Would you consider this Mobi-C failed and what would be the next step?

Hello @danylko and welcome to Mayo Clinic Connect. It is good that you are seeking support when you are feeling doubtful and concerned.

Feeling instability in your cervical spine must be very concerning. I would have to think that despite what you may have been told to date, this is worth another opinion at another hospital. Have all your consults, to date, been at the same hospital? Have you seen other doctors for additional opinions?

@danylko I am a spine surgery patient from Mayo, and I had to decide between artificial disc and fusion of one level at C5/C6. I had read a lot of research before I made that decision. I wasn't a great candidate for an artificial disc because I had 2 mm of slipping of my vertebrae past each other. In clinical trials, having 4 mm of slipping disqualified patients from getting an artificial disc. Other things that can happen are that the spine can grow bone around an artificial disc to try to stabilize it, and mechanical devices can fail. There can be immune responses to foreign materials in the body. Screws can pull out and devices may migrate.

I chose fusion over an artificial disc.

Here is some information on case reports of failure of the Mobi C artificial disc. This link to an abstract in the Journal of Neurosurgery allows you to download a PDF version of the article for free.

The Journal of Neurosurgery
https://thejns.org/spine/view/journals/j-neurosurg-spine/33/6/article-p727.xml
The Nerve
This case literature from Korea describes mechanical failure of the Mobi C that caused paraplegia in the patient that was addressed with emergency surgery.
https://www.thenerve.net/m/journal/view.php?number=237
Seattle Science Foundation
Here is a surgeon's presentation at the Seattle Science Foundation about Mobi C failure:

It helps to first understand a little bit of terminology when the doctor talks about the "ALL" and the "PLL".
That is the "Anterior Longitudinal Ligament" and the "Posterior Longitudinal Ligament" and these stabilize the spine running the entire length of it in front (anterior) and back (posterior). He discusses that part of these ligaments that were removed during surgery may be a possible cause of Mobi C failure.

This link shows the anatomy of ALL https://radiopaedia.org/articles/anterior-longitudinal-ligament?lang=us
This link shows the anatomy of PLL https://radiopaedia.org/articles/posterior-longitudinal-ligament?lang=us

The annulus is the fibrous outer layer of a spinal disc.

ADR is the name of the "artificial disc replacement" surgical procedure.

Video
"Mobi c failures in cervical arthroplasty patients Varun Yadav, MD"
https://www.youtube.com/watch?v=Q_35A1pa9kI
I agree with Amanda, that an opinion at a different facility with a spine specialist would be a good idea. To my eye, your imaging looks similar to what is presented in these cases on Mobi C failure, but because this is a patient forum, no one can give you a diagnostic answer. That must come from a specialist in the field. Not all surgeons do disc replacements. Some only do fusions. My surgeon at Mayo (Jeremy Fogelson) did both fusions and disc replacement and he was a valuable consult for me a few years back. I have not had any other spine issues and I am 6 years past my spine fusion surgery.
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
Do you have a spine specialist in mind for an opinion about your Mobi C disc?

Thanks for responding @amandajro

Thanks for the response. Yes, I have gotten many opinions for this issue. All which have varied. I did not go back to the surgeon who did this surgery since he claimed everything was fine and that it was just a "bad x-ray" on all my post-op visits, without taking additional x-rays to make sure.

Here is what was told to me on them all. None were all at the same facility and all were virtual consultations due to my inability to travel because of this. I am in NJ but wanted to seek out some of the better specialists.

1. "Looks like the Mobi-C failed, replace it with a ProDisc or try a fusion without a plate at one level. Unclear of which approach would be best", recommended me to a specialist in ADR more verse in this case. (Orthopedic Spine surgeon from TN)

2. Surgeon that was referred to me by the above. "Mobi-C failed, causing instability and hypermobility. Needs to be replaced with a ProDisc or a Simplify Disc." Put the surgery on the table for me. (Orthopedic Spine Surgeon from TX)

3. "If you can't walk OR you can't drive/sit in a car, then I'd go to the ER. I see what the problem is, and it's complex. but your insurance is covering my practice so I can't see you" (Neurosurgeon in NJ)

4. "I wouldn't do anything. This looks ok to me but I'm not an expert in these type of things. If you come back to me then I'll refer you to a friend in Philly" (Original Neurosurgeon in NJ who did my first fusion surgery)

5. "I would need to do an EMG, Epidural and Steroid injections first to determine where the pain is, then to PT and if we do a surgery it would be a posterior approach using a spacer depending on what we find. I'm not sure if it's the mobi-c level or a fusion level that hasn't fused after 6 months treatment like this. I wouldn't remove the Mobi-C if we do this though at that level." - Orthopedic Spine Surgeon in NJ after explaining it's instability and not necessarily pain related.

6. "The Mobi-C is 100% bad. I agree with Surgeon number 2's approach. I'm actually friends with him but don't know your case until now, but feel changing to a ProDisc is a risk worth taking. Actually, I'd probably do a hybrid surgery in replacing your fusion since half didn't fuse after 2 years and then this failed Mobi-C, and I'd have a 4-level fusion as a backup plan on the fly in case I don't see room for a ProDisc" - Orthopedic Spine Surgeon in NYC

To be honest, I liked Number 6's approach the best but I don't like that it's just a "risk" and also that he's out of network with insurance. My concern is replacing my current fusion, which everyone has said was absolutely the right move, especially since I feel I have no actual symptoms from there due to the hardware being very stable.

Naturally, I'd like an opinion or option from someone that may see fit of more of a guarantee to get me to 90% quality of life at the minimum instead of the 50% I'm currently living with now (though an improvement from the 10% I was living with prior to these surgeries). I was guaranteed 80% from the Mobi-C and all it did was set me back I feel.

@jenniferhunter I appreciate all the detailed information as well! I'm aware of most of these but hopefully it's helpful in the future and may take a glance at some of the information that I haven't seen as well. You can see me response to Amanda above about the opinions I've seeked.

I sort of wish that the 4 level fusion was an option presented to me at the start of this all. I would have chosen it. As a matter of fact, I asked for it during my first surgery and was told no. The bigger issue is that I have one good level between it all. I do feel my vertebrae were slipped more after the fusion though, so going ADR was a risk I had to take since it was only option presented. The good news is, the pain is gone. The bad news is, I'm much more unstable than before. I've had moments though where I felt stable so there is hope, but those are few and far between.

Thanks again for all the information and sharing the doctor whom you chose. Looks like he's over in Rochester, MN. I've actually been there once in 2019 and loved it there. It was around this time when my condition started to get worse actually. I'd totally go back though if it meant a nice fix up for me, and probably enjoy the simple 5 block city again 🙂

@danylko if you should decide to revisit Mayo Clinic in Rochester, MN, you may use this link to request an appointment: http://mayocl.in/1mtmR63

Actually I have severe kyphosis in my back. I was wanting to find out about spinal fusion surgery for this problem. Thanks

@rball202 Hello and welcome to Connect. Have you consulted a spine surgeon before for this condition?

Some of these spinal deformity surgeries are big surgeries with long recovery times. The surgeon I mentioned previously, Jeremy Fogelson, at Mayo Rochester, is a spine deformity expert and would be a good surgeon for a consult about kyphosis. My spine surgery was a cervical fusion because of a damaged disc. I have read about kyphosis, and surgery may involve placement of support rods onto the spine for the patient to be able to stand erect. Bone quality is very important if anything needs to be screwed into the spine. For example, if kyphosis is happening because of a spontaneous spine fracture due to osteoporosis, they may not be able to use spine instrumentation hardware. In that example, sometimes, a procedure is done with bone cement to support the spine after a compression fracture. Here is a link that describes kyphosis and treatment. My dad had kyphosis and my mom had a compression fracture, and was not a candidate for bone cement because of the degree of osteoporosis that she had.
https://www.mayoclinic.org/diseases-conditions/kyphosis/symptoms-causes/syc-20374205
Are you having mobility issues because of your spine?

Thank you for your response Jennifer. I am 64 years old and have had humpback(I don’t like that word)kyphosis for several years. I have never been to a specialist for this just my primary.I am still working and am retiring on November 1st this year.

I have done a lot of online research about my kyphosis. The only thing that I found that actually fixed the appearance of it is before and after spinal fusion pics. I won’t look at a mirror when I go by it because of it. My friends and girlfriend always ask me “why don’t u stand up straight?” I would if I could trust me. I have chronic pain in my back and neck.
I know the surgery is terribly risky. How does the saying go ? Desperate times call for desperate measures. I have also been reading articles about older people having pretty good luck with it.
As far as if I am a candidate I have no idea. I believe my problem stemmed from years of labor intensive work and racquetball. So I basically developed really bad posture.

It is a seven hour drive for me to come up to Rochester. But I am definitely thinking about it. Do you know if I live in Illinois they can do any kind of video conso?
Thanks sooo much for your help
Jeff

@rball202 Jeff, have you tried any physical therapy to address your posture? Sometimes it can help. I have done therapy with a gal who also does myofascial release. My dad had kyphosis, and doing some MFR did help him a bit, but it didn't last because he was elderly and wouldn't change his habits.

The front of the chest can get too tight and we do so much with our arms in a forward position and we can get stuck like that. It helps to stretch that out because it counters the back muscles that oppose the muscle on the front. What also helps me a lot is building core strength to support the spine, and the best way I do that is by horseback riding. I sit up with good posture and I have to counter all the movement from the horse just at a walk, and it exercises my back and core muscles all over. The more I do this, the stronger I get, and the stronger my legs are from balancing in the stirrups. There are therapeutic riding centers where you can work with a therapist, and they would not just turn you loose on a horse. You may want to ask your physician if this is within your capability.

I had to break my old habits too. When you are a spine surgical patient, it matters. Bad posture can stress your spine further above and below a fused level and lead to more surgery. There is always a tradeoff, and you will trade some motion ability for a more rigid spine, so there needs to be a significant reason to make that choice. My surgeon told me the best way to keep from needing his services again is to build and maintain core strength. This is best advised by a physical therapist or medical professional as to what exercise is safe for you to do.

Maybe you can avoid back surgery, but it will take work and dedication on your part. My surgery resulted from an injury from a whiplash that happened years ago.

Here is our discussion on myofascial release. The first pages have lots of links to information and there is a provider search at http://mfrtherapists.com/

- Myofascial Release Therapy (MFR) for treating compression and pain: https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Have you heard of MFR before? What do you think about this? Have you tried physical therapy for your back?

Jennifer

Good evening Jennifer
Sorry it took me so long to reply,work has been very busy.
I have tried physical therapy and see a chiropractor often. The chiropractor does help,with not only my back but my neck also. I have never heard of MFR therapy. I will certainly do some research on it. My issue is if insurance doesn’t cover it I can’t afford it.
As far as horseback riding it sounds like an excellent way to work on core strength. I will check on that also. I am retiring on November 1st so I will have more time to work on different ways to help my kyphosis.
Do you know anyone that has had spinal fusion surgery to fix kyphosis? I would love to talk to someone who has had it done. Actually I was reading that more elderly patients were having a lot of success with it.
I really think mine is been like this for so long surgery might be the only thing to fix it. But something tells me the surgery is way too risky so I just need to live with it.
Thank you for all your advice.

BTW I saw the video about the portrait of your surgeon. You are a very gifted artist.