I'm a candidate for ADR...now come the 20 questions

[ian]

This is directed at those patients of Dr. Clavel.

I sent my films off to Dr. Clavel and received a response from his assistant telling me that I'm a candidate for ADR at L4/L5, but was told L5/S1 is ok. This surprised me because I've been told that the disc at L5/S1 is collapsed, and I'm also sacralized at L5 on my right side, which creates more pressure on the left. He said the sacralization wasn't an issue. Good news to me, but also confusing since it contradicts what I've been told for years.

I was informed that I could schedule a Skype call with Dr. Clavel to go further into my case, for a fee, which is understandable. I'm waiting for an appointment next month with a doctor at UCLA Neuro, but still wouldn't mind speaking with Dr. Clavel in the meantime and asking some detailed questions.

Was your Skype conference call helpful and did you feel more confident and informed after you spoke with Dr. Clavel?

Thanks

[jss]

Ian,

My phone call with Dr Clavel put me at ease with him in that he seemed like an experienced ADR surgeon that had had all the variables thrown at him and knew what to do when they presented themselves.

He's thrown you a substantial variable in telling you that you don't have a problem where another surgeon has told you that you do. I would encourage you to review your radiology reports before the call and to have him answer the pathologies the radiologist has identified that he says aren't a problem. Is this pathology present or not? Why do you believe it's not a problem? Would you speak to the radiologists concerns on this pathology? etc... Don't let him hang up until he's made you understand. Is he or your radiologist correct? You are the one that has to decide.

Good luck, Jeff

[bwink23]

That is strange Ian. I know it's costly to call him, but could be worth it. Gather up some questions and quiz him. It seems he believes your pain is not disc related, but biomechanical?? I would ask him what your options are at that level. Does the disc on your films show black, which is a strong indicator for dehydration? Your disc can be collapsed somewhat, but still show hydration. But, that doesn't address the mechanical aspect. I personally have a unilateral pars defect(fracture) on my left side. My chiro said that often, sciatic and pain symptoms are more pronounced in patients with a unilateral as opposed to bilateral due to the imbalance. I would certainly look further into that. The sacralization you got can cause discomfort as well. I guess he figures that the disc can't move, no harm no foul. Frankly, i'm surprised by his diagnosis. It would seem to make sense to at least fuse that segment symmetrically from the anterior approach while getting an ADR to balance things out.

[ian]

All he said was that I'm a candidate, no mention of where the pain is being generated from.

Yes, my last MRI shows desiccation at L4/5 and L5/S1. Also there is some stenosis and the disc at L5/S1 is wafer thin A neurosurgeon glanced at my images a few weeks ago and immediately recommended fusion without considering any other options.

I think it's around $400US for a call with Dr. Clavel. Still cheaper than the doc who spent 5 minutes with me and said fusion was my only choice.

That is strange Ian. I know it's costly to call him, but could be worth it. Gather up some questions and quiz him. It seems he believes your pain is not disc related, but biomechanical?? I would ask him what your options are at that level. Does the disc on your films show black, which is a strong indicator for dehydration? Your disc can be collapsed somewhat, but still show hydration. But, that doesn't address the mechanical aspect. I personally have a unilateral pars defect(fracture) on my left side. My chiro said that often, sciatic and pain symptoms are more pronounced in patients with a unilateral as opposed to bilateral due to the imbalance. I would certainly look further into that. The sacralization you got can cause discomfort as well. I guess he figures that the disc can't move, no harm no foul. Frankly, i'm surprised by his diagnosis. It would seem to make sense to at least fuse that segment symmetrically from the anterior approach while getting an ADR to balance things out.

[bwink23]

After looking a little more into sacralization, it seems that many docs still look past pain issues that can be derived from it. I don't know what a doc would do for that other than fusion. opening up the disc space more, with that going on seems like it would do more harm than good. That's a unique case your gonna have to dive deeper into to find what would be best for you. Good Luck and keeps us posted on your findings. Maybe you can find some posters here who have similar issues.

[L4-5-S1]

Ian,

I had two skype interviews with Dr. Clavel. I was very satisfied and I would highly recommend the skype interview. Dr. C answered all my questions without looking at his watch. Prepare a list of your questions and all concerns prior to the interview. Jeff (jss) gave you already very good advice, follow it.

Did you send one MRI file on your CD or two? This is what happened to me (with one European doctor, not Dr. C). I sent old and new MRIs on the same CD for the doctor’s review and to be able to compare them. What probably happened was the doctor’s assistant uploaded old MRIs from my CD. The doctor did not pay attention to the date of the images and I was diagnosed with two level TDR based on old images. I knew that I had some bulging on my third level and I was confused why he did not mention this at all. The next day I phoned and asked if he had reviewed both files. He said he didn’t know that I had two files and he asked to give him a day or two and he would get back to me. His next report was three level TDR because he did not see my new MRI’s at first. Again, this WAS NOT the case with Dr. Clavel.

All the best.

Rad

[Stonewall_Boris]

Rad,

Did you send the raw CD or did you use the Onis program to put them on CD?

[ian]

Hey Rad,

I sent them all of my films via Dropbox. So they had my most recent MRI, xray and CT scans. All of them less than two months old.

I have a call scheduled with Dr. Clavel tomorrow, and have already written down the items I'd like some clarification on. I was unable to have my films reviewed in time for the call, but I still plan to see a Neurosurgeon at UCLA next month to delve deeper into all of the problems in my back. If the doctors at UCLA confirm what Dr. Clavel has to say I won't hesitate to schedule surgery. My only hesitation now is that I have yet to pinpoint what exactly is the primary pain generator.

It's been frickin exhausting and frustrating running around from doc to doc and getting no closer. Numerous opinions but no solutions.

Thanks for the advice everyone.

Ian,

I had two skype interviews with Dr. Clavel. I was very satisfied and I would highly recommend the skype interview. Dr. C answered all my questions without looking at his watch. Prepare a list of your questions and all concerns prior to the interview. Jeff (jss) gave you already very good advice, follow it.

Did you send one MRI file on your CD or two? This is what happened to me (with one European doctor, not Dr. C). I sent old and new MRIs on the same CD for the doctor’s review and to be able to compare them. What probably happened was the doctor’s assistant uploaded old MRIs from my CD. The doctor did not pay attention to the date of the images and I was diagnosed with two level TDR based on old images. I knew that I had some bulging on my third level and I was confused why he did not mention this at all. The next day I phoned and asked if he had reviewed both files. He said he didn’t know that I had two files and he asked to give him a day or two and he would get back to me. His next report was three level TDR because he did not see my new MRI’s at first. Again, this WAS NOT the case with Dr. Clavel.

All the best.

Rad

[JJames]

Hello, Ian.

I believe I can hear the same frustration from your written words which I have been experiencing through all of the years of pain I've lived through so far. I do not believe any of these highly trained, very intelligent, etc surgeons can make a very accurate (in most cases) diagnosis based solely on various imaging and reports. There are always exceptions - as in just about everything in life, but I firmly believe that this is why all of our back issues are so complicated, confusing, and unique.

I wish you the best of luck in whatever course of action you choose. Although I am very nervous about it, I am about to simply go with my next surgeon's opinion (within reason of course) and hope for the best. I am not a medical professional, and lack the smarts, time, funds, etc, etc to make that particular career change now -- too old! LOL

Good luck my friend. Definitely keep posting on this site, as there are a great many very intelligent and experienced people who continue to provide invaluable information - I just don't happen to be one of them. I do however relate and empathise with many or all of the chronic pain issues and frustration our back problems are causing both of us.

Jeff

[ian]

I spoke with Dr. Clavel today. I like him. Not once did he cut me off or try to rush me through our conversation. He said that my images leads him to believe that most of my issues stem from my disc at L4/L5 and thinks ADR will help. He didn't say for sure if it would completely eliminate my problems, but he did say it will definitely help.

When I told him that I experience increased pressure on my low back on flexion and relief when I bend forward at the waist, he said that my facet joints might be a problem as well. So he suggested I get injections in my facet joints before considering surgery. I already know I have arthritis, but I'm unsure to what extent.

So when I see the neurosurgeon at UCLA in a couple weeks I'll discuss with him the idea of doing some diagnostic work on my facet joints.

But I'm definitely glad I spoke with Dr. Clavel. He answered more questions than any doctor I've spoken with so far and posed questions for me to consider. So far I give high grades to both he and his staff.

[bwink23]

Ian,
Nice to see you got some questions answered. He didn't have any other surgical opinions he could give you that did not pertain to artificial disc?

[ian]

As far as surgical options we didn't discuss anything other than ADR. The disc at L4/L5 is pretty much toast. Disc height is actually pretty good, but it's dried out and only gonna get worse. But he did suggest the injections and RFA before surgery.

Ian,
Nice to see you got some questions answered. He didn't have any other surgical opinions he could give you that did not pertain to artificial disc?