Biersdadt vs. Clavel

[pittpete]

Bikersdadt said 3 level adr.
I have an update after having Dr. Clavel look at my films.
Here's Clavels recommendation
Quote:
´The right sided leg pain may come from both levels L4-L5 and L5-S1 as well as the low back pain.
Unless the low back pain is high in the lower back I would stick to doing L4-L5 and L5-S1.
L3-L4 shows some degeneration but preserved height and is not ruptured.
To mention he has a steep sacral slope. These type of spines, specially if this level has undergone a previous surgery, are not best for artificial disc replacement. Instead, an anterior fusion may be better.
We may stick to doing arthroplasty at L4-L5. Keeping motion at the cranial (highest) level is what really matters.
So after seeing the Biersdadt crew in person in NYC and having Malte Peterson recommend a 3 level ADR, i now have a 2nd opinion.
Peterson says might as well have L3-L4 done and Clavel says leave it.
Clavel says fusion at L5-S1 and Peterson says ADR.
In all honest opinions i've read that there is very little motion at L5-S1 and i actually agree with Clavels rec. more

Any advice?

[Jerry5]

I received an email, reply, someone that had an M6 at the L5-S1, this preserved motion to the rest of the lumbar, think about it, if this one degenerates, then it will cause the next higher to degenerate, and then have problems even higher up.

I know, this is what happened to me.

Will have another evaluation on 3 March, but this will most likely be a fusion or possibly a first or second generation all metal and plastic disc.

Have had a recommendation from Bierstedt, and may end up pushing this to the insurance.

I tried another avenue, this did not pan out.

Personally, go with the M6 and someone that has done many, Boree(sp?) or Bierstedt.

If I could only do one (and this may be what I do) it would be the L5-1.

[MikeC]

Bikersdadt said 3 level adr.
I have an update after having Dr. Clavel look at my films.
Here's Clavels recommendation

So after seeing the Biersdadt crew in person in NYC and having Malte Peterson recommend a 3 level ADR, i now have a 2nd opinion.
Peterson says might as well have L3-L4 done and Clavel says leave it.
Clavel says fusion at L5-S1 and Peterson says ADR.
In all honest opinions i've read that there is very little motion at L5-S1 and i actually agree with Clavels rec. more

Any advice?

Hey that sounds like a boxing match on HBO pay per view! :laugh: I have also heard that S1/L5 is not a very mobile joint and, if fused, that will not greatly decrease your mobility...I don't have much of a disk at that level and I can still bend overand tie my shoes!

I am wondering if Malte is a trained medical professional, and should he be deciding on the what disks to replace? I am jsut thinking out loud here...don;t shoot me! Not the saw either please! :chainsaw:

[Stonewall_Boris]

Malte is not, to my knowledge, a medical professional. He relays medical information from Dr. Bierstedt. He is well versed in medical terms and procedures. I've never seen him as a medical professional and I don't believe he ever claimed he was. Imo, if you get an opinion from him it was passed on from Dr. Bierstedt or Dr. Illerhaus. Malte was my main contact point between Dr. Bierstedt and myself. To be clear, I never spoke to Dr. Bierstedt prior to my surgery until I got to Germany, all the contact was between Malte and myself via email.

[pittpete]

Stone, thing is i went to see them in person in NY.
Illerhaus and Biersdadt barely talked and Peterson did all the talking.
My question here is i have 2 well known doctors with 2 different surgical recommendations.
Biersdadt through Malte Peterson says 3 level
Clavel says hybrid fusion/ADR due to my steep sacral slope and leave L3-L4.
I would of course contact Dr. B again before considering the actual surgery.
I also came across a nice article about a steep sacral slope
Dynamic Reconstruction of the Spine - Google Books (http://books.google.com/books?id=XzX8cXmV7SMC&pg=PA151&lpg=PA151&dq=what+is+a+steep+sacral+slope&source=bl&ots=ifTo5rizqY&sig=7NOTRsPe6ffhaxk80ANGCDOHjxk&hl=en&sa=X&ei=I1_9UrSBOuXLsQSq_YKQDQ&ved=0CCgQ6AEwATgK#v=onepage&q=what%20is%20a%20steep%20sacral%20slope&f=false)

[jss]

Pete,

What a terrible decision to have to make; divergent surgical prescriptions from two respected surgeons. I was lucky in that before my double ADR, five of the six surgical opinions were the same. The odd man out was a surgeon that didn't do ADR.

I don't know which way you should go, but were it I ... I'd probably learn everything I could about the reason behind Clavel's contraindication and then quiz Bierstadt about it.

Good luck, Jeff

[pittpete]

Jeff, thanks for the advice.
That is probably my gameplan moving forward.
Since my current pain is manageable yet chronic, i have some time.
L3-L4 has been bulging for 13 years or so.
I really have to investigate how bad my facet joints are at the lower levels even though Peterson told me they weren't bad.
This steep sacral slope thing has me concerned and i'm going to pick both Clavel and Dr. B's brains on it.
My concerns are the longer i wait the more my facet joints will worsen.

[FranklySir]

Pete,

just had mine done in Dec 18. L345. Sacral slope deep on me as well. L5S1 close to almost fused naturally. Upon discussion with Clavel he adivsed that the thinking of ADR at L5S1 is being looked at harder with all the stats and at a symposium supposedly in March this year with all the world surgeons. Since mine wasnt giving me pain then we left it alone. If it was giving pain then Clavel said he would recommend fusion there and ADR above.
Also if you look on here many that have problems had previous surgery or micro lamidiscos which have scar tissue buildup problems and movement now in that area might cause problems.
Keep in mind any surgeon, if they could in good faith, would want to have another triple under their belt.
I bet if you were to have new scans done and sent to Dr. B (who I have alot of respect ) he would look at them and most likely have the same opinion as Clavel as well
Just sayin brother, i have two and wouldn't want three in me in the Lumbar. Well i aslo have two in my cervical as well.

Peace in your choice. Feel well!
F

[pittpete]

I've contacted Dr. Zeegers as well.
Couldn't hurt to have recommendations by 3 of the top ADR surgeons in Europe.

[jss]

Dr Zeegers' opinion would be a very valuable one to have in any case; but doubly so as you have divergent opinions from Bierstedt and Clavel. Good move.

[pittpete]

Just an update on my situation and hope it helps anyone considering surgery in Europe also.
Dr. Zeegers called me today at home. Had a nice long conversation with him.
He does charge a consultation fee to continue and i'm waiting for the email with all the details.

[ian]

Fortunately, Dr. Clavel and Dr. Bierstedt came back with the same recommendation for me, so I didn't have the very serious decision you're being forced to make concerning your diagnosis.

But I'll explain why I chose Dr. Bierstedt. First, his credentials are legit. With his background my decision was easy to make. He's confident, but there's no ego with him. He and I spoke on the phone and I liked him on a personal level as well as professionally. Face to face he's personable and informative.

Second, he and his team have built a comprehensive program that makes sure the patient is taken care of from the moment you land until they drop you off at the airport to come home. The staff at the hospital took great care of me. Then once I left for Medicos, the rehab facility, I was taken care of by a large team of nurses, doctors, massage therapists, physical therapists, etc. Every day my doctor and I sat down and went over my progress. The nurses checked my incision each day, and twice I had blood drawn for testing to make sure there was no infection. I had twice daily massage and trigger release therapy, as well as PT, occupational therapy and personal training. And their gym is pretty sweet.

Everything was covered, from transportation to and from the airport, my meals, hotel, you name it. So my decision to go with Dr. Bierstedt involved not only his surgical expertise, but also their entire approach to patient care. I'd do it all over again if I had to.

[Jerry5]

I have had Four opinions, Two of them are disabled by the FDA.

What I mean, is that the USA will not allow ADR, Yet, one surgeon, stated that they were seeing more artificial discs fail, I wonder what these types are?

People are having a lot of issues with the ball and socket type, they move 'too much' and not natural like the M6.

The movement puts too much motion on the facet joints.

My initial evaluation with Bierstedt, was the L45-L51, M6, but I have had a discectomy/Laminectomy/foramen at the L2-3 level. This looks good on the MRI, 10 months later, but can cause pain, and still get shooting pain, (that lateral femoral is gone/damaged severly) down the leg.

Not really crazy about getting cut open, and I would require two incisions, but you have think, if they go in the first time, you really want two things settled.

One, they take care of ALL issues the first time, and Two, you have the best outcome.
If the Dr can lift this L5-S1, then go for it, you will have the disc height and movement.

The M6 comes in different sizes, the endplates, and the plates have keels to grab the bone, to stabilize, they are coated, so ossification (bone growth on the endplates) takes place, also, the endplates have different (lorthotic) angles for aligning the ADR.

M6-L Artificial Lumbar Disc | Spinal Kinetics (http://www.spinalkinetics.com/patients/m6-l-artificial-lumbar-disc/)

Here are a few pictures at the L5-S1 level.

It is a hard decision, of this, there is NO confusion there.

[henry4956]

Pete, I would be very surprised if Dr Zeegers recommends a 3 lev adr. I had 2 recommendations for 3 level adr and then Dr Zeegers disagreed. He did not say it but he implied that 3 consecutive adr's takes it to another level of risk. I still wont know till the day before my surgery exactly what combination I will get. The only thing I know is adr at L5-S1. L4-5 is probably 50/50 fusion vs adr. And if it's fused I most likely will have a adr at L3-4. If L4-5 is an adr. then Zeegers thinks we leave L3-4 alone

[Jerry5]

pittpete,

Did you make any progress on your decision?

btw, that is 'lordotic' angle of the lumbar.

[pittpete]

Jerry, just saw this...
Sorry i didnt respond earlier.
I don't know what i'm going to do
I change my mind weekly.
I wish we had more info on the activ-L here in the uS..

[drewrad]

Pete, just compared MRIs again in my intro thread in noobies. Our sacral slopes look pitched the same. I may have to raise that issue again with Dr C just to see what he says.

Know what you mean about ActivL. I like it. I also like the M6. I like the ActivL much better than ProDisc due to forward translation, facet saver. I also like the alternate no keel variety. Just three small teeth in front. That's the one dr Z prefers too since it saves the vertebrae from damage. At least last time I talked with him. I agree.

[pittpete]

Any news on whats going on with the Activ-L?
I might be making an appointment with Dr. James Yue from Yale soon.
He was in the FDA trial for the Activ-L, i'd like to pick his brain.
The way i feel now though i can't get myself to consider going to Europe and dropping 50 grand.