Need opinions of Dr. Bertagnoli and ProDisc

[LauraB]

I know I've put this out there in other threads, but I've decided to go through with my ADR C4/5 & C6/7 which will sandwich my 2006 fusion at C5/6. I chose Dr. Bertagnoli mainly due to his reputation, experience and prompt response to my inquiries. Dr. Bierstedt was my only other choice, but I had concerns about the M6.

Most of the current blogs have been about Dr. Bierstedt and Dr. Clavel. Has anyone out there have prior experience with Dr. Bertagnoli and the ProDisc Nova?????? I just need a little affirmation to get me by while I wait for my surgical date (09/24/13). I know there are some, but I spend so much time sifting through the threads and trying to piece together opinions. My pain has continued to get worse this summer and I can only sit at my computer for 5-10 minutes at a time.

Also, has anyone experienced lack of coordination and a feeling similar to vertigo? In the past, my pain has mostly been confined to the upper extremeties - severe migraines, stabbing pains in the neck and shoulder blades, and tingling/aches in my arms. Now I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*

[NJ Gene]

INow I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*

Laura, Before my fusion at C4/C5, I had some of the above symptoms. Specifically, I had the stabbing pain in the heel which did run up the leg and lower back. I could actually create the pain by bending my neck extremely forward. I was told my surgeon that this was called "L'hermitte s Sign". You might want to Google it to get the exact definition. I suspect that this symptom will get better once that level is treated (regardless of whether by ADR or fusion).

Gene

[Conan26]

I know I've put this out there in other threads, but I've decided to go through with my ADR C4/5 & C6/7 which will sandwich my 2006 fusion at C5/6. I chose Dr. Bertagnoli mainly due to his reputation, experience and prompt response to my inquiries. Dr. Bierstedt was my only other choice, but I had concerns about the M6.

Most of the current blogs have been about Dr. Bierstedt and Dr. Clavel. Has anyone out there have prior experience with Dr. Bertagnoli and the ProDisc Nova?????? I just need a little affirmation to get me by while I wait for my surgical date (09/24/13). I know there are some, but I spend so much time sifting through the threads and trying to piece together opinions. My pain has continued to get worse this summer and I can only sit at my computer for 5-10 minutes at a time.

Also, has anyone experienced lack of coordination and a feeling similar to vertigo? In the past, my pain has mostly been confined to the upper extremeties - severe migraines, stabbing pains in the neck and shoulder blades, and tingling/aches in my arms. Now I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*

I personally meet with Dr Bertagnoli in 2011 and to be honest wasn't to impressed with his answers to my concerns over the prodisc design and why he uses it all the time and i am a mechanical engineer and i feel it overloads the facets and the size of the keel used

i am going with Dr. Bierstedt as i feel and through talks with him that he will use the disc which suits me, be it the active-L or M6 or whatever

and yeah it could be connected to your neck as i had nerves that were compressed that somehow effect adjacent ones which i found really odd but my surgeon said it can happen very odd

[jss]

Laura,

To my knowledge, Dr Bertagnoli hasn't had a patient on this site since ... 2009. While he has a couple of patients with bad outcomes whose stories have been widely circulated on the internet, if you are a good candidate for ADR, I know you're going to have a great outcome with Dr Bertagnoli. He was one of the European pioneers with the ProDisc-C and is probably second only to Dr Zigler at TBI/Plano with that device. If I were going to have a ProDisc-C implanted, Bertagnoli would be my second choice to do the surgery. With that device I believe you'll be in very good hands.

I never had the symptoms you're experiencing before either of my cervical fusions (2000 and 2002), but did have some such symptoms before my double cervical ADR (2009); extreme sensitivity of the scalp, numbness and tingling in the genitals and rectum, and my left knee giving out (resulting in a fall). Like Gene, I could exacerbate those symptoms by flexion of my neck. If it helps any, ALL of those symptoms were resolved when I woke up in recovery after the double ADR.

Good luck, Jeff

[LauraB]

Jeff, Conan, and Gene
Thank you so much for your feedback. I can't help second guessing every decision I make - I'm hoping that this will be the last surgery and it will a good outcome. When I had my fusion, I only experienced a constant ache, headaches (which I didn't know was associated) and numbness/tingling in my arms (which I could turn off with the turn of my head). With the two levels of "new" problems, the symptoms are more erratic. I was worried I was developing new problems; I'm somewhat relieved that (Gene) you have shared some similarities. I haven't found what is triggering it - I can't seem to locate a posture that triggers it....yet.
I started this venture when I discovered the website for the M6. Although it seemed like the "magical" cure - I did share some concerns regarding its efficacy over the long-term and the number of parts which made up the core. The ProDisc seemed to seem more simplified in its design. I am not an engineer, so I would be interested in your opinion, Conan. I did read some issues regarding the facet load and failure, but those who posted didn't divulge the surgeon - my assumption was it may not have been positioned properly or plate size incorrect. I felt that Dr. Bertagnoli would be the better choice as a surgeon for this device. Harrison expressed his opinion in regard to keel choice and felt the Pro Disc was less invasive. Again, I'm not an engineer and would like to understand the concern about keels and loads on the facets.

JSS - I had been in contact with Dr. Zigler during my quest for a surgeon, but was concerned about the number of multi-level ADRs he had performed. I had also been concerned about negative comments about TBI being a surgical mill (???) I thought the European experience would be the best choice for experienced surgeons. I originally started my quest based upon the names of successful surgeons brought up on this website. He was the only one that responded to my inquiries at the time (weeks went by before I heard back from Dr. Bierstedt and Dr. Clavel). When I researched Dr. Bertagnoli, I felt that he had the surgical credentials and experience I was looking for. I was hoping to have been able to read more updated outcomes than 2009. Perhaps mine will be (?)

Thank you again for sharing your concerns, opinions, and similarities. I do feel somewhat more at ease. However, still concerned about the ProDisc.

[TPatti]

Just my opinion, but a couple of weeks for a response is not a long time and should not play a part in your discussion process. I own a remodeling company and our standard time frame is 2 weeks to schedule an appointment and an estimate 2 to 4 weeks after that depending on the size if the job. If a doctor has 2 surgery days a week, 1/2 day or more for pre-op consults and the same for post-op consults, it only leaves 2 days for appointments with local patients and reviewing overseas cases.

[LauraB]

You are absolutely right. From my entry, it does sound as though my decision was based upon impatience (partitially so), but it seems that my husband had been listening (unbiasedly - as he is without pain) to the technical aspects of the devices. As I read him the various blogs and viewed the mechanics, he was concerned about the longevity of the internal components of the M6 (again, we're not medical/mechanical engineers). I was good with my decision until I kept reading all of the positive outcomes with Dr. Bierstedt as of late, and have not seen many responses about Dr. Bertagnoli (2009 from what I've been told).
I like what I have read (in research) about both surgeons, but doubt is always still there. I had made my arrangments for Sept. surgery, but can't help feeling uneasy about it (with regard to the device).
Really, I guess, my concern is......ProDisc or M6?????

[zenmunk]

I share your concerns about the longevity of the M6, LauraB. But that extends to pretty much all ADRs for varying reasons. The following two threads address the M6-L:

http://www.adrsupport.org/forums/f51/spinalkinetics-m6l-testing-data-11634/


http://www.adrsupport.org/forums/f51/10-million-cycles-20-millions-cycles-85-million-5198/

The general consensus on those threads is the testing data which Spinal Kinetics have released is insufficient, and it's unclear how it correlates to robustness and longevity in the human spine over long periods of time. Forum members (some of whom are engineers) find this incomplete data troubling. Some flat out predict M6 failure between 10 and 20 years. An important caveat to this is the forum members are also anxious spine patients without access to the full data and perhaps an inability to correctly interpret that data if they had it. Their logic or mathematical analyses are compromised by lack of crucial information and plain fear. Spinal Kinetics may have more data which would help patients understand longevity better, but, if so, who knows if they'll ever release it? Probably not. Also, it's reasonable to assume that not every M6 is made equal. There are unpredictable variables which could make one M6 weaker than another.

It would be wonderful if we had more incontrovertible scientific/testing data upon which to rely when making our ADR decisions, but ultimately it comes down to an act of faith. Follow your gut and hope for the best. Good luck.

____

TPatti - Hope you're having a smooth recovery. Can you tell me how much time passed between sending your diagnostic images/reports to Dr. Bierstedt and having the phone consultation? And, from that consultation to surgery day? Thanks.

[TPatti]

Sent info and mailed images on 5/7, received diagnostic and treatment plan 5/23. The Skype consult with Dr. Bierstedt was about a week later. Remember that part of the time frame may depend on if your films arrive the day before or the day after Dr. Bierstedt's review day. My surgery was 7/16, there were earlier dates but my wife is a teacher and we wanted to wait for her to be on break.

Remember that with the Prodisk or any hardisk there is >50% wear to your facet joints. My facet joints at L4/L5 were graded at a hight 2 so a contraindications for a hard disc, M6 can be used up to a grade of 3. Even w/out facet wear a hard disc will definitely cause more wear-maybe facet joints wear out before your disc or M6? It might be worth scheduling a consult with Dr Bierstedt to discuss in more detail, he knows more than me:)

[jss]

Laura,

My views on some of your concerns are a bit different, so I'll go ahead and throw them out there for you to chew on...



On TBI being a surgical mill. I almost had a ProDisc-C implanted by Dr Zigler and know a few people that have been treated there. I never got the impression that they were a surgery mill. Some months ago someone on this site posted that their impression was that TBI was a surgery mill. As far as I can tell TBI has a reputation on this site as a surgery mill because that one statement grew legs. I don't know if they're a mill or not, but haven't had that impression from my numerous interactions with them.
On Dr Zigler's multilevel experience... I don't know how many he's done, but he is well published on his multilevel experience with the ProDisc, and there is one poster on this site in whom Dr Zigler implanted four contiguous ProDisc-L's. As of his last posting, he's doing great. His handle is david???? It starts with david and has some numbers after it.
On concerns about the M6... I am an engineer and share the concerns that it may be more prone to fail because it has more parts. I don't doubt that such failures will (and do) occur, but since in its 7+ years of service no one's posted on this site either of experiencing or reading of such a failure, my concern is not great. Compared with the ProDisc where there are documented cases of device failure; specifically the polyethelene sleeve sliding out of the bottom plate. My biggest concern about the M6 is its potential to house an infection.
On the M6 keels being too large... I don't share Harrison's concern. Yes, the M6 requires three keel cuts to the ProDisc's one. But the M6's keels are neither as deep nor wide as that required by the ProDisc. Because the quantity of bone removed for the ProDisc keel is so great, there are documented cases of the vertebral body splitting both during surgery and years after implantation. I presume this is why Synthes came out with the Nova; its smaller keel should fix that problem. Because I don't know the dimensions of the keels in question, I've never calculated the total volume of bone removal required for either device; but would bet that the ProDisc requires an order of magnitude more to be removed.


When I was selecting a disc, with two prior fusions and two pending ADRs, my biggest need was to have an ADR that would best preserve my two remaining natural discs. Because the ProDisc preserves motion in only unnatural ways, and was documented to cause facet problems, I didn't have a great deal of faith that it would not add to the stress of the two natural discs I had left The ProDisc had significant documented problems, and the M6 was new enough that its problems may have not yet had time to surface. (that's still true of the M6 BTW)

Given all that, I don't know which device you should receive. If you do get the ProDisc, Dr Bertagnoli is probably a very good choice of surgeon. As has been observed, there is no incontrovertible evidence that one device is better than the other. I chose a pair of M6's because, in my judgement, they gave me the best chance of preserving my remaining anatomy and avoiding future surgeries. So far it looks like it was the right call. Will they fail in 10-20 years? ... I sure hope not.

Good luck, Jeff

[LauraB]

Thank you both Zenmunk and TPatti.

I can definitely see mechanical issues with either device. I'm hoping for the lesser of two evils (which I really believe is fusion in my case). I have spoke with Dr. Bierstedt (personally) and Dr. Bertagnoli about their chosen device. Both make a great argument toward the functionality in the spine. I am noting the load on the facet joints (prodisc) and will look into that as well. From what I understand "stenosis" and bone density play a significant factor in the success of implementation and longevity. I plan on addressing these issues by having a specific bone density test for the cervical spine and having a surgeon review the stenosis issue.

I came into this endeavor when I discovered ADR and the M6. Like you, Zenmunk, my husband is very concerned about the stability of the core. He fears that over the course of time, it will wear and break down. He liked the simplistic design of the ProDisc. As for me, I want my life back and it is true, anxiety if playing a big factor and I fear it could cloud my judgment.

TPatti - I am envious that you are there right now being fixed up. I wish you the best. I am a teacher as well and had to resort to substituting this year due to my physical condition and potential for absence. Since I'm not tenured in my district, I couldn't risk taking time off and losing my position so I'm doing the next best thing....financially it stinks (other choice of words but I'm suppose to be a role model for my kids). Thank you for responding during your recuperation time. I truly appreciate it.

[LauraB]

Jeff, I agree that one bad "rap" has more weight than a positive one. I've only been on this site for about a month and the information i gleaned about TBI had to do with the number of surgeries - I was more concerned about Stenum (since that was my first introduction to possible sites). Dr. Zigler seems to have a fantastic reputation - I had inquired a few times as to the number of multi-levels he performed, and had not received an answer. It was one of my first questions when interviewing surgeons as I had learned that the complexity of multi-level cannot be compared to a single level. Either way, that being said....I do feel good about either surgeon...Dr. Bertagnoli or Dr. Bierstedt. My real concern is the device. I also want to live with it for a minimum of 20+ years. To spend my entire savings (and then some) only to be back in the place where I started (looking at fusion) is futile. I really appreciate the information. I need to re-examine my options.

[TPatti]

Have you looked into the Kineflex disc? It is a hard disc as well but unlike the prodisc it has a restraining ring to stop movement before the facet joints are forced to do so. Dr. Cappuccino, the doctor that is doing my follow-up stateside, had given me this disc as a hybrid option. He would have fused L4/L5 and implanted a disc below and above. It is also not fda approved but Dr. Cappuccino is a member of AIMIS and could have performed the surgery in Cypress. He discussed both options, his hybrid or 3 M6's, said they both had pros and cons and the final choice would be up to me and that he would follow up with me if I choose to find a doctor to implant the M6's.

[zenmunk]

TPatti,

Thanks for the timeline. So, hopefully I'll talk with Dr. Bierstedt approximately 3 weeks from Wednesday (when they're expected to receive my stuff). Organizing and waiting for all of these diagnoses/consultations with numerous surgeons at home and abroad is really draining when you feel like s&#@. I keep hoping I don't do something stupid to make myself worse before I have the surgery.

__________

Jeff,

I've heard that Dr. Bierstedt was told at a conference that the M6 failed at L5-S1, but that Bierstedt attributed it to one or both of the following:

- the M6 should not have been put at L5-S1 in that particular patient
- poor surgical technique

Why exactly are you concerned about the M6 housing infection? Can you elaborate on that a little more?

__________

LauraB,

Advanced facet hypertrophy and poor bone density are contraindications for TDR. Some would argue that even mild facet hypertrophy is a contraindication. As TPatti points out, perhaps some discs will allow for more hypertrophy than others. I suggest you get checked for both and then trust your surgeon's recommendation. You might also consider a metal allergy blood test to make sure your body is good with whatever is implanted: metal allergy testing (http://www.orthopedicanalysis.com/metal-allergy/index.html)

If you believe that fusion is the lesser of two evils, then you should strongly consider it. I know it's sort of apples to oranges since it's lumbar, but I was fused at L5-S1 in 1992. It afforded me almost 20 years of relatively little pain and no restrictions. Unfortunately, in 2011, adjacent segment disease finally started catching up with me at L4-5. I believe fusion will inevitably lead to adjacent segment disease. How much and when will vary greatly. That said, sometimes it's undeniably the better (or only) choice. Even if ADR was available to me in 1992, I wouldn't have been able to get it, because my condition was spondylolisthesis. Point is - don't make the mistake of drinking the ADR cool-aid. It can do wonders for the right candidates and cause horrors for the wrong ones.

[jss]

Zen,

Inside the M6 ADR sheath, there is a lot of empty space and a lot of surface area of the internal components. The sheath contains two pin holes that will allow our interstitial fluid to fill up the inside of the M6 and will also allow that fluid to flow in and out of the disc. It seems plausible that a pathogenic microbe could pass into the disc through the aforementioned pin holes and begin reproducing inside the M6, feeding off our interstitial fluid, creating a colony that, due to poor access to the microbes, our immune system could never eradicate.

While the ProDisc suffers from this same potential, its only hard to reach surface area, between the polyethelene sheath and lower plate, is far smaller than exists within the M6. Which should greatly reduce the ProDisc's potential for such a scenario.

Is that scenario possible? I don't know, but it does seem plausible.

Make sense?

[NJ Gene]

Have you looked into the Kineflex disc? It is a hard disc as well but unlike the prodisc it has a restraining ring to stop movement before the facet joints are forced to do so. Dr. Cappuccino, the doctor that is doing my follow-up stateside, had given me this disc as a hybrid option. He would have fused L4/L5 and implanted a disc below and above. It is also not fda approved but Dr. Cappuccino is a member of AIMIS and could have performed the surgery in Cypress. He discussed both options, his hybrid or 3 M6's, said they both had pros and cons and the final choice would be up to me and that he would follow up with me if I choose to find a doctor to implant the M6's.

Todd, are you sure that U.S surgeons can't implant the M6 off-label? Just because it's not FDA approved doesn't mean it's illegal. Vitamin supplements and many over-the-counter meds are not FDA approved, yet they're still sold in stores. Furthermore, if you recall, there was a problem with many people who received epidural injections, where the medicine came from a compounding facility in New England. Apparently compounding facilities are not subject to FDA approval, and this facility was more interested in profit than the well-being of the patients. They were ultimately shut-down. However, their mere existence was legal. I was also told by surgeons in the U.S. that they could do 2 level fusions "off-label" before it became FDA approved. Don't get me wrong, I would rather stick with a device that is FDA approved or well documented by experienced surgeons in Europe. BTW, my spine surgeon advised against AIMIS. He was one of the founders of it. Once he heard that it consisted of mostly U.S. surgeons doing risky operations outside the umbrella of the FDA and without risk of U.S. malpractice, he divested his funds from it and no longer has anything to do with it. That being said, I'm sure many of those surgeons are excellent, and I would consider using them here in the U.S.

Gene

[LauraB]

Zenmunk, Like you, just entering into this journey really does take a toll on your energy. I keep myself sane by investigating everything and making positive movement in the right direction. Although I'm still young for osteoporosis, I don't want anything to conflict with my success. I will have any possible test that might cause a possible "failure;" which includes the bone density and metal testing as well - although I do have a titanium plate fused in there. As far as fusion being the lesser of two evils - no way. I waited 5 years for something better - otherwise I would live with my pain. My fusion, I believe, is the root cause of my new troubles - typical DDD below and herniated, bulging discs above. I spoke with Dr. Bertagnoli's office today, and feel very good about the steps he takes during surgery. He is open for discussion on any type of device I'm concerned with and his personal attention to my unique quality of my cervical spine. I feel better.

TPatti - I did look into the Kineflex briefly as it is designed for DDD. It does have some good qualities and will be part of my presurgical discussion. Thank you.

Jeff - You brought up some pretty scary biofilm complications (possible). I'm sure the potential is there for almost any type. I did read (few years back) about a staph infection setting in during surgery - causing failure.

I believe ADR is the best option for me at this point in my life. Come what may I do have to take that leap of faith and go with my gut. I'm sure I will be back on this forum worrying about something else - as I have 8 more weeks to wait and I'm climbing the walls right now (running out of meds).
I pray to have a positive outcome and will still enjoy skiing when I'm 84. That's the plan! Thanks all. :)

[TPatti]

I could be wrong, but I am going off of what Dr. Laurysen told me. He is going thru a lot of trouble trying to find a hospital overseas to use for M6, I think he would using here if he could. Spinal Kinetics website states that it is not available for distribute in the US:

Spinal Kinetics, M6, Motion for Life, 6 Degrees of Natural Freedom, and the Spinal Kinetics Spine Logo are trademarks or registered trademarks of Spinal Kinetics, Inc.
M6-C Artificial Cervical Disc - CAUTION: Investigational Device. Limited by Federal law to investigational use.
M6-L Artificial Lumbar Disc - WARNING: This device is not cleared by the FDA for distribution in the United States.
Copyright © 2012 Spinal Kinetics, Inc. 7/12

[zenmunk]

Jeff,

Yes, it does make sense. Very scary sense. Here's hoping none of us ever suffer that fate. I plan to mention that kind of infection risk when I consult Clavel, Bierstedt, Lauryssen and Zeegers.

LauraB,

I misunderstood you. When you wrote, "I'm hoping for the lesser of two evils (which I really believe is fusion in my case)," I took that to mean you thought fusion was the lesser of two evils in your case.

Now I know you feel the opposite. I think most people on this forum do. I want to avoid another fusion if i can as well. However, for some conditions that isn't possible or advisable.

Best of luck navigating these rough waters.

[NJ Gene]

Zenmunk, why do you say three weeks until Dr. Bierstedt receives your stuff? Do you mean three weeks before you hear back from him with an evaluation? i sent my records to Malte Peterson via U.S. Global Priority Mail. It cost about $20.00 and took about 4 days to get to Germany.

Gene

[LauraB]

Zenmunk: I actually did it quicker by uploading my scans and diagnostics to a zipped file, and using dropbox. Although it is better to send it, at least he can have a quick look and give you a preliminary diagnosis and treatment option. I had a little more trouble interfacing with their computer system since my only working computer is a MAC, but it worked.

[zenmunk]

Gene,

Yeah, I meant 3 weeks until the evaluation. I sent the package via FEDEX International Priority. They should have received it today. I'll follow-up with Malte tomorrow about it.

LauraB,

I asked Malte if I could use dropbox, because I have everything uploaded, but he said it's better to send the discs. Dr. Lauryssen also wanted the discs. His assistant said, "It is important for us to be able to view all of the axial and sagittal images at once." So, sometimes dropbox won't suffice I guess.

[Cheryl0331]

Laura, You know what will happen if you do nothing. At least Beirstedt also uses the mobic if needed. He not 100% devoted to the M6. He will act in what is best for the patient. the mobic is better than the Pro-disc. I just have s trong feeling about Beirstedt. The only thing holding me back is getting the money. I am looking at trying to get a medical loan, but so many won't send to a doctor outside the US. :confused:

[LauraB]

Cheryl, This has been the most difficult decision I've made for quite some time. I've let my situation go for five years because I didn't have confidence in the alternatives offered by US surgeons. I really have very little time left before permanent damage can occur - so I basically am not allowed to do anything around my house so as not exasperate my condition.

I had to look at my life in a completely different way. I've never spent anything on myself, raised my kids, and our date nights are trips to Home Depot (oooooh). People spend more on a car for five years than they would on their body. This was something I had to keep repeating as a mantra to consider myself as an asset.

I have taken out a home equity loan, cashed out my IRA, emptied my savings, and talked to a few relatives about assisting with some travel. It has been a very humbling experience, but I plan on going back to work full-time with my new neck. We've changed the spending attitudes around our home and our kids (adults) have new responsibilities. This situation has had some silver linings too.

[Stonewall_Boris]

Cheryl, LauraB,

We arranged another mortgage on our house to be able to afford the surgery in Germany. As I was pretty much bed ridden, couldn't work and going to lose pretty much everything we had. it was a calculated risk. If I couldn't get back to work our lifestyle was going to be very different. My wife spent too many years and much time getting this house the way we want it, and we didn't want to move.
I could barely get out of bed, I felt like I was going to fall down every time I stood up. My wife couldn't support us and I knew I had to get back to full time work and that was only going to happen with back surgery. So we rolled the dice.
My back is getting better, core muscles are not so good, but consider a 7 inch vertical cut down from your belly button, how good should I do?

[LauraB]

It is a difficult adjustment financially, but I've been through worse. I've had to start over and make new beginnings throughout my life (lastly when my husband died of cancer in 04). I remarried in 08 and two months later we had a car accident that left me in this condition. My poor husband has had to deal with my pain management and crankiness. We both deserve better, and if it takes starting over again - it just makes us stronger individuals.
I am very resourceful and will make this work. We are not like video games - no "do overs" or "unlimited lives." I want to enjoy the one I have.

Stonewall Boris - You made the right decision. Every day you spend out of bed as a functioning human being is worth every dime spent. I'm sure your wife appreciates having her husband back too.

[Cheryl0331]

Cheryl, This has been the most difficult decision I've made for quite some time. I've let my situation go for five years because I didn't have confidence in the alternatives offered by US surgeons. I really have very little time left before permanent damage can occur - so I basically am not allowed to do anything around my house so as not exasperate my condition.

I had to look at my life in a completely different way. I've never spent anything on myself, raised my kids, and our date nights are trips to Home Depot (oooooh). People spend more on a car for five years than they would on their body. This was something I had to keep repeating as a mantra to consider myself as an asset.

I have taken out a home equity loan, cashed out my IRA, emptied my savings, and talked to a few relatives about assisting with some travel. It has been a very humbling experience, but I plan on going back to work full-time with my new neck. We've changed the spending attitudes around our home and our kids (adults) have new responsibilities. This situation has had some silver linings too.
My car is $22,500, why not spend $32,000 or so on myself. Wow, what a shocking eye-opener! Now I have sheltered my husband from most of this. I need to arm myself with my final facts and show it to him. I need to know how to move forward with a loan or 2nd mtg. and I can't do that without his support. He has lost faith since every surgery has only made things worse. It the fusion that caused the adjacent level ddd. The 3/4 was doing fine before the fusion at 4/5.

[Cheryl0331]

Cheryl, LauraB,

We arranged another mortgage on our house to be able to afford the surgery in Germany. As I was pretty much bed ridden, couldn't work and going to lose pretty much everything we had. it was a calculated risk. If I couldn't get back to work our lifestyle was going to be very different. My wife spent too many years and much time getting this house the way we want it, and we didn't want to move.
I could barely get out of bed, I felt like I was going to fall down every time I stood up. My wife couldn't support us and I knew I had to get back to full time work and that was only going to happen with back surgery. So we rolled the dice.
My back is getting better, core muscles are not so good, but consider a 7 inch vertical cut down from your belly button, how good should I do?
What will I need to have ready to go to the mgt. company with? Did you tell them what you were using the money for?

[LauraB]

Cheryl, By all means get your husband involved. You can't do this alone and shouldn't. Your finances involve him as well - unless your both independently wealthy (my dream). He may have some great resources or thoughts too.

The first thing you will need to do is fill out an application. They will guide you through the process. The value you receive greatly depends upon your current loan to value. Due to the poor lending practices in recent years, banks and mortgage companies scrutinize more, but that really is more protective on both parties. There are just way to many people who are over extended in their debt. Of course, like your first mortgage, a credit report, work history and appraisal on your property are all the factor needed. I don't believe it is necessary to give personal details of its purpose.

I opened a line of credit about 5 years ago. I have a fixed "max" amount that I have access to. Like a checking account, I write out a check to cover whatever it was I needed and I pay back on the principal and interest (only on the amount I used). Fortunately, I have a fantastic rate 1.5% and only have to pay on the interest. The principal is due on its 10 year birthday (which I have 5 more years to pay). By then, I hope to sell my home and pay it off - get something smaller. PLUS, (bonus here) I will be able to go back to work and increase our income.

Other resources: IRA - although you take a hit with the 10% penalty and its taxable in the year you take it out (not social security), but if you are like me, with barely an income, your tax rate may be low and the impact won't be so drastic. Again, you take out what you need. Pulling money from a credit card can be (and is) a financial nightmare - not recommended unless it is a small amount and you can pay back quickly. You may be able to find a credit card that will allow you interest free rates for a period of time - use this for your travel expenses - Capital one MC does not charge for international exchange transactions.

As I am gathering my finances to pay for my trip, I will certainly pass along my strategies to you (if it helps). You can PM me and we can exchange cell #'s. I'm learning a lot as I go along.

OOHHHH one more thing. When you send money (transfer US to Euros), look into the method of trade. The banks charged an extra few cents which can amount to a larger sum for exchange - check out XE Trade (if necessary).

[TPatti]

I financed 1/2 of my surgery. I was fortunate, I have a line of credit for my business, up to $70,000 @ 3.1%. The nice thing about a line of credit compared to a traditional loan is that your minimum monthly responsibility is only the interest. If you have a tight month you do not have to pay any principal. If I do not have it paid off in 2 years, I will refinance the house and roll into the new mortgage if rates are still good. I am a contractor so the front of my house is currently ripped apart (shoe makers kids with no shoes), that is why I did not roll into mortgage now. The whole process can seem overwhelming at time but just take it one step at a time. I broke down at a point when I did not have a follow up spine doctor and primary told me he would not have anything to do with it unless I had a local spine doc on board. I kept just fighting the next battle and not looking at how many battles were ahead and finally got there. Decide what the best surgical treatment for you is, then figure out how to make it one step at time. There may be times with set backs that add a few more steps but just keep working at what you is the best for you.

[LauraB]

TPatti (Tod?) Very good advice. It is exactly what I did. Fortunately I did mine five years ago before the real estate market took a nose-dive and interest rates were nothing.
Focus on the method of treatment and where you plan on doing it? Need a starting goal to work with.

BTW....how are you doing? I'm talking with Dr. Bierstedt today and planning my trip there as well (early September). Are you still in Germany? Would be interested in how you are spending your time there.

[TPatti]

I got home yesterday. Tell Dr. Bierstedt I said hello (Todd Patti) and that his eyes were closed in one of the pictures my wife took of us. Let me say that as impressive that he is on a phone or skype conversation he is even more so in person! I got back from Germany yesterday and am doing quite well. Still plan on posting a detailed report but busy doing my rehab and getting my caught up on my business. I would be more than happy to talk to you about my experience including things that you and support partner can do while there. PM me with your contact info and we can arrange a time to talk. This goes for anyone out there who feels that speaking to me about my experience may help them.

[bohnrods]

You do know that they changed the name of this hospital right? I would not believe a word you hear @ stenum! stenumnightmare.com

[TPatti]

You do know that they changed the name of this hospital right? I would not believe a word you hear @ stenum! stenumnightmare.com

Bohnrods: to what hospital and I assuming a doctor are you referring? I do not think any of this thread is referring to Ritter-Lang or Stenum

[heidi]

Hi everyone
This is my first post. Laura its been fantastic to read your posts about your journey so far with ADR. I have sent you a private message to you but wanted to join the thread if it does continue. I have been amazed at the body of technical knowledge here about replacement devices. I think I have come to the right place.
My issues began in 2000 when I was diagnosed with disc bulge and compression at C4/5 , 5/6, and 6/7. The neurosurgeon discouraged me from having fusion, to see if just backing off from aggravating activity and ant inflammatory drugs etc would work. I got away with this (on and off) up until a few years ago, when things got progressively worse, as they do when you dont change behaviour. I am a professional artist, and work very hard physically in the garden (and anything I turn to), so the continued use of the right arm, led to further deterioration of the discs. Spurs and stenosis drove me back to finally get another MRI where damage had increased considerably.

I am in Australia, and 52 years old, and quite fit. There is an aversion to multi level ADR here unless you are 20 years old it appears or have a career as a sports-person. Otherwise fusion is what you get (and maybe one ADR if you are lucky).

I have been told some pretty strange things so far in my enquiries to spine clinics here in Australia (east coast and west), including raging abuse by the clinic staff of 'overseas surgeons', including Germany! Its been a real eye opener and I have felt very intimidated after trying to learn more about what I can do to regain flexibility for my future. One neurosurgeons assistant told me that 52 years was too old for ADR, and that the surgeon didn't waste these on older people as older folk didn't have as much time to live so probably didn't need the flexibility!

Anyway enough complaining, its seems its a common story as I have found out. I came across Dr Bertagnoli and his practice through much research.

I have begun consultation having sent my MRI's etc to them and they have come back suggesting replacement of C5/6 and 6/7, and a surgery date of Jan 12 next year in Straubing.

I would love to know how you got on Laura if you have come back from your surgery or from anyone else who have had an experience of working with Dr Bertagnoli. So far I have gleaned much from this thread.

Its a pretty big deal I guess, and I have noted some reference to the use of different devices perhaps being less suited to those with Stenosis. I have some stenosis and the bone spurs. My bone density at a 52 year old post menopausal woman (early meno) is that I have a little osteopenia (normal for my age apparently), but I am as I said, fit, and youthful.

I am concerned now about the Pro-disc, given what I have read here about its use if there is vertebra issues. When I asked Mr Tim Vicknar (the international go between guy for Dr. Bertagnoli) about this, he said they used ceramic to treat the bone if there is some deterioration before they insert the disc.

Do any of you know about this? Hope to hear back from anyone. As Laura said, there are so many threads, so I just searched Dr Bertagnoli and found this one. Any suggestions of other threads would be great.

[TPatti]

Heidi,
Laura surgery was performed by Dr. Bierstedt, not Dr. Bertagnoli. I also had surgery performed by Dr. Bierstedt. It seems that many regard Dr. Bertagnoli as a good surgeon but question his favored use of the ProDisc based on his financial interests. In my opinion, you should seek consult from some other doctors as well.

[heidi]

Heidi,
Laura surgery was performed by Dr. Bierstedt, not Dr. Bertagnoli. I also had surgery performed by Dr. Bierstedt. It seems that many regard Dr. Bertagnoli as a good surgeon but question his favored use of the ProDisc based on his financial interests. In my opinion, you should seek consult from some other doctors as well.
Hi TPatti
Thanks for getting back so quickly. I must have missed a post by Laura. Laura had said she was booked with Bertagnoli at one point. I did see the discussion on the device and this has made me aware of the choice. I will look into Dr. Bierstedt now. Just quickly, I think from what I can see Dr Bierstedt uses the M6? I see you have your Lumbar region operated on this year with this device. Have you any view on whether or not the ProDisc might be more suitable for the cervical region? Sorry I am just wondering as I imagine the pressure on the lumbar spine would be considerably more than the cervical. Hope thats not a silly question. I note the 'financial' connection re the ProDisc. Being new to the forum, there is much to review, and I can see many here have very good engineering knowledge. Could you tell me what you have worked out about the M6 in favour? Thanks heaps. Helen

[heidi]

Hi TPatti
Thanks for getting back so quickly. I must have missed a post by Laura. Laura had said she was booked with Bertagnoli at one point. I did see the discussion on the device and this has made me aware of the choice. I will look into Dr. Bierstedt now. Just quickly, I think from what I can see Dr Bierstedt uses the M6? I see you have your Lumbar region operated on this year with this device. Have you any view on whether or not the ProDisc might be more suitable for the cervical region? Sorry I am just wondering as I imagine the pressure on the lumbar spine would be considerably more than the cervical. Hope thats not a silly question. I note the 'financial' connection re the ProDisc. Being new to the forum, there is much to review, and I can see many here have very good engineering knowledge. Could you tell me what you have worked out about the M6 in favour? Thanks heaps. Helen
I found this great post on the site...on the pro's and cons of the two different devices - ProDisc or M6 - so Ill have a good read

http://www.adrsupport.org/forums/f51/m6-l-prodisc-l-11276/

[Jerry5]

Hello Heidi,
Trying to get some more feedback from this place, seems they are one of the most, if not the most experienced with the M6, (L) in my case.

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)

Take a look, very encouraging, I have emailed a couple of people that have this done.

Jerry

[LauraB]

Hi Heidi (Helen)
I've responded to some of your posts on other threads, but do want to express that I DID change my surgical venue from Dr. Bertagnoli to Dr. Bierstedt. My personal reasons for changing were very similar to TPatti's. Dr. Bierstedt is not financially tied to any particular device, but will use the ADR best suited for your unique physiology.
I was appalled to hear that Australian surgeons don't want to waste an ADR on 50+ patients. You will find that the median age of our posters are in their 50's, me included. I'm probably more active now than I was in my 20/30's. I scuba dive, ski, and still do cartwheels (a performance when my students do well on their tests - great incentive). Many others are marathon runners, bikers, active "weekend" athletes, or just want quality of life. You have made the best choice by casting those flippin, pathetic excuse for medical professionals aside (had stronger words, but chose to change them), and take charge of YOUR life! You are your own advocate, and that is why we are all HERE.

[heidi]

Hi Laura B and Jerry 5. How fantastic and generous of you all to share your experience and real information. I was so motivated by what I read on the forum I submitted all my scans and files to Dr. Bierstedt's team immediately. Actually I sent a broad enquiry on their site and in a day Kelli was back to me with the links for the uploads of my images etc. I still have to have fresh x-rays done, and will upload these next week. Kelli got straight back to me to tell me that they will begin the assessment with the MRI's and Bone Density tests with Aust Neurosurgeon reports, etc. and let me know if they need the x-rays to clarify. Will do them anyway. I have gleaned mountains of preparation info from your entries and journey's which will save me allot of mucking about. I keep making notes of the tests I should get done - such as the metal alloy test.

Some days I think - Oh, I can manage, maybe I can go on for a while longer... then I do some small thing (heaven forbid), such as clean a floor or pick up a paint brush and do an hours painting, and bang...all the pain is back. Also Laura, when I filled out my patient report, I didn't put down 'leg pain', and a few other 'pain's', that come and go... but later, when I go to pick up a coffee in my left hand, and drop it, I remember. The leg pain is so subtle, but its there all right. I think I read here (was it you or another person) about the issues with vertigo. I don't have headaches (but used to big time when the problem started in 2000), but when I push myself, I feel like I am going to just pass out. The other issue is a sort of feeling as if my head is in a glass jar. Hearing is sort of weird. This creates a sense of imbalance. I reckon its related as after I rest it goes away. And I know its not the 'hormone thing'. I know the difference. Its quite distinct and its coming from the spine. So, here I am, and I am really glad I have found this site.

Hearing about your recoveries is really important to me, so I am going to stay inspired by reading the post op section too often :D

I was a bit confused when I first found the site - like a kid in a lolly shop - where I didn't know where to look first as there was so much pertinent information. The lollies are all relevant in this case!

I can see that you will all be able to help me with the various questions I have on the actual process, and decision on who to get to do the operation, as well as all these really important little details leading up to the op, during it, and afterwards - re travel, accommodation and other things.

I noted on the video for spine patients video preview that only 4 Aussies were listed there out of the 100% having travelled o/s to Europe to do this in a certain year. Most were from the US, UK and then Germany of course.

I guess this is just a further intro. I will post again with some questions and details. Thanks again to you all.

[LauraB]

Helen, Glad to be of help. We are all here together with a common bond. You will soon be on this side sharing your experience as well. I'm happy to hear that you are already getting prompt feedback from Dr. Bierstedt's office. The bone density test may be important, but he will also make that assessment during surgery as well (this is what he had done in my case, and I was pleased to find that he felt my bones were still in great condition - in spite of the grinding of the degenerative levels. I had a hard time trying to find a metal test, but Dr. Bierstedt didn't feel it was of dire necessity. I think it is important though for your own piece of mind.

I did have vertigo for about a year. I've had some of the strangest symptoms that may or may not have been a result of my neck injury. My ability to last for five years with my degenerative discs was the same as yours. I would have good days and feel "almost normal," but then I would do a little yard work, vacuum, or reach for something in my upper cabinets - and that would be the end of me for nearly a week. I could deal with the muscle and nerve pain throughout my extremities, but then a dull headache would turn into a monstrous migraine - my last one was so severe that my family thought I was having a stroke.

I have to laugh (sorry) about breaking dishes. I thought I was being a "clutz" but really it had to do with weakness and spasm in my hands (unbeknownst to me). I will be getting new dishes very soon - as I won't be breaking any - anymore.