prothesis' via an anterior approach.

The operation was less painful than a laparoscopy I had years ago, thanks to a morphine infusion for 24 hours then oral narcotic pain relief for 4 weeks. I was discharged 4 days post op, but was ready for home on day 3.

I have spent the last week gardening and packing up my house to move, not something I would have dreamed of previously.

Anyone contemplating this procedure should go for it, I am now looking forward to a new start and getting back to work.

Julie

Tassie Nurse

Dear Julie,

I have severe degeneration of L4-5 and L3-4 is quite bad as well. I also have a missing facet joint at L5-S1 which is a deformity that I was born with. I am having a discogram done on Friday. I have Blue Cross insurance which has always been terrific, but they have denied the ADR. I am going to appeal. Did you have any problems with your insurance and what kind do you have?

I am 45 yrs. old and have been active and in very good shape all of my life. My life has changed dramatically over the past 2 years. I am taking narcotic meds around the clock because the pain is so bad. If I do anything to make it worse, like grocery shopping, I run the risk of not being able to relieve the pain. The discogram hopefully should give us a clearer direction. I have read a great deal of information about the Charite disc. I am concerned because it is relatively new, but I am in favor of it because of the mobility that one would receive as opposed to fusion. I live in Los Angeles and Dr. John Regan, who is very highly regarded, is treating me. Is there any info can you give me regarding insurance, any reservations that you had, your history of your case, etc. Did you have a discogram - was it painful? The instructions say to get someone to drive me, so I am assuming that they are going to give me an analgesic or relaxant. ANY info would be so appreciated.

pm me w/info.

Laura

Specializes in NICU, Infection Control.

I'd like to point out that the OP is dated 2003. I'd also like to mention that putting your private email (or any other personal info) in a searchable Bulletin Board is not the best idea! Please don't!! Thanks.

Mod team

I have 4 torn and 6 herniated discs in my back. I am scheduled for ADR on L4/L5 on January 17 and am scared to death. I am 47 and have lived with this injury for 20 years. I am sick of not being able to do anything and tired of the pain and vicoden addiction. The two discs above are herniated but not collapsed like 4/5 is. I would appreciate any input anyone can give me. I am seeing and orthopedic, Brian Grossman in Simi Valley...any comments ?

forgot to mention....I have Blue Cross and was fully authorized. That was what triggered my posting.

Hi,

this is my first post, so if I do anything wrong .. please be patient.

I am currently on W/C for a back injury. I have received, P.T. pain meds and chiropractic. I do not want epidural injections. I have said that I would consider surgery when I can no longer get oob.

I want to return back to work preferrably in the ICU where I injured myself. However, would NICU be less of a strain on my back? how about L& D? I am not really interested in a desk job.

I live in So. Cal and would be interested in hearing any and all advice about disc replacement or job replacement.

Thanks

Catfish RN,

Be careful!! Once you have surgery, it seems things just keep getting worse (at least that is my experience). If you can go with conservative interventions, they are the best. If you go with epidural injections, make sure the doctor is good. If you want to go back to work, NICU is a good option, but there is a lot of leaning of the beds. L&D is not a great choice since you often have to assist patients into positions and this puts a great amount of strain on your back(especially when pt has epidural). Consider wearing a back brace/support. You have to learn to function with the pain. 20 minutes sitting, 20 minutes up walking. No twisting or bending over. Regular massage seems to be benefitial. I hope this helps. Good luck.

Dear Healing Mom,

I just got a rejection for the ADR (Charite) from BC. I am going to appeal their decision. I am 45 yrs old and have 3 children. My quality of life is greatly declined. I take pain meds around the clock just so that I can straighten up and do light work around the house. I have 2 discs that need replacement - one is completely gone and the other is on its way. I have been suffering for over 2 yrs. I finally faced the fact that I am going to need surgery only to find out that my insurance won't cover it. I am beside myself. However, I have to have something done because I am building a tolerance to the pain meds and they are messing up my system. If I have to I will pay for the surgery myself, but I find that option to be, quite frankly, absurd. What luck have you had with your appeal? Also, how are you managing with your symptoms and your daily life? I look forward to talking with you as I feel so awful and now depressed after the rejection. Thank you!

I was denied through Insurance at all levels. Appeal didn't do anything either. I am afraid to pay out of pocket in case of major problem following surgery that insurance may not cover do to non-approval of treatment. At this point, it is try to deal with things day to day. I don't know the answer. Hopefully insurance will change their thinking soon. Good luck

Specializes in Case Management.
I was denied through Insurance at all levels. Appeal didn't do anything either. I am afraid to pay out of pocket in case of major problem following surgery that insurance may not cover do to non-approval of treatment. At this point, it is try to deal with things day to day. I don't know the answer. Hopefully insurance will change their thinking soon. Good luck

You always have the option of going to your employer and requesting out of plan approval. If you are a valued employee, they just might agree! Remember that the insurance company covers what is written into the plan. Some companies are self funded and thus can write their own plan.

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