referral to surgeon in Europe

[Cheryl0331]

I have read some about Dr. Clavel in Spain and Dr. Bertagnoli in Germany; which of these has done the most levels in the c-spine that include the c 2/3 using ADR? Thank you, Cheryl :confused:

[jss]

Cheryl,

I'd bet that Bertagnoli is the more experienced of the two. I know that he's been around longer and has been doing ADR's longer. But I wouldn't know who's done the most C2/3's. I know that access above to the spine above C4/5 is difficult. One of the reasons that my double ADR took 3.5 hours was due to the difficulty in accessing C3/4.

Good luck, Jeff

[marlin5353]

Hi Cheryl;

I would have to agree with JSS that Dr. B. would have more experience. I have been in contact with Dr. B for them to look at my MRI's and I actually have been dealing with Dr. Andrea Fenk-Meyer who seems terrific and has explained everything to me. She mentioned she would do the surgery unless I specifically asked for Dr. B.

The question when considering Clavel and B is not experience as they are two of the most experienced but rather the device you prefer. Dr. B has a investing interest in the Prodisk so you will most likely get that device if going to them where Clavel will do the M6.

Good luck in your journey. I soak all the information up that I can get from all the great people on this forum so that I will be able to make the best decision possible when/if that day comes.

Good Luck.

Mark

[LauraB]

Hi Cheryl,
I am also in a similar situation as you. I have contacted both Dr. Clavel and Dr. Bertagnoli about a multi-level cervical ADR. From my own research, both surgeons are highly rated from their patients based upon excerpts I have read. Both have performed countless surgical spinal implants, and I'm sure that you would have a good outcome with either. At this point in time, my preference is toward Dr. Bertagnoli. His colleague, Dr. Andrea Fenk-Mayer has already been in touch with me and both have extensively reviewed all of my diagnostic tests. Their office required more extensive history and data. After reading about Dr. Bertagnoli, I am impressed with his outstanding credentials and background knowledge. I feel very informed about his philosophy and treatment protocol.
Just for the record, I did read under his "ProSpine" website - under the subtopic of "Engineering" that he is not contracted with any manufacturer of a device and is free to choose the best implant for the patient. I am leaning comfortably toward the M6.
On the other side, Dr. Clavel's office quotes a fee that is inclusive of your surgical experience, hotel, and aftercare. Dr. Bertagnoli's office will assist in discounts and suggestions about your hotel and travel, but I believe, base their surgical fee on the medical aspect of your trip. As I communicate more with both offices (determining my final decision - which I must do quickly), I will be happy to stay in touch. Please feel free to contact me as well with any information or findings you may have. Best of luck to you

[marlin5353]

I speak on this with no personal experience with Dr. Bierstedt in Germany but have researched him and looks like a good surgeon with some very positive results on this and other forums. What I like about Bierstedt is that physiotherapy is included in his price. I think that is so important with any surgery let alone such a major surgery.
Cheers

Mark

[mary2013]

Just for fyi, I specifically requested the M6 from Dr. B and was refused based on his "center of rotation" theory that is posted on his website. He is patented for the ProDisc and that is what he recommends.

[NJ Gene]

I just need to add my two cents. It sounds like Dr. Bertagnoli is going to lean towards pro-disc, whether it's a financial interest or a patent. It sounds like it's his "baby". If you want pro-disc and have done research and think that is the best device for you, then by all means, use him. If you want the M6, then stick with Dr. Clavel, Dr. Bierstedt, or Mr. Dare. The research ought to be amongst those 3, leaving Dr. Bertagnoli out of the equation. I must add that it is a nice service when hotel arrangements are taken care of and included in the package. When going abroad for surgery, one has enough to be concerned about without having to make these arrangements.

[LauraB]

Mary2013 & NJ Gene

Thank you for the clarification of Dr. Bertagnoli's interest in the ProDisc. This is the type of information I have been looking for and may have misunderstood.
In my opinion as well, I agree with NJGene about paying for everything inclusive in one package. There are far too many loose ends when making travel arrangements and you want to consider a surgeon who has a corporate account set up with an airline - in case you need to make date changes (?)

[Cheryl0331]

I can't tell you how valuable this information is. You have all given a lot to consider. I think I have what I need for now...Keep me updated if anyting else comes to mind! Cheryl

[NJ Gene]

LauraB, Unfortunately I think you are on your own with respect to the flights. I think the most important thing to do is get travel insurance. The cost of it is minimal (perhaps $100.00 per traveler to go to Europe). I always get this regardless of whether I fly domestically or internationally. It paid off a couple of times, once when my wife was diagnosed with Breast Cancer (thank goodness she's now ok). We had to cancel a vacation to the Caribbean. Also, years ago, my Dad was ill and we had to cancel a cruise. Besides non-refundable cancellation costs, it provides coverage for lost luggage, costs incurred in travel delays (i.e. hotel if you miss connection on last flight of the night), costs to change flights (need to come home sooner than expected) due to illness, and supplemental car rental insurance. It even covers emergency medical costs. Unfortunately, herniated discs are a pre-existing condition and this insurance won't cover you for that.

In terms of planning your trip, I believe you should allow for the time that the ADR surgeon you choose recommends. If you need to stay longer, the surgeon can sign off on the insurance claim form to cover the change fee. It can't hurt to ask the surgeons you are considering if they have deals with certain airlines. I know that Dr. Ritter-Lang has a deal with Lufthansa, but I would stay away from him based on everything I've read on these boards.

I hope this helps.

Gene

[LauraB]

NJGene: Very good advice about the travel insurance. I've always used it, but didn't even consider it as an option; why? I don't know - logical and good common sense. Thank you.

Cheryl, I recently joined this forum about a week ago, and have learned more from the members and their experience than I could have researched on my own. My eyes are wide open. I have just been quoted from Dr. Bertognoli for my 2 (possibly 3) level cervical ADR. I am gathering all my information and will be happy to share with you. I haven't heard from Dr. Clavel in a week. All of my information had been forwarded and received 10 days ago. I'm still waiting on Dr. Bierstedt and I have contacted the Texas Back Institute (Dr. Zigler) - all bases are covered.

[Stonewall_Boris]

Hi LauraB,

I don't think you'll go wrong with any of the doctors your considering.

This is what I did. When I had my MRI and X-ray images in digital format I sent them to 6 doctors/hospitals, 3 in the US and 3 in Europe. Only the Mayo didn't respond. 5 responses were consistent that I needed 3 disc's done. The responses did have different solutions from fusion, ADR, combination, posteria and anteria operations.

Something I read somewhere, the US is 20 years behind Germany in ADR, I live in Canada and I think we're sadly 30 years behind Germany.

This was going to cost my wife and I a lot of money and I had to know what was seen in the MRI, what did the doctors see in my MRI slides I sent them so I asked. I got a response ( not going to be specific ) this slide, this slide and this slide.

My thoughts were okay, don't know what you saw but it seems about right. I was quite hard on the doctors/hospitals I dealt with, not nasty, but asked a lot of questions before I made my choice.

[LauraB]

Stonewall Boris: I believe that is sage advice. I also sent my diagnostic CTs, MRIs, and X-Rays, along with previous surgical reports and discography to several surgeons. I also was looking for treatment options. The US doctors consensus was fusion (2-3 levels). ADR was suggested by European doctors and with my research added, I agree that it was the better of all - preserving mobility and quality of life. Being your own advocate is your best alliance in this endeavor. I, annoyingly, ask a lot of questions and expect answers.
Dr. Bertognoli with Dr. Fenk-Mayer were diligent about answering all of my queries in regard to the surgery, ADR devices, insurance coverage, payment options, and assistance with travel and scheduling. My expected date of surgery is September 24th - was hoping sooner. (Will post details soon - on another thread).
Dr. Clavel ??? I have heard great things about him, but unfortunately he hasn't responded.
Dr. Bierstedt - had to send my films - may take a little longer.
Texas Back Institute - not sure I want to go that route after some of the negative comments.

Cheryl, question everything! Research the doctors and read the surgical outcomes. It was my best tool in helping me to decide where to go. That...and my husband. While I've been perusing through this site and others for hours on end - he's been practicing his German.

[Stonewall_Boris]

Hi,

I would urge you to ask as many questions that you can regarding your situation. Things like flight info, insurance and accommodation is not really things you should burden the doctor with, in my opinion the only thing you want from the surgeon is what he/she will do. Many places have people that will answer questions about travel, accomandation and such.
One thing I'm trying to get out there, if you travel via plane, let the airline know you are disabled, they will pick you right off the plane and take you to your next destination. But, please, don't take advantage of boarding early and then disembarking as fast as you can.

"the stone"

[Cheryl0331]

Certainly ProDisc C is better than actuall fusion but the M6 looks like it preserves more natural motion. Since I already have adjacent level ddd from the fusion above and below, I feel that ADR is the only option for the c 2/3 and or c 6/7. I can't risk the need for further surgery. The insurance companies would have already saved a lot of money had they approved the two level ADR in the first place! That said, my surgeon did not tell me about these other options; which should be a requirement! I wish I could find a US surgeon that would do the disc removal and I will pay for the ADR's myself. The FDA need to approve the multi levels ADR's and stop the :censor: red tape!!!

[LauraB]

Cheryl, you are absolutely right! The M6 is still possibly another 10-15 years from approval (according to Spinal Kinetics). Fusion is certainly not a logical alternative, but it is the only covered treatment option. I truly believe my 2006 fusion is the root source of my current disc bulges and DDD. ADR's with specific FDA devices are covered only at one level; providing it is NOT adjacent to a fusion. I will continue to fight the good fight with them. I do have the empathy of my insurance company's medical management team and they are assisting me in appeal. When my money is involved, I won't give up.

[NJ Gene]

Cheryl, you might want to check out Dr. Carl Lauryssen, who is based in Beverly Hills. He is a U.S. surgeon who has the most experience of anyone in this country with the M6. I'm attaching a link to his website. If it doesn't work, cut and paste it into your browser: Carl Lauryssen M.D. | spinal Neurosurgeon in Los Angeles | Beverly Hills (http://towerorthopaedics.com/lauryssenfull)

Dr Lauryssen spends part of each year in Dubai working with the M6. However, he can operate on you in CA with it off-label, meaning that insurance won't cover any of it. It might be an alternative to going overseas. Travel will certainly be easier and less expensive. Furthermore, follow-up would be easier. BTW, even if you don't use Dr. Lauryssen, it might be good to get aquainted with him. If you end up going to Europe for surgery, he is one of the few U.S. surgeons who will see you for follow-up.

Good luck!!

Gene

[TPatti]

Dr. Biersstedt is not tied to any one disc. The M6 is probably used most often by him especially for lumbar, but he does use different discs if there is a better fit for the particular patient. I am 2 days post op a 3 level lumbar with Dr. Bierstedt and could not be happier with the care I have received to this point.

[2Confused]

Congrats and best wishes for your speedy recovery!!Dr. Biersstedt is not tied to any one disc. The M6 is probably used most often by him especially for lumbar, but he does use different discs if there is a better fit for the particular patient. I am 2 days post op a 3 level lumbar with Dr. Bierstedt and could not be happier with the care I have received to this point.

[Cheryl0331]

Dr. Biersstedt is not tied to any one disc. The M6 is probably used most often by him especially for lumbar, but he does use different discs if there is a better fit for the particular patient. I am 2 days post op a 3 level lumbar with Dr. Bierstedt and could not be happier with the care I have received to this point.
Where is Dr. Biersstedt practicing? I have not heard this name before. My fear is that a doctor here in the US would say they'd do the ADR and I'd wake up with more fusion!

[TPatti]

Hattingen, Germany
Use the search, there are a few others or this forum that have used him. Link to website, you can send info and images for evaluation:
ONZ Spine Surgeon for Disk Replacement, German Spine Specialists – M6 ADR Artificial Disk Replacement - Stop spine pain now, Lumbar Cervical Spine Surgery (http://www.germanspinespecialists.com/best_spine_surgen.html)

[LauraB]

Cheryl: I felt the exact same feelings as you. I had several US doctors tell me that they can perform the surgery. When asked how many multi-levels they performed, usually can be counted on one hand.

Economically I thought it would be better for me to find a surgeon here in the states. However, since I'm looking at a 2-3 level ADR, I found the Germany doctors to be far more experienced, and the surgical outcomes to be considerably positive. Dr. Bierstedt, I believe, is a high ranking contender. Before hearing back from his office, I had been in continued contact with Dr. Bertognoli (ProSpine - Bogen, Germany). He is a professor, surgeon, and engineer, and had been performing and teaching the procedure to other surgeons for over 20 years. These doctors have the track record.
The cost was very similar, if not somewhat less in Europe. I found the US hospitals to be somewhat ambiguous. In most cases, I couldn't even get a committed "ballpark" cost. Overseas airfare and probably an extra week of hotel fees were really the only "added" cost to a European excursion. In the end, I felt that I needed to "live" with my decision and felt that the extra travel cost was well worth the surgical, healthful outcome.

Google search the doctors names and read about them. You need to feel comfortable. Also submit your information and fill out the patient data forms for a few choice surgeons. Their response will help you feel better about your decision. Also, look up Dr. Clavel, Barcelona, Spain. I've read very good comments and surgical responses about him as well.

[NJ Gene]

LauraB, the information in your last posting was very helpful. TPatti, provided a link to Dr. Bierstedt's website in his posting directly before yours. Here is a link to Dr. Clavel's website: Dr. Pablo Clavel - Barcelona Spine Center - Medical Advantage Barcelona (http://www.medabcn.com/doctors/pablo-clavel) One can also get to him through Medical Tourism. However, it will take much longer to get the results of an evaluation that way. I made the mistake of using Medical Tourism when trying to get results through him. It took much longer than it would have if I had simply used the link above.

If one is interested in Dr. Bertagnoli, he/she can go to this link: Artificial Disc Replacement (http://www.dr-bertagnoli.com/)

Cheryl, you know can now simply click on the links to get to these European surgeons.

Good luck!!

Gene

[LauraB]

Links are always better. I also made the error of going through Medical Tourism while trying to get in touch with Dr. Clavel. I had a lot of contact with the tourism office submitting data, but not a word from Dr. Clavel. When his office finally contacted me - over two weeks later...they told me he was reviewing and will be in touch - still not a word. I don't believe this is typical of his office, based upon other fantastic reviews - i planned on reconnecting, but decided to go in another direction - Dr. Bertognoli.

[Cheryl0331]

Hattingen, Germany
Use the search, there are a few others or this forum that have used him. Link to website, you can send info and images for evaluation:
ONZ Spine Surgeon for Disk Replacement, German Spine Specialists – M6 ADR Artificial Disk Replacement - Stop spine pain now, Lumbar Cervical Spine Surgery (http://www.germanspinespecialists.com/best_spine_surgen.html)
It's good to know that a surgeon takes their time. I wonder what are some of the sever complications of the three being dicussed here? A c2/3 surgery is very risky to say the least. I guess that is where I am stuck. who has the most experience with that level.

[NJ Gene]

Cheryl, Just to clarify where Dr. Bierstedt practices, Hattingen, Germany is not far from Dusseldorf, the closest international airport. If you look on his website in detail, you'll see that. Have any surgeons in Europe come back to you yet with their recommendations? It sounds like you are doing the right thing, looking for the surgeon in Europe with the most experience in ADR. You probably know this already, but it seems that ADR at C2/C3 is almost never done in the U.S. because it is considered too close to the brain. Personally, from everything I have read and heard, it seems that we just don't have the best devices in the U.S. for that type of risky level.

Good luck with finding the right surgeon!!

Gene

[LauraB]

I wholeheartedly agree. That level is a very tricky one and you are going to want to make sure that you choose a surgeon who is experienced. I'm sure everyone will agree that you will find a reputable surgeon in Europe as opposed to the US. No surgery is without risks, but you want to make sure you are in the most capable hands. When you send your diagnostics and data to these surgeons, you are interviewing them. They should be able to tell you exactly how many they have performed. I'm sure if you look at the patient histories of some of the members of this forum, you may find those who have had ADR. Contact them too.