Hybrid in the US or Hybrid/2-level ADR in Europe?
 

Hello all - This is my first post, but I've been reading your stories and all of the useful information thanks to the experiences and personal details you've shared. So, first and foremost, thank you to the entire community!

My history can be quickly reviewed down in my signature, but long story short, I've been suffering with lower lumbar DDD for 12+ years now. There is no single/specific incident or accident that I can recall, but rather just a life full of riding/racing motocross, snowboarding, surfing, running, etc that has contributed to my present state.

Back in 2016, I was very close to traveling to Germany for a 2-lever ADR procedure with Ritter-Lang (M6 @ L4-5 and L5-S1). I personally know four different people who have had successful procedures at Stenum with RL, so at the time, I was sold that he offered the most advanced option. Admittedly, I did not research other European surgeons back in '16 given the recommendations I had received from friends, and I was certain that 2-level ADR was lightyears better than a single level fusion at L5-S1, which is what multiple surgeons in the US recommended.

I took a break from the process and continued managing the pain for another 3 years, and now here I am. This time around I have done more research, sent my images to a few more surgeons, and even traveled to Texas Back Institute (from CA) for a consultation with Dr. Zigler.

Here are my current options:

Stenum/Ritter-Lang: I sent my latest images to RL, and his updated evaluation is the same as it was in 2016 (2-level ADR with the M6 @ L4-5 and L5-S1). We've gone back-and-forth with several rounds of questions, but he hasn't wavered on his recommendation. I was VERY close to booking my surgery date before the end of the year (2019), but as luck would have it (I think?), I received a recommendation from a surgeon here in the US to explore other surgeons in Europe if I was adamant about going overseas for the M6 (or other disc - ESP, etc). The "recommendation" was actually more of a warning against surgery with RL, so as you can imagine, I lost some of my confidence, despite the fact that I have friends who still recommend Stenum/RL 3-5 years post-surgery.

TBI/Zigler: Recommendation is for a Hybrid procedure (Fusion @ L5-S1 with ADR using the activL @ L4-L5). I really like Dr. Z, and trust that his recommendation is the best option here in the States, all things considered (finances, FDA-approved disc options, etc).

Dr. Clavel/Barcelona: After the recommendation to consult with other surgeons in Europe, I sent my info and images to Dr. Clavel. So far my experience with his team has been great. Olga has been very friendly and responds quickly, and I actually received my initial surgery recommendation within just a day or two of submitting my images. Clavel is also recommending a Hybrid procedure (Fusion @ L5-S1 with ADR using the M6 @ L4-L5). I have a Skype video consult scheduled with him in a little over a week to discuss in greater detail, but his initial reasoning is as follows: "I would recommend Hybrid due to the foramina stenosis, level of disc collapse and disc degeneration at L5-S1. Makes it better for an ALIF than ADR. Plus the osteophytes at the foramen don't make ADR safe."

To be honest, I was expecting a 2-level ADR recommendation from Clavel, so this caught me off guard. On one hand, I'm a little bummed, as I would like to avoid fusion if at all possible. On the other hand, it was somewhat refreshing and reassuring to receive the same recommendation as Dr. Zigler, whom I have a lot of respect for. The biggest difference, of course, would be the disc itself (Zigler/activL vs. Clavel/M6). And what about the 2-level ADR recommendation from RL… I’m thinking that must be a pretty aggressive approach given what Clavel had to say about my condition?

Dr. Desai: I also sent my info/images to Dr. Desai in Cologne, Germany last week, but I have not heard anything back yet.

So... That's where I currently stand. Any thoughts or advice?

Thanks for reading... Hope you're all feeling great today!

Hello 10n2010
 

Well, if you have time to take a step away and come back the way you did, it's good to do.
Sometimes we can be too quick to make a decision.

First and foremost I am glad that you didn't have surgery at Stenum with Ritter-Lang. There is a long list of stories here and on other forums.

TBI is probably one if not the best the U.S. has.
I dont know much about activL. I have read some positive outcomes.

Problem is unless you live in Texas, out of network will cost more than going to Europe. That was my case.

Funcrew and another have had good reports on Dr. Desai.

I had surgery with Dr. Clavel, so obviously I am pro Clavel!

About Dr. Clavel saying 2 level. He caught something in his assessment two others missed.
He is very conservative, so he wouldn't tell you 2 level unless you needed it.

Just stay away from Ritter-Lang.

I agree to stay away from RL. You might also check out Dr Bierstadt in Germany at Oz. I met him personally when he was marketing in the US, but we didn't click the way I did with Clavel.
Due to my spondy at L4-5, Clavel also recommended hybrid for me, but in reverse, ie fusion L4-5, ADR L5S1. I hadn't seen that construction and wasn't ready to go for it. Plus, I'm not sure M6 is best for lumber yet. I also heard good things about Activ L. I am hoping that lumbar ADRs progress at a rate faster than I get worse, but at my current leg pain levels, not sure I can wait. Luckily I have torn meniscus to distract me right now along with a bicep tear! getting old is bad.

Please see Marzman54 post on 12/21/15 before deciding to go with Dr. Bierstedt. We conversed before my decision and it influenced the reason why I decided not to go to Germany. Also, after my Skype session with Dr. Clavel, there was no doubt in my mind that he would be my surgeon.

In addition to the 3 level M6-C neck surgery, Dr. Clavel recommended a fusion at my L3/L4. We discussed this in person and I decided to not have it done. Three years later, I'm still happy with that decision. My neck pain, at the time, was off the charts. I can deal with my back pain.

https://www.adrsupport.org/forums/sh...ad.php?t=13259

Cyn, you are right and now I remember that I even have that image printed for my files to remind myself to be grateful. Don't know how I forgot. Perhaps I was thinking it was RL who did it. I hope Robert has found a solution. Dr B did have a certain arrogance that I disliked. Clavel had what I can describe as quiet confidence.

10n2010,
I'm looking at lumbar 2 level l4-S1. Researching for surgery. Of course the Covid 19 has not helped matters any.
I'd like an update if you had surgery and where you went.
Thanks,
Farmgirl