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Mr. David Harrison and the M6-L
This is basically a copy of my first post and intro here to adrsupport. I'm gonna try and keep a running thread of my progress for those folks interested. Excuse me as I am knew to posting but not to the wonderful forum (thanks Harrison).
Hello everyone, I have been quietly scouring this site for about a year but only wanted to post when I was about to proceed with surgery. I am planning an L5-S1 M6-L ADR with Mr. David Harrison (spine surgeon) in the UK at BMI-Princess Margaret Hospital. He's hardly mentioned here but he's had decades of experience with the older type discs and has done approx 70+ M6's both cervical and lumbar. He has also performed an M6-L on Retief Goosen (Interview Link is below) who's a pro golfer at the L3-4 level. He returned to pro golf tours at 5 months amazingly. Of course that level is not as stressed as the lowers. I was also considering Dr. Clavel or Mr. Dare who are also fine surgeons. After doing research, I personally can't see why you would choose outside of those docs if planning on going overseas. Cost is about the same, slightly higher in the U.K. If you'd like to know details just email me at afhstock@hotmail.com I'm planning for surgery on April 16 2013. He's busy but not so busy as to feel overlooked. Of course only post-op will I give you a real outlook ...but his PA has been wonderful. Must read. pro-golfer M6-L ADR by Mr. David Harrison (U.K.): ASAP Sports Transcripts - Golf - 2013 - AT&T PEBBLE BEACH NATIONAL PRO-AM - February 6 - Retief Goosen Praying for a pain-free life for everyone. ;) |
Hi,
I have been considering two level cervical (C4/5 and C5/6)ADR as i am starting to lose strength and dexterity. It seems like I have been down the same road as you. I have seen several US docs who dont want to talk about ADR. I have scheduled an appointment with Dr Laurrysen next month to consider m6. I have seen many posts about Dr Clavel and a few about Dr. Harrison and Dr. Dare as well that are very positive. I have been in email contact with one of Dr. Clavels patients who speaks very highly of her experience and results. I then saw the report about Retief Goosen. I also saw an excellent US doc at Virginia spine institute in Reston Virginia who suggested a hybrid fusion with Bryan disc at one level and fusion at the other. He felt there was a chance insurance would pay for this hybrid fusion. He also had an excellent PA and seemed to have a more open mind than most other US docs I consulted with. I have not spoken with any of the European docs you mentioned but was very pressed by positive comments about Dr Clavel! Could you please advise me about your experiences with Dr Laurrysen and other European Docs? I have also been looking at axiomed freedom disc. They recently wrapped up lumbar trials in US and Europe |
I have not heard of a single insurance company that would pay for a hybrid. You should ask if they have been successful at that before with your particular insurance company.
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L5-S1 = Fusion L4-L5 = ADR/TDR Success is based on patient outcomes and some biomechanical studies. ADR/TDR placement will affect the surgical success and clinical outcomes. Fusion at the bottom-level of a lumbar operation as above avoids the wedge effect at the bottom level of the spine. The biomechanics articles describe it as compressive shear at L5/S1 because of the natural/normal angle of the vertebrae. The powerpoint from Dr.LeHuec/France on hybrid lumbar surgery was on the hard disk, but I can't find it now. Dr.LeHuec was president of the ISASS. adrsupport Hybrid Lumbar Patients: HGrantnz http://www.adrsupport.org/forums/f47...grantnz-11134/ M1013828 http://www.adrsupport.org/forums/f47...age-bmp-11716/ JStuckey Healthy Back 2011 valandguin L4-L5 ProDisc L5-S1 ALIF (anterior fusion) Kinematics of a selectively constrained radiolucent anterior lumbar disc: comparisons to hybrid and circumferential fusion. Clin Biomech (Bristol, Avon). 2012 Oct;27(8):759-65. doi: 10.1016/j.clinbiomech.2012.05.010. Epub 2012 Jun 27. Daftari TK, Chinthakunta SR, Ingalhalikar A, Gudipally M, Hussain M, Khalil S. Resurgens Orthopaedics Spine Center, 270 Chastain Rd, Kennesaw, GA Kinematics of a selectively con... [Clin Biomech (Bristol, Avon). 2012] - PubMed - NCBI Hybrid construct for two levels disc disease in lumbar spine European Spine Journal February 2010, Volume 19, Issue 2, pp 290-296 Stephane Aunoble, Robert Meyrat, Yasser Al Sawad, C. Tournier, Philip Leijssen, Jean-Charles Le Huec Hybrid construct for two levels disc disease in lumbar spine - Springer PubMed: Hybrid disc replacement Hybrid disc replacement - PubMed - NCBI 2012 BritSpine P235 COMPLICATION RATES IN THE ANTERIOR LUMBAR RETROPERITONEAL APPROACH: A SINGLE SURGEON SERIES IN A TERTIARY REFERRAL CENTRE http://www.adrsupport.org/forums/f50...-2012-a-11654/ 2011 UCSF CME {Continuing Medical Education, cervical} http://www.adrsupport.org/forums/f50...-2011-a-11648/ 2012 ISSLS Annual Meeting P309 Hybrid: TDR + Fusion (ALIF) 385 Patients, Combined Arthroplasty and Anterior Lumbar Interbody Fusion (Hybrid Procedure) in 385 Patients with a Minimum of 2 Years Follow-up http://www.adrsupport.org/forums/f50...-2012-a-11608/ MAVERICK™ (17.9%) (A-Mav: Medtronic) and In Motion Lumbar Artificial Disc™ (40.8%) (Depuy Spine), and CHARITÉ® (Depuy Spine) (41.3%). 2010 ISSLS Annual Meeting GP176. HYBRID COMBINED TOTAL DISC REPLACEMENT AND FUSION PROCEDURES IN THE LUMBAR SPINE: CLINICAL AND RADIOGRAPHIC OUTCOME Retrospective http://www.adrsupport.org/forums/f50...stracts-10667/ 2009 NASS North American Spine Society, Annual Meeting, Poster #158. The Hybrid ADR: Long-Term Analysis of Sagittal Motion and Clinical Outcome after Concurrent ADR + ALIF (Minimum 2-Year Follow-Up) Alexandre Rasouli, MD 1, Rick B Delamarter, MD 2, L.E.A. Kanim, MA2, Nomaan Ashraf, MD 2, Brandon Strenge, Sr., MD 2; 1 University of California, Irvine, Newport Coast, CA, USA; 2 The Spine Institute at Santa Monica, Santa Monica, CA, USA Biomechanical comparison of two-level Maverick disc replacement and a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion, The Spine Journal 2009 http://www.adrsupport.org/forums/f50...-2009-a-10162/ 2009 Spine Arthroplasty Society http://www.adrsupport.org/forums/f51...-program-9928/ Abstract: 536 Hybrid Surgery: Fuson and Disc Arthroplasty Is Superior to Two Disc Arthroplasties in the Lumbar Spine J.C. Le Huec1, S. Aunoble2, P. Leijsen2 EuroSpine 2008 SP 3 Hybrid construct: fusion L5S1 and disc arthroplasty L4L5 for DDD. 3 years follow up • JC Le Huec MD PhD, S Aunoble MD, R Meyrat MD, C Tournier MD, http://www.adrsupport.org/forums/att...4-l5-3-yrs-pdf 2008 German Spine Congress P 50 Clinical outcome in primary bilevel cervical intervention with disc replacement, hybrid supply or fusion M.G. Detzner1, F. Weber1 1 Städtisches Krankenhaus Köln-Merheim, Klinik für Neurochirurgie, Köln Objective: Safety, clinical outcome and complications of 105 bilevel cervical interventions with disc replacement, hybrid supply or cage interposition for fusion are compared. Methods: The patients data were obtained retrospectively from 882 patients operated for cervical disc herniation or combined cervical stenosis between 2004 and 2007 at the department for neurosurgery in Cologne-Merheim. Primary interventions in two cervical levels were necessary in 105 Patients. Clinical follow up occurred on an average of 7,6 months. AANS / CNS 2008 Annual Meeting (Link) AANS = American Association of Neurosurgeons CNS_ = Congress of Neurosurgeons Abstract: 321 Outcomes Analysis of Hybrid Disc Arthroplasty (Lumbar 32 patients) Pablo R. Pazmino, Rohit Verma, Todd Hopkins Lanman, John J. Regan http://www.adrsupport.org/forums/f50...g-2008-a-7279/ http://www.adrsupport.org/forums/f50...1-2008-a-4757/ 2007 AANS / CNS http://www.adrsupport.org/forums/f50...s-2007-a-6744/ Hybrid Constructs 2005 Orthopaedic Clinics N.America Rudolf Bertagnoli, MDa,*, Patrick Tropiano, MD, PhDb, Jack Zigler, MDc, Armin Karg, MScd, Sandra Voigt, MScd Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: a finite element analysis. Eur Spine J. 2012 Jun;21 Suppl 5:S663-74. doi: 10.1007/s00586-010-1382-1. Epub 2010 Apr 2. Schmidt H, Galbusera F, Rohlmann A, Zander T, Wilke HJ. Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany Effect of multilevel lumbar disc arthroplasty on... [Eur Spine J. 2012] - PubMed - NCBI We hypothesise that: (1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension; (2) deviations from the optimal implant position lead to strong instabilities. Charite' - specific testing The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition. Deviations from the optimal implant position lead to unfavourable kinematics, to high facet joint forces and even to lift-off phenomena. |
Hi Krossi201. Yes, I agree that losing strength in your arms is an indication for neck surgery (only my opinion, not medical advice). I have only been web post browsing for almost a year before I contacted Mr. Harrison after long rational thought. Like I said, you can't go wrong with any of those 3 but I like Mr. Harrison since he has about 2.5 decades of implanting all types of discs including the lates M6-L which is less surgeon-dependant on errors. And yes, operating on a pro-athlete only confirmed my decision. When there is unlimited resources and Mr. Harrison is picked, someone getting paid a lot did their homework.
As for other personal reasons for picking Mr. Harrison...I like that he noted he hasn't had a case of retrograde ejaclation complication (can happen to any male in the lumbar, a 2-5% risk), he uses a barrier between the disc and the great vessels and he doesn't use a vascular surgeon- takes his approach all the way down to the spine himself since he is educated in both vascular and orthopedic spine. Dr. Clavel would be my second choice since he seems to have done the most M6-L's with success after the late Mr. Boree (who was my original hope-God bless his soul). Mr. Dare I don't know too much about but sounds very promising. Good luck and oh..btw Dr. Lauryssen is the best neurosurgeon in L.A. IMHO. He did do the first U.S. M6-L in a trial and plans on doing more in Dubai but since I was on a running list and didn't know when his first batch would be sent there I had to look elsewhere for now. He will be on the hot list once he starts internationally. Very caring and wants what's best for YOU (rare these days). As for the discs, don't know too much about the Bryan disc. Freedom disc sounds like they use the latest polyurethane core too but not sure since they only say 'proprietary polymer' on their site--fishy. M6-L doesn't hide anything...a polyurethane core and UHMPE outer 'annular' fibers. BTW polyurethane is used in 30 yr hips now and is the latest in mimicking cartilage. Good luck! |
Lillyth,
You are a brave woman.. wishing you the best on your 3 level M6-C and 3 level M6-L ADR's. Please keep us posted! oh wait....you just had it YESTERDAY!! wow. Speedy recovery |
Hi afhstock, thank you for your answers. It sounds like we did a lot of same research. I am assuming you met with Dr Lauryssen in person. I was considering phone consult but I think in person would be better. Did you tell him you were considering these other surgeons( Dr Clavel and Dr Harrisson). If so was he willing to give you advice without being offended? ( as many others surgeons I have met do).
I believe the polymer is mixture of silicone and polyurethane and possibly one othe ingredient for freedom disc. I had the papers but they are not in front of me now. My concern for freedom disc is the bonding between the titanium and the polymer. If it should fail it seems like could be catastrophic. Also I almost wonder if the wedge design helps or hurts? Would it be more physiologic or would it create more facet problems? There are less pt reports since it is newer. I have spoken via email to Dr Burkhard Rishcke in Zurich Switzerland and he is doing first cervical cases with freedom trial in Europe. He has used M6 as well and says he prefers the Freedom. But I know that is just one mans opinion. The M6 seems to have best track record but there is small concern of wear debris from the polyethylene annulus fibers rubbing together and they could be released if the outer sheath were to break. All in all both look like good products and right now I am leaning toward the m6 due to more experience with it both pts and surgeons. Two level cervical for Freedom with Dr Rishcke is between 30,000 and 40,000 as preliminary quote. Did you get any figures from Harrison versus Laurryssen versus Clavel? Thanks |
Hello there again Krossi201, yes I certainly did meet Dr. Carl Lauryssen in person and he interviewed me in full and did a quite thorough physical examination. He is not absolutely offended at all with seeing other surgeons outside the US. I don't want to make a private conversation public but he did say that he is not a litigious person however he feels people should have the best disc possible and if he were to have an Opportunity to take U.S. insurance companies to court because of all the ADR fuss and non-repayment he would! I said sign me up and put me on the list LOL.
He knew time was of the essence in relationship to my ADR/pain and stated he would have me on a running list to be the first batch of disc replacements in Dubai sometime in July or later. After I contacted his team they were not sure when exactly everything will be finalized so I told them I would go with an international Doctor. Even at that point he was helping me by getting the necessary CT scans and imaging to have it done overseas.. so he is totally on your side. Anyone would be lucky to have surgery by him. I agree that the freedom disc has a mix of polymers in there and possibly silicone. Yes I agree with you that the junction of titanium and polymers is not supported by anything else. I will take my chances with the small residual debris release hoping the M6 L-sheath will hold it in place. There is a link with all the testing of M6L on another post.. if you have not seen it let me know and I will send it to you. There is a video on YouTube of the freedom disc, Just type in the name and you will see them testing it at the extreme angles. The cost in total for my surgery and discogram (under sedation) not including flight and hotel will run approximately USD $37,000 at the time due to the conversion of the pound and dollar. That is for 1 level lumbar. Apologize for the spelling errors, I am using Siri on my iPad :) Thank you for your posts. They do really help. I'm grateful to this forum Altogether! |
Thank you for your responses, they are very helpful and insightful. I am looking forward to meeting Dr. Lauryssen next month. I am also going to see Dr. Coric in Charlotte next month as he has worked on trials of both M6 and Freedom discs. I too felt the same that if Mr. Goosen picked Dr. Harrison he must be great. If I were lumbar I would probably go with Dr. Harrison also. An added bonus is there would be no language barrier! Does Dr. Harrison do neurological monitoring during the procedure? Do u know if Dr. Clavel does? Keep me posted on your spine journey. I wish you well.
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Also is Dr. Lauryssen willing to follow you when you return to states?
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-Krossi201
Yes, Dr. Lauryssen will follow up with any ADR patient if they had an international surgeon. He is very understanding of why patients go outside of the U.S. and I won't be surprised if he soon becomes an international doc for the M6. I don't know the doc in N. Carolina but as for yourself, you have way more options as a cervical patient. Lots of great U.S. neurosurgeons like to work in the neck and outcomes with just about any ADR will be fabulous. It's the longterm of course. There's about 10 times less forces in the neck. If I had to stay in the U. S. I'd probably go with the Freedom or Bryan disc if promised in a trial (texas back inst comes to mind-dr. Zeeglar). Can't go that astray with the M6-C (id take it as first choice if done here) but that's a personal decision you'd have to make. In regards to neurological monitoring, i'm embarrassed to say i haven't asked?! It's been so long a standard of care to have a running surface EMG/NCV that it slipped my mind? Thanks! Gotta ask but i don't doubt it. A lot of these docs go to international conferences and bounce ideas all the time. Ttyl. Take care! |
I would not recommend Mr David Harrison personally. The joke about spinal surgeons thinking they are gods is likely modelled on this man. He may or may not be a good surgeon but my impression having met him and been under his care is he's more interested in celebrity than patients. His secretary is his wife and she is the passive aggressive type. This duo was an unhappy experience for me and other doctors share this view when asked candidly. Back surgery rarely goes perfectly. It's at that point you want to be with a down to earth guy not a t***
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I saw Dr Lauryssen and liked him a lot!!! he thinks I have bad disc at C 3/4 also and too much kyphosis for most discs available to me as I am allergic to nickel. Two docs said the M6 has too much movement for my level of kyphosis and Bryan disc also bad for kyphosis. So I guess M6 is not for me. They felt the freedom disc or hybrid with freedom disc would be better choice because the plastic is stiffer and it has wedge shape which may help stabilize my kyphosis some! But best for kyphosis would be fusion alone but would have adjacent segment risk to deal with later. It makes it so hard to know what to do. Freedom disc is new and only available ineurope right now. Good luck on your quest. Keep me posted
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Walterwhite, I have to thoroughly disagree with you so far. I am on my hospital gurney next in line for my ADR with Mr. Harrison in the UK.
His bedside manners and professionalism are the best in class and rather 'top shelf.' He spent a significant amount of time pre-op explaining all surgical details, reviewing imaging and answering all my questions to make sure I was a good candidate. I'll let you know how the surgery goes but as far as my experience goes, you couldn't be further from the truth. |
Hi Afhstock,
First off, I hope your operation has gone fantastically. You are probably now in the clouds with morphine. It will be some weeks before you can tell the result but I am sure Mr Harrison is a fine surgeon and has done a good job. My concern is about what happens if things go wrong. Will he be there. Only bad luck and time will tell and I hope for your sake you never need to find out and that in the case that you did, that it would be different n your case. For me however, my experience is negative. I do acknowledge (especially when on the hospital guernsey about to go under the knife) a tremendous sense of loyalty to your surgeon. In fact it would be wholly irrational for you to feel otherwise at this juncture. I also am loyal to my surgeon but I really have tried hard to separate the quality of care and degree of compassion, from the outcome of the surgery. I have done this because I have already had one botched procedure. Psychologically I could not choose a surgeon that I did not believe would take care of me in the event things didn't work out well. I can somehow accept bad luck or bad healing but it would be a constant source of upset that the doctor that caused the problems just didn't care. That he was just too high up in the clouds to care about the bad cases. This is the way I feel about Mr Harrison. I don't want to delve into details but he acted with me like a cross between Tom Cruise's Maverick and David Brent from The Office. In my opinion, both his rude, nepotistic office culture and his own arrogant demeanour was drowning in self-importance. His primary concern from my viewpoint was his own celebrity status. I work in medical devices industry and I have seen the doctors at the top of their field and the way they bask in their own glow of celebrity. They publish to get plaudits. They attend conferences to be treated as VIPs. They have forgotten their roots and raison d'être. There was a moment in Mrs Thatchers 'reign' where she announced to the press that "we are grandparents" which was much lampooned and in many ways confirmed what most people thought... that she was once grewt but she had been in power too long and had let success get to her head and had forgotten the people she was meant to be fighting for. I saw exactly this attitude with Mr Harrison in EVERY interaction I had with him and his office. Not just once. But every single interation. It maybe that Mr Harrison was a brilliant man when he was younger. It maybe (although I am sure it's a long shot) that Mr Harrison has seen my feedback and it has come as a shock and he has recognised he must get back to grass roots. In which case (and this is just to argue the hypothetical that giving feedback is important) that you are the beneficiary of my earlier complaints. Something I feel passionate about is that us spinal patients should stick together. Doctors stick together. So do lawyers. This is the one place I have found on the Internet (started by the Harrison I do respect) where we as patients get to support each other. Please don't shut me down. Even if you have had a good experience, this is what you should have. It doesn't cancel out my bad one which affected my life quite dramatically. I really do hope you have an amazing result but that shouldn't affect you from being objective. The outcome from your procedure is not related to your or my views on his bedside manner. Likewise, my surgeon Mr Lam was incredibly generous with his time and made me feel like I was seeing a real expert who card about patients. However, my surgery (now 8 weeks) hasn't gone amazing. I am still a while from knowing for sure but nothing will change that Mr Lam was a stand up guy. There is a risk that surgery won't work that well and I don't think it's fair to blame a surgeon for all of that. However I made my comments irrespective of the surgical result, and from my personal perspective. I am quite a measured person and would never seek to rubbish someone who has made even a big mistake (as per my first surgeon who gave me an unnecessary Discectomy and started this whole process for me). My complaint about Harrison is the culture of his practice, his demeanour and nothing to do with surgery outcomes or decisions to do one thing or another. I will leave it to others to place a weighting on my comments after reading my other posts. I have done my bit to give feedback to the community that helped me find Mr Lam. By the way... Sort of my last point... I presume from your relative assessment of Mr Harrisons bedside manner that you spoke to other surgeons. i met with about 5. The two who i met after seeing Harrison (thanks to this forum for showing me there were other choices) both asked me if i had seen anyone else. i said Harrison. They asked, quite bizarrely i thought, what i made of him and i said my view albeit much less candidly than here, so as not to professionally embarrass them - i said "we didnt gel that well" - and to my genuine surprise they both smiled in obvious agreement. One even muttered. "Yes he is a one isnt he". Make of this as you will. It's just my word. Perhaps the doctors meant something else. Or indeed perhaps they are jealous. I know doctors will stick together so I am not going to make libellous remarks. Just my opinion as facts I truly believe to be correct. Thank goodness for your first amendment which means I can legally express myself. Good luck to you. I look forward to hearing your story in the 'outcome thread' which no doubt you will start soon. Please know that whatever happens, your only friends will be the fellow patients on this board. We will support you after the doctor has left the room. We need to count on each other. Can I count on you to at least give me the benefit of the doubt? Best wishes, Walter |
Hi Walterwhite,
I apologize. I did not mean to touch a nerve. And yes, everyone has a right to express their opinion. And I respect yours. Back surgery is a big deal and a true life changer for many. As you said, I am doped on morphine lol and yes, I'll report on my outcome in the correct forum. In short still way too early but there are lots of signs it has been mostly successfull, don't want to judge prematurely. Thank you for standing by others as I will stand by you. We're all in this sort of misery together and hoping to desperately get out. I have seen 6 ortho spine/neurosurgeons and I myself am a PA in pain medicine (go figure). Take care and see you on the surgical outcome forum. |
Krossi
I'm happy to hear you've narrowed down your options with calculated measures. I understand you're delaying surgery for now. Please keep us posted on your status. God speed. |
Hi Afhstock. Enjoy the button! It's always a good sign to have a good sign. Assuming something like tingling gone in one leg. It's all good. You seem positive but guarded and I think that's the right approach. I've seen a few people who start out well but once they're off the painkillers it can be a different story. It's easy to be disappointed if you raise expectations. It's kind of academic now anyway :-) You have to do your exercises and don't overdo it. Stick to the program. Don't twist or bend. Walk often. If u check out my Outcome thread you can see I've written a few posts up to about week 5. I'm waiting for an appointment next week before I send my next update. I feel like I've hit a recovery plateau but it's hard to say if it's normal because of fusion part of the procedure which takes longer to heal.
All the best. Did you know the word morphine comes from the Greek Morpheus (nice one Matrix) meaning dreams.... Enjoy pain free. Peace. |
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