What are some opinions of the ADRs out there?

[LauraB]

I'm still in the early stages of deciding upon my surgery. I have narrowed my decision between three surgeons and are pleased with their backgrounds. Dr. Bertagnoli is in the forefront along with Dr. Bierstedt and Dr. Clavel.
From what I have gleaned off the forum, Drs Bierstedt and Clavel heavily rely on the M6, while Dr.Bertagnoli has patented ties to the the ProDisc. I have read great things about the M6 (but it is still relatively new). On the other hand the ProDisc has similarities to the M6, but I have come across some negative outcomes which were not elaborated upon (other than MRI artifacts impeding clear scans).
I apologize for my "green-ness" in this field. I've only learned about ADR in the past few weeks (My US surgeons never disclosed this as a possible alternative to fusion due to insurance coverage). I have a fusion at C5/6 and need attention to C4/5 and C6/7 with a possibility of C3/4 as well. I want to make the most informed decision with hopefully little regret later........Fusion was my best friend in 2006, but has turned against me just two years later. I've waited five years for this opportunity.

[Harrison]

Laura,

You may want to include American clinics in your decision process. After all, there are many surgeons here that have been doing ADR since 2000. As well the costs have come down, somewhat, on cervical ADRs. These are approximate cash prices for Texas Back Institute:

Two level ProDisc: $35,000

Two level hybrid (fusion and ProDisc): $26,000

A reminder that insurance companies may for some of this, or all of it, depending on the company and its reimbursement policies.

I am not a fan of keeled devices, but I like the ProDisc better than the M6, which has more parts and materials. A simpler design is a better long term solution. As well, kinematics in the cervical spine are important, but not nearly as much as in the lumbar spine, where torsion and loading are more intense.

If you do end up with a keeled cervical device, don't forget to take NSAIDs post-op!

[LauraB]

Thank you Harrison, I really appreciate your input and opinion.
I really would have considered a US location, but found that since I needed a multi level (above and below an existing fusion), it is not FDA approved. My insurance has already denied all aspects of surgery. I was also concerned that cost would be extreme here in the US. My own Neurosurgeon could perform the surgery, but I am apprehensive about his experience in multi-levels. The hospital was an enigma when it came to surgical fees as well. TBI might be an option, but I haven't read enough about US doctors with the background of European surgeons (like Dr. Bertagnoli). My head is spinning.

I feel better about the prodisc now. Thanks.

[LauraB]

Harrison:

Can you provide me with a few names of surgeons who are well-experienced with multi-level ADR's here in the US (of course based upon your extensive involvement with this topic). I just need somewhere to start if I'm looking for an alternative to Germany.

Again, I am not looking for ANY type of fusion. I need ADR at C 4/5 (already
fused at C5/6) and ADR and C6/7. There is a possibility of an additional ADR placement above at C3/4.

Sorry for being a "pain in the neck," both literally and figuratively.

[marlin5353]

Hey Harrison;

Are you saying you prefer the Prodisc in both cervical and in the lumbar? You mention you don't like keel designs yet is the Prodisc not considered a keel device?

When I first started looking at ADR for myself it seems everyone naturally falls in love with the M6 because it looks like a real disc but I hope everyone takes your idea of the thought that " a more simple design is better" and really thinks it through.

Good healing everyone.

Cheers


Mark

[Conan26]

Originally Posted by marlin5353

Hey Harrison;

Are you saying you prefer the Prodisc in both cervical and in the lumbar? You mention you don't like keel designs yet is the Prodisc not considered a keel device?

When I first started looking at ADR for myself it seems everyone naturally falls in love with the M6 because it looks like a real disc but I hope everyone takes your idea of the thought that " a more simple design is better" and really thinks it through.

Good healing everyone.

Cheers


Mark

Hey i kinda agree but i would love to see a doc that uses the right disc for you and not what one they get paid for, i like the look of the active -L as it comes in more shapes and sizes

[Harrison]

Mark, yes, both discs have a keeled design. You can see the actual discs in the Manufacturer's forum, look at the specs and brochures.

Laura, you are not a pain, this is why the community was established in 2004. We try to help patients cut through the baloney!

This is a good topic, sift through it carefully:

http://www.adrsupport.org/forums/f50...doctors-11140/

You will find the docs you need -- see all the different sub-topics!

[ADRADR]

Harrison, would the Freedom Disc be considered keeled? They claim "no excessive milling" but I don't know if it is keeled or not. I think its keeled but less so than the M6.

[LauraB]

I've been in contact with Dr. Bertognoli and Dr. Bierstedt in regard to my upcoming multi level ADR. Now keep in mind I have a fusion sandwiched inbetween the two cervical levels in need of ADR. I have already decided to go with Dr. Bertognoli and the ProDisc C

Per Dr. Bertognoli (copied from a recent email describing his ADR choice)
Prof. Dr. Bertagnoli would use a pro disc c nova model. It`s esp. suitable for cases like yours – multilevel, and it can slip next to a plate without compromising on primary stability.
Dr. Bertagnoli does not favor unconstrained disc replacements, esp not for multilevel: Having a “free core” means no guidance of movement by the ADR, which is intended. And which is close to a physiological discs, which does not have a fixed centre of rotation either. But: degenerated discs are not virgin discs. They as a rule lack the necessary external guiding structures. A natural disc IS guided in it`s movement by ligaments, annulus and facets. It`s not “wobbling freely”. Exactly those structures are involved in the degeneration process, and either are slack, or calcified and tense. In ADR implantation with a good mobilization and regain of disc height e.g. the dorsal and lateral annulus has frequently to be resected. One should not compromise on nerve liberation to keep them unresected. And hence the additional guidance of a semiconstrained disc (like Pro Disc or PCM etc.), are highly appreciated. These factors are the more relevant in multi-level, where positioning can positively influence spinal alignement in semi-constrained ADRs. And these factors in Dr. Bertagnoli`s judgment far outweigh the lack of a “cushioning function" in ball-and-socket concepts. Cushioning in the spine is predominantly provided by the global s-shape.
MRI-options postop are similar in any models made from the same materials – incl. M6. And we routinely do MRI after ADR, with relevant blurring by artefacts only in the immediate surrounding of the implant. Adjacent levels or soft tissue structurs behind the spine at the implanted level are usually well visible. And they are why an MRI is made.


Dr. Bierstedt had actually ''CALLED" me. As mentioned before in another thread, I was very impressed with his personal attention. He explained that the M6 (preference unless size became an issue) because it is the "state of the art" device. I've read its reference in design to be most like the natural disc, that it is called the true, "artificial Disc." Dr. Bierstedt feels the Prodisc needs a more aggressive approach for placement.

BUT, Harrison you've talked about keel design, and being that I'm not an engineer, what are the pros and cons of either device? I really only have the choice between the two????? I've read about both and easily swayed by each doctor's argument. Sorry guys.....I'm not trying to have someone make the decision for me, but just when I feel i'm on the home stretch, something else stirs me in another direction. PLEASE PLEASE PLEASE help me out here. This is the LAST time I'm having surgery on my neck - I know it, therefore I want to make the best informed decision.

[Stonewall_Boris]

Hi LauraB

This might be usefull to you

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