Got approved for Active L but going to try to get something better instead.
 

I received and Preauthorization for Artificial disk replacement surgery for Active L disc at the end of the month. This would be in Charlotte North Carolina at Carolinas Medical center.

I am seriously considering about getting a next generation disk with cushioning and passive resistance instead of the Active L. I figure I only got one shot at this and will be stuck with the choice for the rest of my life so might as well get the best one I can get even if I have to cash out part of my retirement savings or wait a year until the disk I want gets FDA approved.

When I met with Dr Coric a few weeks ago I asked him if he was in my shoes and had the money to get the best disk available what would he do. He said he would travel to Germany and get a next generation disk with cushioning and probably the M6 since it has been tested the most. He did say the Active L disk is a great disc and he does have patients that have done very well and are able to be very active and run and jog with this disk.

I am still trying to narrow down what would be the best artificial disk for me and where and when I could get it my disk replaced.

1. Cheapest option since insurance will cover in USA. I would only pay 10% since I have met my deductible. The Active L disk is the latest disk that the FDA has approved in 2015. It has an 87% success rate and most patients achieve a reduction of pain to less 2 out of 10 within a few months after surgery. This disk has anatomically designed S1 endplate which is the level I need replaced. I has XL endplates (size 33 mm X 40 mm) It allows for motion but does not have any cushioning or passive resistance to motion.

https://www.soactivesofast.com/low-b...rtificial-disc

Active L disk Study results and success rates.

https://www.dovepress.com/the-activl...t-article-MDER

2. My top choice Axiomed Freedom disk. http://www.axiomed.com/
Made in USA. Not FDA approved yet but should be by end of 2017 , over 800 installed worldwide- Available in Canada, Australia, EU. This disk has cushioning and passive resistive motion. This is has large silicone polymer core the full width of disc. Really strong polymer-metal bond. This disk actually 5 times stronger than human disk. I am really impressed with the 45 degree 15mm sheer test at 2 minutes in the video below. I think this test would probably destroy any other disk I have seen.

https://www.youtube.com/watch?v=2k8WRoBjS6s

I should probably just stick to wakesurfing. But I am thinking the Freedom disk would survive wakeboard wipeouts  https://www.youtube.com/watch?v=XxTgCKwEM8o

Freedom® Lumbar Disc —Clinical Outcomes BenchmarkedAgainst All TDRs in theSWISSspine Registry http://www.axiomed.com/pdf/WPaperSWISSSpineReg.pdf

Half the patients in a 50-patient study of the Freedom Lumbar Disc reported less than 10 percent disability score and less than 1/10 on the pain scale two years after surgery.
http://www.beckersspine.com/orthoped...s-to-know.html

I have not found a document with sizes available yet. If you find one please let me know.

I am also not finding many doctors that use the Freedom disk yet. It seems to be mainly used in Switzerland. I have been in communications with Dr Zeegers and he would consider it. He has met with Axiomed reps since I have started communication with him.

3. ESP Elastic Spine Pad http://www.esp-disc.com/ Made in France- available in EU. Does not seem very common outside of France. I have not done lots of research on this yet. Just learned about it from this forum a few weeks ago.

4. The spinal kinetics M6 disk is probably the most widely used. Made in USA, but not available in USA. . Over 10,000 installed. Have not even started and FDA trial for Lumbar in US. This might be higher on list if I needed a disk at another level or had smaller bones I just don’t think it would be a good choice for me at L5/S1. The bottom of my L5 is 37mm x 50mm. The M6 disk is only about 25mm diameter with an even smaller diameter center core. It does have XL 33mm x 44mm endplates but disk size is only 25mm and covers 50% of width of my spine at the L5/S1 level.

http://www.spinalkinetics.com/m6-l/m6-l-procedure/ (This link shows sizes available, I would need the XL)

I keep thinking of the old Pontiac Grand Prix wider is better commercials https://www.youtube.com/watch?v=RO6U_KawAdg

M6 disk https://www.youtube.com/watch?v=O0pOn09DnB8

As far a Doctors and Hospitals are concerned If I am going try get Bluecross to pay I would probably need to stay in network. I do have emergency coverage worldwide. https://www.bluecardworldwide.com/ RVP is code on my card to search for providers. When I talked to Bluecross in US about possibility of getting surgery in another country since better disc are available I was told I would need a waiver from my employer to allow an elective surgery out of the country. I work for Varian Medical Systems and we even have a factory in Switzerland where we make the robotic arms that holds the X-ray tube that I was changing out when I herniated my disk back in 2007.

My girlfriend would rather go to Canada Vancouver/Victoria island since she has a friend she could visit and we could stay there. It wouldn’t be as long as a flight as Germany. I am dreading a flight and looking for travel options. BMW factory is in SC and ships cars from SC Europe several times a month. Maybe I could travel on a cargo ship and stay in bed for a few week.

I really want an experience surgeon in Blueworld network that would do most of all or what Dr Bertagnoli says on his superior surgery page. http://www.dr-bertagnoli.com/superior-surgery.html

1. Preserve the anterior longitudinal ligament ( I have seen dozens of videos where they make two cuts and remove a 10-15 mm of this anterior longitudinal ligament instead or preserving it. )
2. drill or saw the keyway for the keel and clean out, not just chisel it in.
3. Application of bone wax to ADR preparation sites in the bone or remodeled areas of the bone helps prevent osteophytes from growing.
4. implants a protective membrane to prevent adhesions between the operated area and the veins and arteries in ventral lumbar surgery. This is a look to the possible future for the patient, because it is these adhesions that make future operations in this area so dangerous.
5. packs the surgery site between and around the vertebrae with anti-thrombin agents to efficiently inhibit thrombin-induced fibrin formation and platelet aggregation

Wow, what a tough decision. Everything I've heard about the Freedom disc has been great. From what I hear, it is very close to FDA approval. Perhaps you could contact some of the doctors in the trial to see how close it is and how it performed?

Activ L is incredibly strong and sturdy, and from what I hear it does a great job of preserving the facets.

Another factor you might want to take into account is the segment you are getting done. If it's l5-s1, the motion in that segment is relatively small.

I've always thought or read
Surgeon experience > device

Believe it or not, you have overlooked the most comprehensive repository of ADR outcomes in the world -- this web site. Look at the post-op forum, where you have post-op outcomes since 2004!

As well, you can do advanced searches:

https://www.adrsupport.org/forums/search.php

My personal preference is an ADR that has the least amount of materials and parts. More variables, more failures.

Sorry, I don't have time to reply on this. Sorry. Look at the last 12 years of posts. Read, read, read the post-op forum. :look:

YES!

Statistically, the best way to have a lousy result is to use a lousy surgeon. Second best is for your (moderate to good) surgeon to screw up during the surgery. The first is less extreme now that the average patient has many more surgeons to choose from but my advice would be to find a surgeon that you trust, and can afford, first then decide if you like the ADR he/she is offering.

Get a metal analysis first. CoCroMo may or may not be for you, depending on how your body responds to it. Titanium is better IMO.

BTW, I have pics of the M6L for the L5/S1 on my Instagram page. A real one they use.

not sure what I will do next.
 

Dr Zeegers insisted I get a Dexa and it shows I have osteopenia in certain parts of my back. I have started taking extra supplements no more Coke Zero for me. L1 is -1.9 T score but L4 is an-.08 The L5/S1 levels where I need surgery are not on the Dexa scan but I did get a CT scan done two months ago they should be able to what the bone density is at L5/S1. As long as L5/S1 are less than -1 I should be able to get active L.

I still don't have my metal allergy results. My primary doctors nurse practitioner ordered wrong test. I don't have any metals in my blood. My doctor was referring me to allergist for patch testing and it was going to be weeks before I could get and appointment. I gave up on them and ordered kit from orthopedic analysis. I have a friend who is a Dr who signed the paper work and drew the blood for me. $400 test.
http://www.orthopedicanalysis.com/te...-testing-panel

bone density
 

You have to have good bone density to get an ADR. I recently found out mine is low and spent lots of time doing research on what I can do to improve mine. I wanted to post some information that might help others. I am getting some blood work done to see if there is a medical cause of my low bone density but really believe now it might be because of a High protein diet and the fact that I used to drink 2-3 Coke Zero 12 oz cans a day.
How your body works.
Endocrinology - Calcium and Phosphate Regulation https://www.youtube.com/watch?v=EEM0iRJNhU8
Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. https://www.ncbi.nlm.nih.gov/pubmed/17023723
Researchers at Tufts University, studying several thousand men and women, found that women who regularly drank cola-based sodas -- three or more a day -- had almost 4% lower bone mineral density in the hip, even though researchers controlled for calcium and vitamin D intake. But women who drank non-cola soft drinks, like Sprite or Mountain Dew, didn't appear to have lower bone density. Phosphoric acid, a major component in most sodas, may be to blame, according to lead study author Katherine Tucker, PhD
http://www.webmd.com/osteoporosis/fe...osteoporosis#1
http://www.webmd.com/osteoporosis/fe...osteoporosis#2
From all the stuff I have read and watch it is my understanding that anytime you drink a Cola with Phosphoric acid your body has to balance the PH and Calcium level of your Blood. It does this by releasing hormones that cause the bones to release calcium into the blood.
Your body also has to balance PH depending on what food you eat. I have lost a lot of weight in the last few years. I used to weigh 265 and I am down to 190lbs. I did this with a High Protein diet which might also be why I have low bone density. This very long video goes into a low acid diet.
https://www.youtube.com/watch?v=9zFlr46eXeM
I wanted to make sure everyone is aware of this as well. If your bone density is fine you may not want to take a supplement because High levels of Calcium can double your risk of Heart Attact.
http://www.foxnews.com/health/2012/0...tists-say.html
What I am doing to try to make my bones Stronger.
1. I am taking extra supplements.
2. Cut out any Cola products that contain Phosphoric Acid. ( I used to drink 2-3 Coke Zero a day)
3. Reduce caffeine consumption.
4. Eating more Green vegetables. (Kale, Collard Greens, Broccoli etc)
5. Eating bone broth soups. (This gets all the minerals from the bones. Collard greens with smoked neck bones)
6. Trying to do some weigh beating exercises on spine. (This is hard one since it increases pain).

I decided on 2 level LP-ESP with Dr Rischke
 

I got tired of waiting on Zeegers and I still have not found out what sizes of Freedom disc are available or don't a final. I have still been communication with him and all I know at this point is he said sizing might be a problem with Freedom disc.

I contacted Dr Riscke earlier this week on the 8th using form on his website. http://www.spine-center-rischke.ch/?lang=en

I shared my MRI, CT, bone density, metal allergy test results with him via Dropbox and got an answer an then Quote within hours.

" thanks for sending your images. In L4/5 there occur a DDD with bright protrusion of the disc into the spinal canal with narrowing both foramen. At level L5/S1 there occur a DDD and black disc with lost of height and protrusion of the disc material into the spinal canal.Therefore again from my point there is no doubt for an indication of ADR in both level L4/5 and L5/S1."

Dr Rischke was an investigator on the Freedom disk but prefers the LP-ESP over the Freedom for a couple of reasons.

"with experiences since 20 years in ADR - the viscoelastic discs prothesis a the most natural like one. However from my point the LP-ESP is more adequate than the Freedom. The LP-ESP saves more the bone endplates than the more aggressive endplates of the Freedom." "LP-Esp is able to implant anterior-lateral, and the surface of the end plate is covered by hydroxyapatite which enables a save bone in growth . On the other hand I noted in the past a subsiding of the Axiomed prosthesis caused by the aggressive fins which damage the vertebra end plates Therefore I prefer the LP-ESP"

With my bone density on the light side I believe it is my best choice as well.

He is charging 25,000 swiss franc. He gave me choice of a surgery at one of two surgery centers. The high end option would be 35K-40k. I went with the least expensive option at Klinik St.George. He said is would be aprox 25,000k but the quote I have received is for

Aufwand Klinik St Grorge (OP dauer 150 Min) FR 10,295
implantate 2x LP-ESP inkl Leihgebuhren FR 6,880

for a total of 17,175. It says it includes a lot of stuff but it is in German so I don't know if this includes everything.

I have booked surgery for February 28th. I will be flying out a few days early on the 25th-27th depending on availability of unsold seats. My nephew works for American Airlines as a flight attendant and will be coming with me for the first week. He is hoping to get us upgraded to first class or business class seats. We just have to find a flight that isn't sold out of them.

I have added some more documentation on the FH Orthopedics LP-ESP thread that show the size, thickness, angles of the disc at https://www.adrsupport.org/forums/sh...ad.php?t=13104

Now I just need to figure out where I am going to stay for few weeks in Switzerland for the first part of my recovery.

Seems like an amazing disc. So let me get this straight, he is going to implant it laterally? I've never heard of this being done.

I think laterally simply refers to how the disc is pushed in between the vertebra. I think the cut is still done as anterior, meaning a cut going down from the belly button.

ah ok, thanks. Hate to sound like a noob.

No he meant it could be put in laterally from the side for certain levels.
 

I might be wrong but I believe he meant it could be put in from the side for certain levels (l4-L5). I need L4/L5 and L5/S1 so mine will be Anterior approach.

During my email conversations with Dr Rischke I emailed a suggestion to him on tools I had seen from spinefrountier where they have developed a long
tri-retractor that is used for lateral fusions. They are using this at Less surgery locations in Florida.

https://www.youtube.com/watch?v=or24J8Wlpzs&t=2s

Dr Rischke replied with

You are right But the LP-Esp is able to implant anterior-lateral, and the surface of the end plate is covered by hydroxyapatite which enables a save bone in growth . On the other hand I noted in the past a subsiding of the Axiomed prosthesis caused by the aggressive fins which damage the vertebra end plates
Therefore I prefer the LP-ESP
The next OR slot is on Febr 28th at clinic St Georg
Best regards

Von meinem iPhone gesendet
Prof Dr Dr Rischke

Take a look at the way the LP-ESP it is put in this video. The surgeon does not have to chisel in any groves for a keel because it does not have one. The LP-ESP has 5 small spikes on each end plate. The disk are spread apart and then the disk is inserted between the vertebra. When the spreader is released the spikes hold the disk in place. Watch the section that is from :55 to 1:10 where they show 3 views slowly 3 times. https://www.youtube.com/watch?v=r7T74bRip2g it seem like it would be just as easy to put the disc in from the lateral approach. I know that Dr Chin with Axiomed says they plan on doing Laterally insertions in this video. https://www.youtube.com/watch?v=QJkRSuMGoVk

Outcome foe wakesurfermike
 

It has been 2 weeks since his scheduled surgery. Anyone heard from or about him? Been keeping him in my thoughts and prayers

Update- complications
 

https://www.facebook.com/groups/Disc...793552987/Well crap! I knew my osteopenia might be a problem and it is. Well I was feeling great for the first four days had zero back pain. On the fifth day I was feeling pretty good but did experience some pain when sitting/laying down. It felt better to be standing or walking so I went for a long walk around Goldock. About 3 miles in all. I was only taking acetaminophen and ibuprofen for pain meds. That night I started having pain on my right side of my back and little bit of shooting pain down leg when sitting. It still felt good standing up or walking. On Monday the 6 (6 days after surgery) I rented a car and drove 1:45 min to Zurich. During the drive the back pain got up to a 6 out of 10 and I was getting shooting pain down leg. The pain stopped after I walked around a bit. I saw Dr Rische and explained what was experiencing and he ordered X-rays for the following day. I checked into Airbnb and returned rental car. I bought a few groceries the next morning and walked about 1.5 miles to get some large bandages at a pharmacy. During this walk my back was not hurting but I Started getting pain in my right forefoot. In the afternoon I took another .6 mile walk to get x-Ray and haircut. On the walk back I only had very minimal pain. I showed up at physical therapy at 3 pm. (.2 mile walk) and was told Dr Rische need to speak with me. They called him and he gave me the news that the l4/l5 implant is subsiding (sinking into the vertebrae) and he needs to do a revision surgery. The surgery fee/ Klinick Pyramid surgery and 2 day fee will be $16.6 k. My family is working the money today and surgery will be on Friday the 10th. The procedure will use a ballon to lift implant and then the vertebrae will be filled with bone cement. https://youtu.be/_lUhQLFHriw Expect to be in hospital 2 days for recovery. I will need to stay in Zurick at least 2 weeks for follow up X-rays, physical therapy and removal of stitches , before returning to USA.

https://www.facebook.com/groups/Disc...7775853234981/

I am in recovery room now. Dr Rischke used two balloons to lift implant back to position and the filled l5 vertebrae with bone cement. The kit had extra needles and so he injected bone cement into L4 vertebrae to strengthen it . He says it was successful and implant is back in position. I have to lay flat for 1 hr I am allowed to get up. I still have pain 6/10 in center of back, but no leg pain. I am not certain if pain is from vertebra or the 4 small incisions. Getting some pain meds by IV now and pain is going down. Images are from fluoroscopy print out so are not as clear as x-Ray image, but good enough to see implant is back in place. Pain med helping so down to 3/10 now.

https://www.facebook.com/groups/Disc...9137663098800/

I'm kind of shocked they would charge you for this extra operation after the disc subsided. Didn't it subside due to their miscalculation?

Hi Mike,

Read your facebook updates. I am very sorry for the set-back. I dearly hope the vertebra will get stabilized and you get a full recovery. There is still hope for that! I know it is so difficult to know what to think just after the operation, when you feel that you are actually worse off. But much is temporary. Once you get healthy, I am sure you can earn back the lost cash in no time. Let us hope the work insurance gives you a helping hand!

Wishing you all the best and keep us informed. Btw. Your videos are great!

Mike,
That sucks, I wish you and your family luck. You will get through this!

Mike, wish you good luck. Sometimes the journey is longer then we expect, stay strong! Best Regards

I you don't mind sharing, which insurance did you get the ADR approved through? I was just (repeatedly) denied by BCBS FEP and I am quite devastated. Since open season is coming around, I am hoping to switch to someone to try again! Any advice/input is highly appreciated!

As someone with BCBS FEP, I'm in the same boat. If you receive any feedback, would you be willing to pass it along...since I'm considering Europe vice dealing with FEHB at this point :mad::rant::censor:

Subsidence
 

Yeah your vertebrae might have been porous had you been inactive for quite a while. I had epoxy injected into my verts n thank God it held. Laterally I think means they come in from the side of your obliques? Good luck bro I wish you a painfree life. But your mess seem kind of light how much pain were you in that you went for surgery?

Still waiting
 

Hello, Tatonka_usn,
sorry for the late reply, I've been all over the place lately. My surgeon in Miami all but abandoned me after the initial denial, so I ended up retaining an attorney. I am still trying to get an urgent appeal processed but I am not really sure if that will do anything. I am from Florida, which state are you in? I contacted my senator here after BCBS kept stone-walling me and brushing me off. He asked me to sign a consent form because of HIPAA, no idea if this will make a different...for what it's worth, I am not going down without a fight!

I just got evaluated by Dr. Bergatloni in Berlin, Germany. He is supposed to be one of the best but also pricey: for a one-level ADR, I got a price estimate for $32,000 Euros. I am still waiting for the evaluation from Dr. Dasai (Cologne, Germany). He also has a good reputation. I heard that the Texas Back Institute may offer cash-prices as well...

I am so confused in terms of what device is best: I was initially going for the activL (that's the one the surgeon in Miami uses), TBI I believe does the ProdiscL, and Dr. Dasai uses the LP-ESP...

What is your status/plan?

Hello! Just wondering how you are doing after your ADR with Dr. Desai?