SpineNevada, or other ADR options in U.S.

[jimb]

I've been trying to evaluate my options in the U.S. as well as Europe. I would really like it if I could find someone closer to home who could do an ADR placement so if I need follow-up I can get it. Since this is spinal surgery, seems like chances of needing follow up are not at all remote! SpineNevada looks like a good option on their website - looks like they use the ProDisc C and Prestige. Anybody know anything about their reputation? They have Dr. Lynch and Dr. Sekhon. They've done over 300 ADR placements. Does it really matter if you've done 300 or 3000? I'd think after a couple dozen a good surgeon would have it down. My Neurologist thinks so, and there are others on this forum (like CP7959) who also firmly believe this is true.

Implants in U.S. may not be as technologically advanced as Europe, but I don't know how to evaluate which 'Technologically Advanced' designs are ok. Stenum and others use Spinal Kinetics M6 (looks like best to me), but Drs. Zeegers told me he's had to remove some of these, and that the LDR Mobi C is better. Then I've heard Dr. Bertignolli uses Prodisc Nova. Auggh... I'm not a Doctor, so I don't know. Getting frustrated. SpineNevada is an 8 hour drive for me, so that sure would be nice. But certainly don't want to make my decision based on that.

Thanks!

------------------
- Injured playing football in 1978, and subsequent car accidents
- Many bad experiences during 20+ years of ill-informed Doctors insisting nothing was wrong
- C5-C7 fusion 2002 (helped tremendously for a while)
- C4-C5 Stenosis, bulging disc and left foraminal narrowing at same level

[Harrison]

Originally Posted by jimb

...but Drs. Zeegers told me he's had to remove some of these, and that the LDR Mobi C is better. Then I've heard Dr. Bertignolli uses Prodisc Nova... Auggh...

Well, as many here know, there's been many different removed lately, and that's unacceptable. If M6s are being removed, can we know why? In Steve's case, it was attributed to subsidence -- without any more information than that.

Careful, people. I don't like patients getting little "teaser bits" of information on this forum from highly paid Euro-German surgeons. I can't stand the thought of this forum becoming a battleground of pawns (we patients) to "market" hardware that surgeons helped design (Zeegers-Mobi; Bertagnoli-ProDisc/Nova). So, make it better! Ask Dr. Zeegers why these devices failed. If he's amenable, I'll do (another Q & A with him).

It's a shame too, as my personal opinion is that the Mobi C is one of the best out there. For the record, I don't like titanium devices for reasons that have been published in hip/knee other arthroplasty literature (mostly infection-related).

[annapurna]

In the early days of ADR in USA, they tended to talk of surgeons passing the 100 mark. If you went to one who had done less than 100, you needed to be desperate enough to be willing to accept whatever you got. If you were still willing to be picky, you tended to be advised to look for someone with 100 or more ADRs

As for the designs, pick one you like. As far as I know, there have still been no patient to patient comparison trials to see which ADR is actually better. Bench-top studies tend to show improvements but, speaking as a long-time designer of bench tests and analyzer of experimental data, bench-top testing tends to give you the answer you design the test to give.

[jss]

Originally Posted by jimb

... Since this is spinal surgery, seems like chances of needing follow up are not at all remote! ...

Ditto! Of the two reasons that I went to Europe for ADR, one was that I simply did not have the money required to have it done here in the US. One of the concerns that is foremost on my mind is that of having a problem that requires acute medical intervention. That would put those like me that went overseas in a precarious situation.

Originally Posted by jimb

... Implants in U.S. may not be as technologically advanced as Europe, but I don't know how to evaluate which 'Technologically Advanced' designs are ok. ...

A dilemma we all share. I made my decision for the M6 based on my lifestyle, analysis of the device (I'm an engineer and have two pre-med degrees), the short history of devices on the market, and available funds. I felt for my circumstances that the M6 was best, followed by the Nuvasive Neodisc and then the Mobi-C. Had I been more sedentary I would have probably chosen a ProDisc-C or Prestige.

But the question remains, did I choose the right implant for me? The unfortunate answer is ... I don't know and can't know for possibly many years.

I believe that there are many aspects to choosing the right device, and that the right device for one person is not necessarily the right device for another person. I certainly wish you the best in your quest for the right implant.

Good luck!

Jeff

[CP7959]

For what it's worth here are the questions / criteria that I ask myself now. It helps me stay focused on what I feel is best for me.

1. Pick a good surgeon close to home. One who can perform the surgery and give you your best chance for a succesful outcome. But can be there if you have a problem. For me it's in the states.

2. Cost. We all have only so much money. For a single level in Germany it's in the $30K's, India, France, England, you can be anywhere from low teens to $30K's. In the states you can go anywhere from the high teens to $40K's.

3. ADR type. Long term results are not available for any of these devices. The M6 does sound the best (I have 2), but who really knows. So as time goes by we will all learn.

My preference is the Prestige ST. It fits my criteria. It's FDA approved so I can get it close to home with experienced surgeons. It's cost effective and removal is 4 screws away. I will be ready for the next great thing in xx years. If it doesn't last or there is a problem.

The Presitige ST is probably not a consecutive multi level solution due to anterior fixation.

My opinion on the Pro Disc (FDA approved) is with a large center keel, there could be significant bone loss if removal was required. It can however be used in consecutive multi level solutions.

For the M6, it appears they are getting ready for FDA trials. So hopefully it's not to far down the road if this one is preferred.

This is only my opinion. I hope it can be helpful.

[CP7959]

Jim,

Have you seen this.

http://www.spinalneurosurgery.com/

Hope this helps with your decision.

[jimb]

Harrison - I will try to find out what Zeegers doesn't like about the M6. We just haven't connected again via IM, but I've sent him another email. I'll post what he tells me once we get in touch.

jss - I think you make a good point about what considering your lifestyle when picking the disc design. Downhill Skiing and also Backpacking are among my very favorite things in the whole world. It depresses me greatly to think I'd have to give up skiing. Also love horseback riding with the wife. I'd like to be able to ride a mountian bike again someday too, even if it was just on easy trails. The more I think of it, getting an older implant without shock absorption would be a very bad idea for me.

CP7959 - Thanks for your recent advice during our phone discussion. I appreciate your insight very much!

- Jim

[Harrison]

Thanks Jim, but what I was inquiring about the implication you reported from Dr. Z -- that these M6 discs were being removed from patients for some particular reason. If this is true, we need to get to the bottom of it. If he can present the facts describing the "common" factors leading to revisions, that's what we need to know -- and it would be appreciated by many people here.

There are all-too-many reasons why these surgeries can go wrong (you've all read the very first topic in this forum about risks and contraindications...), so let's learn from one of the pioneers himself. Please let us know as soon as possible!

[jss]

Originally Posted by Harrison

... the implication you reported from Dr. Z -- that these M6 discs were being removed from patients for some particular reason. If this is true, we need to get to the bottom of it. If he can present the facts describing the "common" factors leading to revisions, that's what we need to know -- and it would be appreciated by many people here.

Yes Jim. Having just had two M6's implanted in me, if Dr Z-- is aware of some specific problem that often requires removal/revision, I'd very much appreciate knowing what it is.

[kimmers]

jimb,

Interesting discussion. I agree with the above that 100 surgical procedures by a surgeon is considered a watermark. I have read that in several different places/publications.

There is a learning curve with new technology and I mean technology that a particular surgeon has not used before. However, I can say with some laughter that I was somewhere between No. 7 and No. 15 for my ProDisc. That surgery turned out well. It actually did but (too bad I have another bad disc at a different level).

Now, my surgeon is at least over 40-50 lumbar ADRs done? He might be over 100, they were doing a lot last time I checked. I don't know for sure. But he did have a lot of experience with cervical ADR before he did lumbar ADR and he had lots of ALIF experience and has a top-notch vascular surgeon.

There are several factors. Surgeons will say that any surgeon can make a mistake. Like they say, s*** happens.

Sekhon sounds really good. I knew next to nothing about him until i did research on him for my appeal. He is experienced. I don't always think that the "top' surgeon is the best surgeon. The surgeon has to fit the patient. It just depends.

good luck,

Kimmers