Prepping for c5/c6 decompression - surgical choices
 

Hi Folks,

So after almost 14 years of conservative therapy it seems I now require surgery at c5/c6 to protect/preserve nerve function. This is mainly due to the exhaustion of free space around the right nerve in conjunction with related symptoms.

A local consult suggests M6-c ADR at c5/c6 (if viable) to give adjacent segments the best chance as neither are in the best condition. Previous consults have suggested fusion or ADR at c5/c6 or c5..c7.

I was feeling quite happy (well, as happy as one can be) with the latest consult but just recently heard of some M6-c failures. It seems there have been at least 2 cases requiring revision due to the nucleus becoming detached with related radiculopathy and incipient myelopathy. Maybe with the number of M6s implanted these numbers are not so significant compared to other issues requiring revision but they've got me concerned. Does anyone have any additional information on this topic?, or suggestions for alternative ADRs?

Thanks to everyone here for the wealth of shared information.

I personally would not feel comfortable with either the M6-L or the M6-C... Due to reported failures.


I'm considering both the LP-ESP and the CP-ESP. Neither have been on the market as long as the M6's, but it seems more and more physicians have been moving to them... As (apparently) no device failures have been reported.

A "few" failures
 

Some of which have not been substanciated and let's face it, all devices have had a failure or complication. There are risks with every surgery. But once you fuse, there is no other recourse.

It's a tough call - the only truth I currently see is that all surgical options are to some extent a gamble and one should weigh the risks against the potential outcome. There appear to have been two reported cases of m6-c failure in German publications. If these are outliers then probably not significant compared to the reported ca. 30 .. 50k(?) implanted m6-cs. I read the latter numbers somewhere so hopefully they're correct, this may make the m6-c the most widely used cervical ADR? I heard about these (failures) just as I was planning a date for surgery, I've now put that on hold and hope to find further clarity via additional consults.

Jacks back
 

JackBauer

"I'm considering both the LP-ESP and the CP-ESP". Jack why would you consider the CP-ESP , when your concern is your lumbar spine??
Thanks...............

Because I do have neck concerns as well - occasional pain (not constant / frequent like lumbar)... But the imaging looks pretty bad and it won't get better.


Unfortunately I'm currently "hung up" on the elastomer within the ESP and the chemicals it can degrade into... Search for "salted" in the LP-ESP 7 year study. (I also made a post about it in the manufacturer sub-forum)

My M6-C 's
 

Mine were done in May of 2015 and still look great!
Placement is key too!

And long may they continue :) I'm getting the impression surgical skill is possibly more important that technique (ADR type, fusion, etc).

Interesting
 

I also find it interesting that these reports are from Germany, where two prominent surgeons are devoted to Pro disc or Mobi.

Germany
 

Maybe because the majority of ADR surgery has/is been done in Germany?, possibly just a numbers game in that case. I have to concede it's hard to obtain reliable outcome/revision/failure data, disappointingly so.

Surgeon is the most important decision.
 

I have three M6-C's implanted by Dr. Clavel in May of 2016. Had x-rays done a few months ago. They haven't moved and look great. When I made my decision, the ESP was not on the market. I chose the M6 because of Dr. Clavel first and secondly because it is made out of titanium. My metal sensitivity blood test came back problematic for the Mobi-C. I also chose the M6 because it restricts movement more like our natural discs and that was a shortfall of the Mobi-C. I know patients who have had the Mobi-C implanted who did great and some not great and had to have them removed. In the end, there is always a gamble when we have neck surgery by any surgeon. Even the ones with the best track record have patients who have failed surgeries. I have learned after seven spine surgeries and having many friends now who are survivors of spine surgeries, that there are no guarantees, that you have to weigh the odds in your favor by first, picking a great surgeon you trust; secondly, the best device for you; and lastly, that the spine is far more complicated than we understand so, predicting someone's outcome is not possible. Age really comes into play regarding recovery. People in their 30's seem to have a higher success rate than those of us who had surgery in our 50's. I don't know where you would find these statistics. This is just what I have found with the people I have met along the way. Don't do it until the pain disrupts your life in a terrible way or you know you are at high risk of paralysis.

I still believe that Dr. Clavel has the highest probability of success based on the research I did at the time. Barcelona is also a lovely place to visit and recover if you have to endure a surgery. I felt so much better post op than I did when I arrived.

I agree with Cheryl. Once you get a fusion, there is no turning back. I know people who have gone that route and also had terrible outcomes only to have to go back under several more times. The body doesn't fuse all the time and sometimes the hardware creates new problems. One thing I think that has been proven is that fusion creates a higher risk of further degeneration of the adjacent discs.

I'm sure sorry you are where many of us have already been. It's very hard to live with cervical spine pain and it's also a hard decision to figure out. It took me about a year. Best of luck to you and I wish you the best outcome possible.

(Back off the board. I don't come here frequently anymore.)

I was concerned about longevity with the flexible core of the CP-ESP and LP-ESP. This 2012 study got me to commit to cervical ADR with the CP-ESP. 40 million deflection cycles in each of 3 axes on one test unit without any degredation of performance. My surgeon Dr. Desai says that in the unlikely case of core failure, he can chip out the ADR and install a new one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567327/