I came to like Dr. Lawrence Montgomery*, a neurosurgeon specializing in brain and spinal surgery, less and less when I saw his books displayed on virtually every surface of his office: at the reception desk, on the end tables, the coffee table, the exam room, etc. He was a privileged, white, rich doctor dude, and his wealth reeked from every pore.
He was in very high demand and I waited for an hour, then was shepherded down a hallway and ushered into an exam room. One of Dr. Montgomery’s assistant's took my vitals — a five to ten minute process — and let me know that another assistant was on the way, then closed the door on her way out. I waited again for forty-five minutes until a new person introduced herself to me as Dr. Montgomery’s patient's assistant (PA). I think her name was Nina. We chatted for a while and waited for Dr. Montgomery.
The Charité (lumbar) artificial disc — single-level only — was approved by the FDA on October 26, 2004 and removed from the market in 2012.
Once we were together in the same room, Dr. Montgomery reviewed the MRI films; the same ones I had done with Dr. Bridges just a few days ago. He flipped through some pages on my chart, looked at my case, and recommended two options: 1) spinal fusion surgery or 2) artificial disc replacement (ADR).
Even the thought of my bones being fused — cemented or screwed or whatever — was out of the question. I was athletic. Snowboarding gave me joy. So did surfing. I ran marathons. I said no.
The idea of ADR was brand new to me. There was a model of a Charité prosthesis* (prosthesis = replacement) on a ledge in the exam room. Dr. Montgomery picked it up and handled it eagerly and described what it could do. The goal of ADR is to reduce pain (first) and improve mobility (second) in patients (like me) with chronic lumbar (low back) pain. Years ago, it was a new procedure in consideration as an alternative to spinal fusion surgery — music to my ears, because there was no way I was going to let my bones be glued together.
The ProDisc-L (lumbar) artificial disc — single-level only — was approved by the FDA in either August or November 2006 (multiple sources unclear).
I didn’t know other artificial discs were out there until I started researching, not long after our visit was over.
** For the simplest explanation:
An artificial disc (also known as disc replacement or prosthesis) is a device that is implanted into one’s spine to imitate the functions of a normal disc, to bear the load and allow motion. The device itself looks sort of like an Oreo: a white disc sandwiched between two pieces of metal. One piece of metal attaches to the vertebrae above the disc being replaced, and the other to the vertebrae below. The ridges on top — like shark teeth — are what keeps the metal in place. (Yes, those pieces of metal get hammered in, directly into the bone. I know. Ouch, right?) The disc pops into place in the middle.
I was thrilled at the idea! Imagine me, my new spine strong and supple, rocketing down hills on my snowboard; trying to surf, catching waves in our icy cold Pacific Ocean water; maybe even running marathons!
"But the first step is facet nerve block injections," he said. "Let’s start there."
The goal was to rule out the facet joints as pain generators. He scribbled something on a piece of paper with a name for an anesthesiologist/pain management doc and handed it to Nina. As he headed for the door, I asked Dr. Montgomery how many ADR surgeries he’d done. There was a little hesitation in his voice. "None," he said. I remember asking Nina after he left, would she trust Dr. Montgomery if she were to have an ADR surgery with him. She hesitated before answering. "Umm… I’m sorry, I can’t really speak to that."
Humph.
Two weeks later, per Dr. Montgomery’s request, Dr. Oliver Langley* performed the procedure: injection nerve blocks at my L3-4 and L4-5 facet joints. The injections did nothing for me, and effectively confirmed that my pain originated from the discs. The next step was a discogram (that sounds like a party, doesn’t it?) to confirm the pain was discogenic, and identify which disc was the culprit.
The word "None" rolled around in my mind for weeks. I had zero confidence in a surgeon for which I’d be the guinea pig. No thank you.
I began researching ADR to learn as much as I could, and to find second opinions.
*Doctor names changed for privacy.
**More about the history of ADR and further description will be in a future post.