Big decision: US and prodisc C or Europe M6

[DAnn]

Hi all,
Just to get you up to date, I am scheduled for a hybrid cervical procedure (fuse at C6/7) and Prodisc C at C5/6 this coming Tuesday. I have total faith in my Doctor as I believe he is one of the best in the US, or the world for that matter. I absolutely trust him and really can't imagine anyone else that is as good.

My concern follows: I have researched a bit (not an engineer) and "talked" to some of you members about how superior the M6 is to what is available here in the US.

I did talk to a UK surgeon yesterday, and he agreed totally with what my doctor is able to do here in the US--although we are limited here by the cervical devices. By the way, I really liked him too.

He would not do a double adr with the prodisc, but thinks the hybrid is ok.
In fact, he mentioned that he might find, given my degeneration, that he would have to do a hybrid too.

I'm lucky in that I can afford to go overseas and pay all of it out of pocket, although it will be a big hit to our financial plans going forward. My worry is that I've already "told" everyone and my family, work, church and all are here to support me next week. I think they will roll their eyes if I change plans.

Plus, if my hybrid ends up turning into a fusion ( The HO issue) and I end up with the same thing in the UK, what is the difference?. The UK dr says he can do a double M6, although my C6/7 is pretty bad and he might have to do a fusion at that level.

The two things I worry about is the movemeht issue with the prodisc, and the impact on the facet joints. The UK dr said it looks like I have some minor wear, and that the prodisc might aggrevate that. Also, the hybrid vs 2 level adr --if I did actually get a two level M6 adr would be superior and the recovery sounds like it is much better.

My concern here in the US is about follow up care, if you back out of surgery here. I would hate to lose my current surgeon.

Your thoughts and prayers are welcome, as I know this is a short time period to be asking for suggestions.

Plus, any of you that have postponed surgery, after all your family and friends were planning to help??, how has that gone.?
Take care everyone, and please wish me peace of mind and good luck!
DAnn

[MarkH]

DAnn, I wouldn't worry about postponing the decision. At the end of the day it's a huge decision and I doubt that your friends or family will have any issues whatsoever with you considering other options.

My doctor didn't have any plans to test me for an allergic reaction to the materials involved in the ADR, and I considered delaying all family, work, and surgical arrangements until after I could test for allergies. Ultimately I decided to go with the ADR replacement as scheduled without allergy tests and realize that it might bite me in the butt. I do strongly feel that my friends and family would have understood the delay, and yours will also. The people who care about you will find a way to be there either way.

Sincerely,
Markh

[JPJH]

It's your mind & body. Do the surgery when both are in sinc and ready to deal with the surgery. Let people roll their eyes......that's their problem. As for holding off on the surgery if your surgeon is really anyone worth having do the surgery they will understand. If they don't then maybe they should not be doing the surgery in the first place. I saw my surgeon as UCSF for two years prior to deciding to go to Barcelona and have Dr. Clavel do a two level Cervical ADR using the M-6. My surgeon at UCSF was very supportive and has continued my follow-up care since my surgery last October. If fact I was just there last week for my second follow-up with him. He understands it's about me and not about him.

It's a tough call we all know. But you do need to be ready for surgery and that would be any surgery not just this one.

All the best to you.

JPJH

[Harrison]

Mark, JP: nice posts as they are thoughtful and born of experience. Thanks for posting.

DAnne, even the cervical fusion outcomes are pretty good, if that's any consolation. I know many people that had them years ago, and they are doing fine.

This is only my opinion, but I prefer the ProDisc over the M6 for a slew of reasons; basically, there are less materials and less parts. Yes, the kinematics are better in the M6, but these are less critical in the cervical spine than in the lumbar segments, where torsion & stresses are more severe.

I don't like that both the ProDisc and M6 require some serious bone cutting, but that's also why I've been such a bigmouth on the importance of NSAIDs after cervical ADR with keeled devices for years now. You probably saw my posts on this.

Again, only my opinion here! Hope this helps.

[DAnn]

Harrison, thank you so much. I do appreciate your opinion.

This is really good to hear. I will certainly bring up all my questions tomorrow with my doctor at the pre op.

Any thoughts on the hybrid part of my procedure? That will mean no nsaids until it fuses. I'll start taking them as soon as I can (as I much prefer them to other pain meds anyway), which I think is at three months.

Thanks again for this place where we can all share our concerns and learn from others. I also watched the DVD and it was very re-assuring.
DAnn

[DAnn]

Mark and JP,
Thank you for sharing. These are very thoughtful posts and they give me strength.
Thanks,
I'll keep you posted.

DAnn

[jss]

DAnn,

Lots of difficult issues to decide on.

I know that it is an issue and always will be, but would encourage you to not let what your friends and family think about changing your decision at the last minute effect whether you actually do or don't change your mind. You get to address these levels a first time only once, so it is important to not let things that have no bearing on your treatment effect what that treatment will be.

Per my experience, finding a doctor that will follow up with you in the US can be an issue if you go overseas. In the year and a half since my double ADR in Europe I've been fortunate in that I've had no issues. About a month ago I realized that I'd had no follow up since five days after surgery and thought it wise to have a local ADR surgeon look at me. So I called up TBI in hopes of seeing Dr Zigler who was initially going to do the surgery here. After a week of not being called back I called them again. I was told that not only would Dr Zigler not see me, but neither would any of the other of the TBI ADR surgeons. I was told, "Going overseas is a decision that you made, and we don't provide the service of following up with those that decide to go overseas." So it is an issue.

If you have the ProDisc hybrid here or the M6 hybrid in England, you're going to do great. Either way, you'll be on the "other side" soon.

Good luck, Jeff

[catelynnw3]

Hi D'Ann,

I agree that you shouldn't follow through with a surgery if you're not totally sure regardless of how other people might react ~ including your surgeon. Of course, I don't know if anyone ever goes in to a surgery like this without some apprehension.

I don't think I mentioned in my previous PM that Dr. Cappuccino (who recommended 3 levels) said he'd do a Prodisc on the top and bottom with a fusion in the middle because of the risk of splitting the bone at the adjacent levels with the large keels. I'd feel reassured that both the UK doctor and your surgeon are in agreement with a hybrid if you go with the Prodisc.

So basically your decision is between a hybrid with a Prodisc done here, two M6s in the UK, or possibly a hybrid with an M6 in the UK. I guess my questions to your local surgeon would be regarding your facet joints and the Prodisc. Also, does the amount of axial rotation affect the fusion below during healing (or after) at all? I assume you’d wear a collar for a longer amount of time to allow the fusion to heal properly, but does the temporary immobilization effect the level with the ADR? One more thing is whether he uses bone wax at the level of the ADR since that is supposed to help minimize the chance of HO

I hope your appointment goes well and either confirms your decision or helps you to confidently proceed in another direction. You are in my prayers!

[DAnn]

Thanks Jeff and Catelynn,

Your replies mean VERY much. I did see my Dr. today and I am going ahead with the surgery tomorrow. I've got to go get ready for a very early surgery so have to run now,
But I will have my husband keep a journal of everything.
Your support means very much.
DAnn

[Jstuckey]

Hope you are doing well. In my thoughts today.