We hear a lot myths and bad advice tossed about on the Internet. We would expect this from people new to spine surgery and even marketers for certain medical devices, but some of the sources of these myths are surprising. We encourage readers to send in statements they hear or read, which don't exactly sound right. Perhaps we can post and respond to the suspect ideas here. Here are listed some of myths and then the reality.

M. Facet arthrosis or facet hypertrophy is a contraindication for ADR surgery.
R. Only severe and untreated facet arthrosis or facet hypertrophy is a contraindication for ADR surgery. Although though there was concern about facet arthrosis or facet hypertrophy in the early years of ADR surgery, it has been proven with many success stories of ADR surgery, that this is not the case in mild to moderate facet problems are not a contraindication. Indeed, ADR relieves the pressure on the facets, by restoring the height of the intervertebral disc space. Also in severe cases sometimes the facets can be removed and a type of ADR surgery known as TSMS can be done, or ADR in combination with facetomy and spine stabilization can be done.

M. ADR surgery causes facet degeneration.
R. If the ADR is improperly placed this is true. We have seen many cases where surgeons have improperly placed the ADR and subsequent facet pain has occurred. There are many inadequately trained surgeons doing this procedure. There is one observational paper claiming that ADR surgery leads to facet pain, but the paper is only reporting patient responses and makes no judgment about the placement of the ADRs and views many old ADR designs, hence it suggests a false conclusion about ADR surgery, which is ADR surgery causes facet pain.

M. Cushioning ADRs, known as "third generation artificial discs" are automatically a better device than traditional discs. R. Cushioning is certainly a desirable aspect for an ADR, but it is not the whole picture. If the cushioning ADR is unconstrained, it offers no protection to overloading the facet joints. Also, simplicity of the device's construction and its reliability of its chemistry is part of an elegant and durable design. There are many such devices in Europe.

M. ADR revision surgery is life threatening.
R. This is true in 40% of the cases, if the surgeon did not sew in a barrier between the spine and the major arteries. However, Dr. Bertagnoli does sew in this barrier.

M. All I need is a total discectomy to cure my disc problems. Once the discectomy is done the bones will fill in the intervertebral space. (We know of one spine surgeon saying this).
R. Both ADR and fusion surgery were developed to restore the intervertebral space and decompress the radiating nerves from the spine and the facet joint and the nerves associated with the facet joint.

M. AMP vertebroplasty should be done in every patient to prevent subsidence. (We know of one spine surgeon saying this).
R. AMP vertebroplasty has its risks, mostly the leaking of the ceramic material into the spinal canal through a defect in the bone. That would result in an emergency surgery to remove the ceramic material from the spinal canal. Statistics show, that if this were done on every patient, more patients would be harmed than helped.

M. Subsidence only occurs in ADR surgery.
R. Subsidence also occurs in fusion surgery. Newer versions of most ADRs have broader endplates to further reduce the chance of subsidence.

M. The high-density, cross-linked polyethylene core of the ProDisc is just a piece of plastic, which will easily break or deteriorate. (We know of one spine surgeon saying this to patients, but he probably got the idea from a medical device marketer)
R. High-density, cross-linked polyethylene has been in the human body for 40 years and is chemically inert. It is extremely durable.

M. “Back surgery will make my back like was when I was 18 years old”
R. There is no substitute for a young healthy back and surgery can never restore a back to its optimal youthful condition, if the patient ever had such a back. However, surgery can greatly reduce the pain of a patient and restore function. In some cases like cervical myelopathy, surgery will be responsible for saving the patient's life.

M. “One back surgery will cure all my back problems, now and in the future”
R. While this can be true for many patients, particularly trauma patients, most of our cases deal with spondolysis and its nephew degenerative disc disease. These degenerative conditions continue throughout the patient’s life and it is impossible to predict the rate of progress for an individual patient.

M. “Back surgery is 100% successful in every patient”
R. No surgical intervention is 100% successful in every patient.