Dr Zeegers (right) and me
Alphaklinik, MunichFor countless numbers of chronic backache sufferers diagnosed with degenerated intervertebral discs, artificial disc replacement (ADR) is regarded as the preferred solution- High-Tec in contrast to the established alternative old-technology, vertebral fusion, and offers the dream of restoring a fully mobile, pain-free life. The growth of the internet has allowed back-sufferers the world over through glossy websites to learn about the new technology. It is not just by chance that simultaneously there has been a mushrooming in Europe of private clinics charging from £12,000 for a 1-level ADR to £32,000 for a 3-level ADR. Against the current background of a tightening of credit and a decline in economic activity in much of the developed world, clinics are competing for a growing but limited number of private ADR patients. One of the pioneers of ADR, Dr W.S. Zeegers, a Dutch surgeon (see above photo on the right) has recently commented that in their haste to milk this lucrative market, some of these clinics are offering ADR to desperate, vulnerable patients some of whose pre-operative back condition makes them highly unsuitable ADR candidates and asserts that a small but significant percentage of these patients in the months and years following their operation are coming to regret their decision.
My own case may be seen as a cautionary tale for would-be ADR candidates. It should be pointed out that ADR received NICE (National Institute for Clinical Excellence) approval in 2004 and there have been an increasing number of ADRs on the NHS but finding an orthopaedic surgeon with a large number of successful ADRs under-his-or-her-belt is difficult. I concluded that if I should contemplate an ADR it would be with a surgeon with a worldwide reputation who has carried out several thousand ADR operations.
It’s 8 o’clock one Friday morning in late April 2008 in the operating theatre of one of the leading ADR clinics in the world- Alphaklinik in Munich. The previous day over a 12 hour period after I had seen various specialists, undergone MRI scans and x-rays, a thorough neurological examination and cycled twice around Munich (it seemed) in the gym attached to a computer monitoring my heart and lungs, Dr Zeegers had concluded I should make a suitable candidate for ADR. Immediately ahead of my planned 2-level ADR operation it had been decided to carry out a discogram- a kind of medieval torture in which I was paying to allow a series of fine needles to be inserted under X-ray guidance, carefully avoiding my spinal cord, into my lumbar discs. The purpose of this diagnostic tool is to determine precisely which discs are causing pain and by injecting a water-soluble dye into the disc itself, to ascertain whether there is leakage from a disc rupture. Needless to say, during the procedure it is necessary to allow the patient to recover some level of sensation in order to ensure validity of the results. As each needle is inserted, withdrawn or just tweaked, as is expected with each degenerated disc, I screamed, faithfully leaped a foot off the operating table each time and was informed later I had at one point accidentally kicked the surgeon in the jaw. (Note-I must check the final bill to see whether I have been charged for dental restorative work!)
All apparently was going smoothly, with results as expected, when Dr Zeegers suddenly announced to a disbelieving theatre team that the surgery would not take place. I was taken to the recovery ward and the next day offered a thorough, 90 minute explanation for the decision (only the 3rd time he has called off an ADR so late in 10 years). He explained that central to his decision was his assessment of the probability of medium and longer term success. As he neared completion of the discogram he became concerned that my back’s instability would leave me vulnerable to a collapse of the ADR stack during golfplay and that were that to happen I could end up paralysed from the waist down. (There were additional issues of moderate scoliosis and poor soft tissue structure around the spine which had been taken into consideration earlier). He was simply not prepared to take the risk and though he felt depressed that I had had my hopes raised and then dashed, he was certain the right decision had been made.
Dr Zeegers left me drawing the conclusion that a different surgeon- perhaps less concerned with statistics and more concerned with profits might have decided to complete the operation. He commented that there are clinics which welcome older ADR candidates as there is a good chance they will pass away before the surgery fails!
Revision surgery for unsuccessful ADR operations is notoriously difficult and potentially dangerous. Worldwide there are a significant number of post-ADR patients who in the months following their operation run into a variety of subsequent spinal problems whose quality of life has not been restored (some with much-increased pain) and whose bank balance has been hugely depleted.
My dream (held for the last 10 years) of a successful ADR and a return to playing golf may have been dashed in Munich but I was able to shake hands with Dr Zeegers thanking him for his integrity and clinical judgement. The cost of my unproductive adventure to Munich was c.£5000 but I am left wondering whether this 63 year-old may have had a lucky escape. I am left contemplating the prospect of a spinal fusion operation in the next year or so on the NHS.
