Need help RE: 2-level ADR
 

Hello,
I am in need of some help and direction. I live in the US and have dealt with back problems since I was 25 years old. Due to a car accident, I sustained a herniated disc, and the tests revealed DDD. In 2010, I had an emergency microdiscectomy with significant left leg nerve damage, which required 6+ months of rehab. Currently, I'm in need of a 2-level ADR at L4-5:L5-S1. I Just turned 38, and want to regain what's left of my somewhat youthful life. Unfortunately, that time has come where I need to do something (ADR or fusion) and the US will only do a single ADR. I am, in no way am interested in a fusion surgery! I found the best ADR surgeon I could get to and made an appointment. It was heart breaking to hear that I am the perfect candidate for a 2-level ADR, but unfortunately it is not allowed in the the US. I found him extremely honest, knowledgable, patient, and he actually provided me with useful information so I could get started on trying to make the best decision for my problem.
Dr. Ritter Lang (Sternum Hospital in Germany) and Dr. John Sutcliffe (London Spine Clinic in London, UK) are 2 of the doctors and facilities I was given by my doctor here in the US. It seems there is also some debate over which is the best device on the market,Freedom,M6,Prodisc -L, etc... Then there is cost, facilities, insurance, travel arrangements, and contact info.,etc....
I honestly, thought I was knowledgable about my medical issues. Currently, I find myself in uncharted waters. I would truly appreciate any information an/or personal experience anyone is willing to share with me.
In my own self-researching on surgeons/facilities outside the US that perform 2-level and beyond ADR's, Dr. Bierstedt (of German Spine Specialists), was one of the main professionals in this area that really stood out for me with his patient success stories, facilities and number of years in the industry.
Living in pain, is no way to live. Regaining my quality of life is my goal.
Thanks to anyone willing to take the time to read and share.

Wombat,

Condolences on your condition, but welcome!

Count yourself blessed that you have an ADR friendly doctor.

Kuddos for researching your condition and options. You are doing exactly the right thing in this situation. I hope you'll continue researching doctors and treatments. The more you know the more likely you'll find that your options will begin to converge on a single treatment.

A thought ... I would encourage you to not be too hasty to poo-poo a fusion at L5/S1. My observation has been that ADR friendly surgeons seem to be less likely to recommend ADR at that level than they used to be. I don't understand all of the issues of an ADR at that level; but would strongly encourage you to not pursue any treatment until you do. A fusion at that level is not a life ending event. A year ago I did an Ironman race and ran part of the marathon visiting with a woman who had a fusion at that level four years prior.

Good luck!

Wombatcat,

Welcome to the forum! You will find plenty of helpful people here.

I concur with Jeff. I am first and foremost a cervical patient and I will be having a two level cervical ADR done here in the states next week, but I also have an L4-5 rupture (that left me with numbness, weakness and a loss of reflexes at the knee in my left leg.) as well as a bulge at 5S1 and L2-3. My surgeon won't touch my lumbar because my cervical isn't stable enough to endure the procedure. Once I heal with the neck, we will move forward with the lumbar plan.

That being said, from what I have gathered, a fusion at L5-S1 is not a bad option by itself or with an ADR above it. From what I understand, a disc failure is mostly caused by poor disc placement or inaccurate sizing at any level) but secondly, it seems as if we are seeing lumbar discs that fail at the L5-S1 level. I am not an expert on this but from what I gather, the movement an artifical disc provides at this level MAY not be appropriate if it is too much movement. Our natural disc at this level has some, but not as much as the others. Make sense? Many many people on this forum have hybrids, and Im sure they will chime in. I will be eager to see what they say as well, since I may be in the same lumbar boat as you. ;)

I hope this helps

Wombatcat,

Welcome to the forum!! I would agree with the suggestions that Jeff and Kelly gave you. I just wanted to add something, since you mentioned Dr. Ritter-Lang. There is a lot of negative press about him on these boards. I'm sure that Harrison, the moderator, would agree. If you search "Nightmare in Stenum", you will get a lot of information about other members experiences with him.

I would first look to get opinions from U.S. surgeons who perform ADR. If you consider the hybrid (one level ADR and fusion at L5/S1), insurance might cover it completely. Just as an aside, I had two levels of lumbar fusion between L3/L5. This was just over 4 years ago (Dec, 2010). I haven't had any lumbar issues since that surgery. I have more issues with my neck, which is what brought me to this forum. While I'm in no way suggestion fusion, my understanding is that L5/S1 is one of the best levels for it. That same level also has some devastating failures with ADR. Don't get me wrong, 95% of people who get ADR at L5/S1 are ok. It's those 5% that suffer badly and often need revision surgery. There is a member named Vicki_In_Florida who you might want to look up.

Good luck!!

Gene

Nice posts from everyone -- thanks Gene, Kelly, Jeff. :angel:

WBC, I am really surprised that ANY doctor would mention let along refer a patient to Ritter-Lang. Pls read and fee free to forward:

http://www.adrsupport.org/forums/f49...utation-10308/

Sacral slope doesn't look too bad at all for an ADR at both levels. Sheer load can be greater at L5/S1 but in many cases it is a non issue. That was not the case with me. My slope was too sleep, much so.

Dr Clavel did a three level hybrid with me in July of last year.

WBC, You are connected with a forum that has many, many members who have used surgeons from most continents (exception of Antarctic), many different medical device products and different operating procedures. While the information can be overwhelming at times, I think you will find answers to most if not all of your questions here.

I agree with the people who posted before me. There are probably ~8 - 10 surgeons overseas who specialize in ADR surgery and have performed more of these procedures that anyone else in the world. There are also a handful in the US that are quite familiar with ADR. However, the fact that FDA as well as insurance coverage limits these procedures domestically might also weigh into the decision. Please feel free to ask additional questions and research the experiences of people who have walked in your shoes before you.

I agree wholeheartedly that living in pain is no way to live.

Titan Fusion
 

Thanks for all of your replies guys. And Harrison about the information on Sternum. I am thankful to have found this sight.

I am struggling with making the right decision with surgery. And, my hope in having any surgery, is that it is successful and to stop my suffering. I try not to think about how long this problem has been present in my life, and how its currently effecting me daily, and forcus on research. But, I'd be lying if i said its overwhelming and frustrating.

Can anyone share their experience with hybrid. Titan fusion at L5-S1, ADR at L4-L5. Its my understanding Titan fusions are fairly new, so there may not be many of you guys out there. My hope is that insurance would absorb most of the cost and I could get it done here in the US.

Thanks for all the support!!!

I am in almost exact sutuation: DDD of L5-S1, microdiscectomy of L4-L5 in 2014. Looking at 2-level fusion or 2-level ADR. Did not want to create a new post since yours pretty much covers all my questions and concerns.

One thing I wanted to add is that I am also looking at Dr. Feil from ATOS clinic. Has anyone had any experience with him?

I had an anterior fusion of the L5/S1 and am doing really well. I am 3 1/2 months post op and have 95 percent mobility back. The Charlie horses in left leg have stopped as well as sciatica and spasms in my feet. Don't give up, keep searching for a surgeon who you feel confident in.

Make sure facets are in decent condition.
Do your due diligence, this is not something that should be rushed.

HI,

I would steer clear from Stenum... I've read about too many horror stories, all though i have seen alot of success, but the bad ones are just really bad.

When i was looking for an ADR Surgeon, I contacted all of them in Germany. Took my time.. Tried to dig up dirt on them via the internet.

The only one i couldn't find any dirt on was Dr Zeegers. I could only find raving reviews. He does charge a small initial fee, but it was well worth the $$. All the other dr just looked at my films and said "yes we could fix you", Dr Zeegers on the other hand, wanted my full medical history and a ton of information, xrays, bone density, mri's etc. When i got down there, he more xrays, ct scans, etc just to make sure nothing had changed. He leaves no stone un-turned.

The one thing i really liked about Dr Zeegers is that you talk to him directly, not some secretary, or administration, but him directly. Multiple skype session etc. Even after my surgery, he still responds to my questions. Super nice caring Doctor. This was also one of my reasons for choosing him, he did a full review and didn't push anything on me. It was completely up to me if I wanted to go though with it or not.

One interesting fact is that after he did his full diagnosis on myself, due to my spine pathology a M6 disc would have failed within 6 months to a year. I was all set on the M6 for a long time. I ended up getting the activ-L which has been true and tried with Dr Zeegers for many years. He has not had one disc slip etc. He only had to remove it once, from an older lady with sever osteoporosis. The problem wasn't the disc, but her bones.

I think it comes down to choosing the Dr you feel is the best for you and let them decide which disc to put in based on your spine pathology.

I guess I am a bit bisis since I no nothing other than my experience with Dr Zeegers, but that's my story and I'm sticking to it :)

Good luck, feel free to PM me if need be.

Cheers,

Karger

Update: Joining the M6 Club
 

Hi Eveyone,
Harrison, this is probably not where this post should go, sorry! but, I am leaving tomorrow for surgery with Dr. Clavel. Other than the pain, I am ready "yay me"!
I will be getting two M6 spinal kinetic discs at L5/S1, L4/L5, and hopefully it will go very smoothly. Other than loss of distal height, and the herniation on my nerve, everything with my facet joints and vertebrae are in good shape for both levels to receive the replacement discs. My worry of things beginning to auto fuse on there on, is finally a none issue. Since Nov. till present, and my newest X-rays shows increase loss of distal height and those vertebrae getting closer together. My surgery decisions are made. I am sure I will feel the soreness after. I am staying at the AKO, Surgery will be on Wed. 25th. I am taking some Euro's and some U.S. currency, but I wasn't sure how much. Did not think I'd feel like shopping. But, I am open to any suggestions on good places to eat. I feel bad that I will be there for Easter and would like to treat the my family going with me, if I'm able. I did get transportation, but not daily after my release from the hospital. So, any suggestions on public transportation is welcome. I will try and let everyone know how I am doing, feeling, and with just the overall experience.
My main reason for this post is to say Thank You, to everyone who took time out of their lives to either talk, email or message with me. There are not enough words to convey what this site and the people who post on it, have done for me. I was overwhelmed, and frustrated. Those are very dangerous emotions because it can lead to rash decision making. I feel confident and informed about my condition an the solution I have chosen to peruse. I am sure it's because I found all of you and this site. So, from the deepest parts of my heart and soul "THANK YOU"!
Wish me luck, guys!

Wombat, you're going to do great. Good luck!

Adr
 

Good luck !!

Safe travels and wishing you speedy recovery from your surgery!

Barcelona
 

Good luck with your surgery. I will be right behind you, 3 level cervical with dr. Clavel on April 8 th. Wishing you safe trip and a great recovery.

Awesome, simply awesome news and good for you! My three level with Clavel is 8.5 months, and doing great. Won't lie though. Post op is tough work for sure, but you are putting yourself in preeminent and first class care here.

You will have an endless constellation of adjustments postop and the usual 'I made the worst decision of my life freakout'. Don't worry. Plan on it. Then be patient for it gets better!

Food: La Flauta, right around AKO on same block. Eat there often. La Caixa is where you can get more euros and they're everywhere so carry light on cash.

Call me if you need to any time(check PMs) and tell Dr Clavel and Yolanda, Andrew Radakovitz said 'Hi'.

Best of luck with the surgery, and wishing you a speedy recovery to pain free life.
Dema & Raouf

Good luck! Please come back soon and brag how good you feel!

Good luck!!

Surgery Experience Update
 

Hi Everyone,
Just wanted to give a quick update about my surgery. It will be short and sweet, as I am only home 1 day from Barcelona, tired and on a different time zone schedule. Everything went as expected, I am very happy with the outcome. My surgical team was top notch, accommodating, and thorough. My sizing of the M6 disc are accurate and placement is excellent for a rapid recovery. I think that is what's most important. My back feels good and strong. My legs are sore but that's mainly from all the walking I've been doing that I was not able to do before. Once my incision has had time to heal, then I can start with a more aggressive form of Physical therapy and hopefully over the next 3 months continue to improve. I've attached a copy of my new x-rays for all to see, and will keep you guys posted. Thanks for all the well wishes, I am so happy I wouldn't change a thing.

Very nice placement as usual.

Curious why he chose not to use the new L5/S1 from SK. Did he say? Probably a sizing issue.

How tall are you and your weight if I may ask?

Adr
 

I'm still waiting to see this new m6 for L5-S1 I can't find it anywhere. Drew have u actually seen it or were just told about it?

The latest and greatest is not always the best choice if the doctor has had more success with the tried and true. ;)

SK don't even talk about the new disc on their website so I would be surprised if Clavel is using it widely yet.

Very beautiful images, they look to me like a talented painting may look like to someone else :)

Clavel is as much an artist as he is a surgeon!

Truly amazing that you are doing so well. I mean from what you were before, not in Dr Clavel's talent. Did you ever think that it would turn out like this? Congratulations on a fantastic outcome. All the best to you.

I've seen two of the new L5/S1 M6L implanted but they are in friends' backs. Clavel seems to be using it often it appears.

Larger, burred keel and better angle for arriving at neutral degree. End plates larger also.

New M6L
 

Drewrad, I would like to know the parameters for using the new disc. From my understanding they are large in size. If you have friends that received them, how are they doing? I feel great and so far my movement has been good.

On another note, I am 4 weeks post-op, and see my ADR doctor here on Thursday. Been walking and taking my time healing. But, need some advice on physical Therapy. I would like to get some advice. In this area it's hard to find someone who does more then just stretch you out. Any advice would be appreciated.

Did you not get the new one? Curious. Let me know.

Post-op update
 

Drewrad,
I thought I had updated my disc info.,Sorry!
I did not get the new SK M6, I think it was a sizing issue.
I have a 10mm medium 10" M6 & a 10mm medium 6" M6 at L5,S1 & L4-5.

I went to PT once for my neck and all they did was give me stretching exercises for my neck. I asked them about my back, now and after I have L3-5 replaced and they said it would be more stretching to loosen and elongate the muscles etc to accommodate the new disk height you now have. They said with the ADR, the motion is there, so all they do is move your head or hips around. You did have sessions with Laia, right. They don't do that here, which is a shame, because she was very good. While I was there, I got her to do my back a couple of times, and I went right to the flexibility I had before my accident.

Recovery
 

I know it been a while since my last post but I wanted to update everyone on my recovery. In a nut shell, it's slow. I feel great no pain just some stiffness at times. As I mentioned before I saw my ADR dr. here on April 30th thinking he was going to start my PT, but instead he wanted the bone to hear around the keels of the implants a little more. So, I saw him again three weeks later on May 21st, and he ordered 6 weeks of PT, and will review everything after those 6weeks for me to go back to work. So, I'll have been out of work for what March 21st - mid July, 14 weeks. Maybe he's being overly cautious an/or I'm stir crazy, not sure. I do not have an office desk job, and as a stylist my job is physical but controllable. My sleep is better, so the tiredness is getting better. I feel normal again for the first time in a decade and I know it sounds like I'm complaining but honestly I couldn't be happier. I just do not want to run my business into the ground. Nothing you guys can help with there but it seems my progress from Dr. Clavel does not match my continued care from my ADR Dr. here stateside.
has anyone else run into this issue? Or, has anyone had any hiccups that extended their recovery time? Anyone willing to share, it would be greatly appreciated.

Hello Wombatcat
 

What do you mean by "Nothing you guys can help with there but it seems my progress from Dr. Clavel does not match my continued care from my ADR Dr. here stateside. " Are you having a correspondence issue with Clavel's office? I know it's slow going at time due to time dif., inquiry, patient load...How are you feeling now? It been just 4 weeks for me today; mine was cervical.