Q. What is spine arthroplasty?
A. Spine arthroplasty is the preservation of spine motion through orthopedic surgery.
Q. How long has Prof. Dr. Bertagnoli been a spine surgeon?
A. SInce January 1989.
Q. How many ADR surgeries has Prof.Dr. Bertagnoli done?
A. Over 5,000 ADR implants have been performed by Prof. Dr. Rudolf Bertagnoli, more than any other surgeon in the world. Furthermore, Prof. Dr. Bertagnoli offers other non-fusion solutions such as Coflex and DSS, when it is appropriate for the patient.
Q. What is the typical artificial disc replacement recovery time?
A. Normally, patients stay a total of two weeks, when 50% of the bone in-growth has occurred. Almost all bony ingrowth into the ADR is complete in six weeks. German patients get 3 months off work, but many US patients go right back to work upon return, although a minimum of six weeks is recommended for 100% of bony ingrowth.
Q. What is your infection rate?
A. Zero for grade 2 or higher infections – no infection in non-fusion procedures with a long term consequence or an affect on outcome.
Q. What is your success rate and how does it compare to others?
A. Artificial disc replacement satisfaction rates are measured by a subjective patient questionnaire. After three, six or 12 months the patient is asked to rate the degree of the reduction of the pain. If the relief in pain is sufficient, surgery is considered a success. An exact satisfaction rate cannot be published every day, because that success rate changes, even at the third decimal place with every patient. Nor can we objectively compare ourselves to others, because no objective data are collected by an objective third party entity. However, a snapshot of patient satisfaction can be published. Scientific peer-reviewed studies are available on this website under the menu title "surgery" and can give the reader an idea of Artificial disc replacement success rates for Prof. Dr. Bertagnoli. Worldwide success rates are significantly lower. We believe that based on the anecdotal stories we hear and our own numbers, that a patient's greatest chance of a good outcome is with Prof. Dr. Bertagnoli. We also know that success rates can vary widely based on the abilities of the surgeon in studies. Also, keep in mind that while a patient may have been biomechanically corrected, thus preventing further damage, such as paresis (partial paralysis), paralysis, and incontinence, the brain and nerves can remember pain and replay that pain, called "pain chronification", despite the causal agent being removed. Also, decompression of the nerves does not always lead to the healing of the nerves. Patients, who wait too long for surgery, are at risk of having vestigial pain. Pain is also a very subjective measure and as such has very real contributing psychological components, such as depression.
Q. Do you take patients with psychiatric problems?
A. Yes. Prof. Dr. Bertagnoli does not use psychological tests for admission screening, although many doctors do. It is ProSpine's position that people with psychological problems have the right to treatment, which will mechanically rectify their spine. ProSpine is aware that these patients have a much higher risk of being chronic pain patients.
Q. Does depression and long-term use of pain medication lead to problems?
A. Patients, who are depressed, usually have a low pain threshold. Long-term use of pain-killers also can lead to low pain thresholds and depression. However, ProSpine's concern is the treatment of all types of people (even the high risk ones) and not excluding patients, who may not help our success rate numbers look better than they already are.
Q. How long should I wait to have my surgery?
A. Until chronicity is established, which is six months after the start of the pain. Also, there is a possibility you can have spontaneous remission. Note: the term chronicity here is not to be confused with the medical term, chronification. The medical term, pain chronification, means that the nerves learn pain and remain in pain even after the cause of the pain is removed.
Q. Can a person wait too long for surgery?
A. Yes. This is particularly true for patients, who are candidates for artificial disc replacement and other forms of spine arthroplasty. Events such as partial or full autofusion or gross distortions of the vertebrae can occur from degenerative disease, which makes spine arthroplasty impossible. However, only tests can determine if a patient has waited too long. Also, the patient should know that pain chronification from nerve damage could develop and while they benefit from the biomechanical correction of their condition by the surgery, they would not have relief of their pain. There is no set calendar date, because degenerative disc spine disease (spondylosis) progresses at different rates in different people.
Q. What if my pain comes and goes, is that still chronic?
A. Yes. It is very common for back pain to come and go. As the condition progresses, the times between pain events will shorten and the pain will increase.
Q. How long must I wait for pain relief?
A. Except for the incision wound, most patients experience an immediate relief of the spine pain. Lumbar patients may experience other abdominal discomfort associated with the surgery, but this will normally fade in a day or two. With some patients total spine pain relief make take days, weeks or months. With severe cases total relief may never come. Some discomfort from ligaments, tendons and muscles, which have shrunk during long spine segment compression, may be experienced. Patients do get taller!
Q. Why do I need a bone density test?
A. A bone density test is required of all ADR patients. Inadequate bone density can result in subsidence of the prosthesis. However, Prof. Dr. Bertagnoli has developed a bone treatment, which makes bones not normally suitable to receive an implant, capable of receiving an implant. Bone density tests are easily performed in Germany at a very low cost (under 100 EUR) to the patient, if the patient does not get one in the US.
Q. Does Prof. Dr. Bertagnoli only implant the Prodisc?
A. No. Most other discs are available. However, the patient should discuss disc choice with Prof. Dr. Bertagnoli before surgery, if they want something other than the Prodisc. There are many factors the patient may not be aware of in disc selection. Some of these factors are discussed by Prof. Dr. Bertagnoli with patients on our video page.
Q. How many Prodiscs have been implanted?
A. Over 80,000 world-wide.
Q. Why does Prof. Dr. Bertagnoli make the patients wear a neck or back orthesis (soft neck collar or plastic back brace) after ADR surgery, while other doctors do not?
A. The orthesis is to remind the patient to limit their range of motion to 80% of their normal range of motion. This is important, because extreme flexion or extension could disturb the knitting of the bone to the ADR or cause the ADR to migrate (slide). Prof. Dr. Bertagnoli's patients have not experienced such a migration to date and we want to take all measures possible to prevent this from ever happening. The surfaces between the ADR and the vertebrae should remain as undisturbed as possible, while knitting together. The first two weeks after surgery are the most critical for bone knitting. Instructions are given to the patient on how to wear each orthesis. After six weeks neither orthesis is need.
Q. What about physical therapy, spinal decompression chairs at the chiropractor, massage, heat, cold and other conservative treatment?
A. Conservative treatment should be tried for six months before getting surgery in most cases. Ninety percent of all disc herniations require no surgery. If the pain persists after six months, you should inquire about surgery. However, if you have paralysis or incontinence, or you are diagnosed with paresis, spinal stenosis or myelopathy you should seek immediately treatment. If you have neck pain and have lost control of your feet or have tingling in your feet, you should seek immediate treatment. If you have any doubt about when to seek treatment, please seek a medical consultation immediately.
Q. Are high-speed Internet connections available?
A. Yes, WIFI in the hotels and/or an Ethernet plug-in cable at the hospitals.