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elorpar 04-05-2022 04:39 PM

Hi from Barcelona
 
Hi,

I was operated by C5C6 Arthrodesis due to a disc herniation last may 2021.

I did not evaluate options at that time, my disc herniation was huge due to an accident 8 months earlier so the surgeons I visited at that time rushed me to do this operation in order to prevent any bone marrow injury.. I should had seeked alternatives but I was nervious and pained.. so I acceded to the operation.

The first six months after operation I was fine, but at the seventh I got neuropatic pain again on the left side of the neck and left arm, as well as muscular contractions and arthrosis in the zone.

I visited tons of doctors in my country (spain) and all of them told me everything was fine with the operation. The only doctor that has been aimed to reoperate me has been Mr. Pablo Clavel, with the possibility to make an ADR replacement.

I have a few questions that I would very glad to receive feedback:

- Do you recommend Arthrodesis replacement by ADR or it is better to keep the Arthrodesis? I am afraid it could be worse in short/middle/long term? Right now neuropatic pain is not so high but I am totally abstained to do any kind of physical exercise or sleep on my left side. I am also afraid about long term adjacent veretebral disks damage.

- Is there any time that I can wait further to make the revision? If I wait further Arthrodesis could fuse both vertebras and make impossible the ADR replacement?

- Mr. Pablo Clavel uses M6 and ESP, which one you think is better? I have read bad things about M6.. and also about the doctor Clavel itself

- Is there any specific disk replacement to prevent heterotopic ossification? Or any specific post-op procedure? I have read about COX-2 NSAIDs but during how many time?

- Do you recommend any specific exercise to keep in good health the rest of my back? I have been recommended so many things like yoga, swimming, musculation, inversion table.. I am totally lost already.

- What do you think about mother cells to prevent other veretebral disks degeneration?


Thanks a lot and congratulations for this forum


Elorpar

annapurna 04-06-2022 10:08 AM

I don't have the knowledge to help with revision of a fusion to ADR. It used to be extremely difficult and chancy but that knowledge is at least a decade old and may be out of date now. To pick what I can help with:

-Adjacent disk damage next to a fusion is less likely with cervical disks. Not impossible but less likely than with lumbar disks.

- The M6 has some bad press recently as well as concerns that Rich (AKA Harrison on this board) and I have raised in discussions on this board. That doesn't mean it's a "bad" ADR, just that it has risks that were not being acknowledged when it first came out. Same thing with Clavel as a surgeon. Anyone who's been active for as long as he has will have bad outcomes. It's more a question of how much risk and what kind of risks you're willing to tolerate. Certainly, if you're local to Clavel, many of the concerns a medical tourist has with unavailability and difficult follow-up are mitigated by your proximity to his clinic

- Heterotopic ossification is much discussed on this board. I'd suggest searching here but the treatments all make it less likely, not impossible to happen. Back when Rich and Laura got their Charites, those treatments were hit and miss and both of them never had ossification, so it's a matter of improving odds on preventing something that only happens some of the time anyway.

-Exercises - any core strengthening exercise within the tolerance of your recovery status and current pain will likely improve things for you but I'd find someone who's willing to listen to your medical problems and tailor a program for you. Many of the exercises are good and healthy done "this way" but mess you up further done that subtly different "that way" so it's important to get training to get your muscle memory trained to do it right.

-Mother Cells - I'm assuming you're speaking about stem cells here? If so, you can find a lot of people who advocate using them to strengthen soft tissue around the spine. The idea is to reinforce the structures around the spine (exercise is needed for this as well), decrease instability in the spine, and make it less likely for disks to degenerate. It's very difficult to find anyone willing to inject stem cells into a disk to try to encourage it to regenerate. Notionally, it makes some sense but the costs and risks involved are sufficiently large that you're not going to see a lot of practitioners doing it, nor will you see a lot of data as to whether it works. I do know of one that does do it in the western US but, to my knowledge, he's not published results of his work. I know he's willing to talk through things on a phone consult. Should you be interested PM me and I'll point you in his direction.

elorpar 04-06-2022 12:16 PM

Thanks for your kind feedback annapurna, it is such a privilege to have direct and sincere feedback from experienced patients like you. I have donated to the ADR support foundation and I hope I will be able to help others in a future.


- Regarding my revision of a fusion to ADR, Doctor Clavel was not afraid about the operation itself but about to change spine byodynamics from a fixed level to a mobile one again after a whole year.. the fusion is probably not consolidated yet so it should be take off the fixed disk and introduce the ADR.


- I insisted to Clavel that if there was any risk of being into a worse situation in the short/long term I would avoid to operate.. and that's why I think ESP disk fits better into my perspectives. Anyway I am aware all of this replacements are experimental but when you see some M6 accidents you become very afraid.. it seems ESP is more robust by design (also more stiff.. but I am already fixed so this would be better for my transition from fusion maybe..). I have also asked diagnosis to Dr. Bertagnoli, I am pretty frustrated about the first operation and I would not like to take a third operation if i re-operate now... it seems Bertagnoli uses Prodisc-C Nova as per answer received today.. is not better ESP?

- I haver read about short-term prevention for heterotopic ossification, 6 weeks post-op taking NSAIDs like ibuprofen or nonaprofen in usual dosis (2-3 per day) if I am not mistaken. But is there any long term prevention? Only mobility?

- Regarding exercice, my neck musculature is weak and contractures oftenly when I am sitted down a long time or so.. but I have residual/cronical neuropatic pain on there so I am relegated to soft exercices like stretching or yoga; I still do not find the one that fits better in my situation.

- Stem cells yes, but I would like to take them directly in adjacent disks in order to prevent degeneration as I have these disks somewhat degenerated. I also take daily SYSADOA.

annapurna 04-06-2022 08:14 PM

Prodisc C Nova vs. ESP - I don't really know which disk is better for any given criteria of better. I know Bertagnoli's spent over a decade perfecting his technique with the Prodisc so it's likely to be a better choice if you use him as a surgeon. A different surgeon might give a different answer. Remember that, statistically speaking, we've seen more convincing evidence that good placement does a better job of ensuring good outcomes than using any given ADR. Certainly, bad placement almost guarantees a failure.

Exercise - one thought might be to work with a surgeon who's got a post-op physical therapist as part of their staff or at least on call and work through the exercise regiment you can use. When you select someone to talk with about your possible revision surgery, that might be an important question to ask. I've used prolotherapy to help tighten soft tissue around specific problem areas or repair partially torn ligaments and tendons but regaining full functionality always required careful strength training for me.

Stem cells and SYSADOSA - Two decades ago, the word on the components of SYSADOSA was that they'd help a bit but not a whole lot. I don't know if that's changed. Like I mentioned, I know of only one person doing stem cell injections into disks. Bertagnoli performed a similar stem-cell like procedure for Laura about 12 or so years ago but it only works if you have a damaged disk that can be harvested during a ADR or fusion surgery and nucleus cultured and reinjected in a subsequent procedure. I tend to get the acronym wrong but I believe it to be Autologous Chondrocyte Discal Transplantation, ACDT, though I may have it backwards and it's ADCT. You might check if Bertagnoli still offers that or has advanced to direct stem cell harvesting and injections.

phillyjoe 04-07-2022 09:43 AM

So let’s see, maybe I can give some helpful opinion on your questions-maybe not.

As you can see from my signature, I had 3 level M6 with Dr Clavel almost 6 years ago. I think he is a great doctor, a very honest and good man, and I found him highly responsive to my post-surgery issues. He does great placement of cervical devices (not sure if he is so good at lumbar), and he will take all the time needed to answer all your questions. He helped me when no US doc would do anything but fusion. Following my surgery, my arm pain was gone, I could use my right hand again, I got my life back. I was able to return to work and finish out my career to normal retirement age. I thank God at least once a week for what Dr Clavel, as well as his Pt and support team, did for me.

BUT, he maybe too optimistic. My bottom disc has fused due to HO. For reasons I can’t explain, Dr Clavel kept telling me it was still mobile, causing me to chase more and more CT’s and US docs trying to figure out why I had problems with severe neck and shoulder pain when lying down at night. Perhaps he saw slight movement which US docs didn’t see. I am still trying to figure out how to address this issue, but have been sidelined with other, unrelated, medical issues. I am old, 66yo, so things happen.

All that said, please search my postings and you might find useful things. Dr Clavel did personally tell me years ago that he reversed a fusion into a successful ADR. I was impressed and wrote here about it. But he also told me it isn’t possible in all cases. He also told me that HO is likely to happen over time to many people, but for most, it would not cause problems. I loaded an article about that on this site. Yes, I took NSAIDs for a long time, due to a head crash I had just 2 weeks after my surgery, and it still did not prevent HO. You can read about that crash on this site, I had to have 8 staples to put the back of my head together….but the M6’s didn’t move out of place.

No doc will tell you that you might not be worse after surgery. My unscientific poll is that 1/3 are much better, 1/3 are the same, 1/3 are worse. But if surgery is needed, sooner is better, or for sure you will get worse. 2 of my 3 are good, and except for inability to sleep because of the pain, I am happy with the result. It is a lifelong commitment to staying fit however, as you are never as good as new. I think that as levels of replacement increase, chances go down. Single level people do great.

I think the M6 might have been oversold, but all discs have problems. The cases of bone deterioration or disc failure exist but I don’t know how widespread. I recall that there was a change in design of M6C early on, which no one seems to acknowledge, that seemed to have made it more secure in the attachment of the plates to the core. In the US there is a cervical disc replacement Facebook group that has many postings of failure of the Mobi C, with my conclusion being that if placement of that device isn’t perfect, there is a failure risk. Texas Back Institute is now using M6 and Simplify-because Simplify can allow mri’s. Please let me know if I can help you more. All this is only my uneducated opinion, so use it as you will. I am not a doctor.

annapurna 04-10-2022 03:10 PM

Stem cell follow-up - I don't know how well your spoken English is (your written English is good) but there will be a meeting of the American Association of Orthopedic Medicine in early May, https://na.eventscloud.com/website/35031/agenda/, that includes discussion of specific treatments for the spine, albeit Lumbar. For previous meetings, AAOM has offered videos of their talks for purchase sometime after the meeting completes. I don't know if that would help you but it's a source of knowledge. I will admit that a review of the talks being given sounds like they're summarizing stuff we've discussed with our prolotherapists over the past decade and a half, so I have some reason to believe that the information presented at AAOM will be a long way away from cutting edge.

elorpar 04-11-2022 09:28 AM

Quote:

Originally Posted by phillyjoe (Post 119345)
So let’s see, maybe I can give some helpful opinion on your questions-maybe not.

As you can see from my signature, I had 3 level M6 with Dr Clavel almost 6 years ago. I think he is a great doctor, a very honest and good man, and I found him highly responsive to my post-surgery issues. He does great placement of cervical devices (not sure if he is so good at lumbar), and he will take all the time needed to answer all your questions. He helped me when no US doc would do anything but fusion. Following my surgery, my arm pain was gone, I could use my right hand again, I got my life back. I was able to return to work and finish out my career to normal retirement age. I thank God at least once a week for what Dr Clavel, as well as his Pt and support team, did for me.

BUT, he maybe too optimistic. My bottom disc has fused due to HO. For reasons I can’t explain, Dr Clavel kept telling me it was still mobile, causing me to chase more and more CT’s and US docs trying to figure out why I had problems with severe neck and shoulder pain when lying down at night. Perhaps he saw slight movement which US docs didn’t see. I am still trying to figure out how to address this issue, but have been sidelined with other, unrelated, medical issues. I am old, 66yo, so things happen.

All that said, please search my postings and you might find useful things. Dr Clavel did personally tell me years ago that he reversed a fusion into a successful ADR. I was impressed and wrote here about it. But he also told me it isn’t possible in all cases. He also told me that HO is likely to happen over time to many people, but for most, it would not cause problems. I loaded an article about that on this site. Yes, I took NSAIDs for a long time, due to a head crash I had just 2 weeks after my surgery, and it still did not prevent HO. You can read about that crash on this site, I had to have 8 staples to put the back of my head together….but the M6’s didn’t move out of place.

No doc will tell you that you might not be worse after surgery. My unscientific poll is that 1/3 are much better, 1/3 are the same, 1/3 are worse. But if surgery is needed, sooner is better, or for sure you will get worse. 2 of my 3 are good, and except for inability to sleep because of the pain, I am happy with the result. It is a lifelong commitment to staying fit however, as you are never as good as new. I think that as levels of replacement increase, chances go down. Single level people do great.

I think the M6 might have been oversold, but all discs have problems. The cases of bone deterioration or disc failure exist but I don’t know how widespread. I recall that there was a change in design of M6C early on, which no one seems to acknowledge, that seemed to have made it more secure in the attachment of the plates to the core. In the US there is a cervical disc replacement Facebook group that has many postings of failure of the Mobi C, with my conclusion being that if placement of that device isn’t perfect, there is a failure risk. Texas Back Institute is now using M6 and Simplify-because Simplify can allow mri’s. Please let me know if I can help you more. All this is only my uneducated opinion, so use it as you will. I am not a doctor.

Thanks for your feedback, right now I am not so bad from my neuropatic neck pain (I am avoiding any kind of exercice and in spain it is not so cold now) so I am doubting to re-operate or not (there is a free spot in May). Dr. Clavel tells me that due to the fusion procesdure my vertebraes are now too flat to implant a cp-esp and the most secure implant would be an M6 if it is possible to reverse fusion at all.. but this freaks me out as I wanted an cp-esp and now I am plenty of doubts again..

- Can you provide me further information about the M6 change of design to avoid nucleus failures?

- Is there any model that provents more than others heteropatic ossifications?

- Is your pain directly related with your ADR or is related with residual pre-op neuropatic pain?

My main concern now is adjacent disks degeneration if I keep my fusion and also I have developed some artrosis on my neck in only one year.. as well as my little finguers get asleep when I sleep on a side position (no Doctor understands why).

Thanks for your feedback annapurna as well, I would appreciate also your feedback regarding these doubts.

phillyjoe 04-11-2022 01:35 PM

Well, I can't speak to Dr Clavel's advice, but you do want a secure implant. You don't want it to move. You can appreciate his honesty.
Unfortunately, I don't know much about the design change, other than it had something to do with making a more secure connection between the titanium plates and the core itself. If you look closely at the M6C, they are connected by the woven fibers threaded through the plates. Maybe it wasn't attached that way before.
If you do some reading about HO, I think the literature is showing that it happens after year 5. But for many, it is only a finding on images and doesn't matter. In my case, I got HO at C6-7, and that causes neck pain at night. Arm pain is gone. The neck just doesn't move right lying down.Basically I am fused by a non moving M6 at C6-7. I am still planning on getting it fixed. Why it happened? No one seems to know, but I suspect it is because the M6 comes in limited sizes and it had too small a surface area for my C6-7, there is less movement at 6-7, and it is by design a more constrained device. This is all my speculation, Dr Clavel did not speculate as to the causes. If I could sleep standing up or hanging upside down, life would be perfect.

annapurna 04-12-2022 09:37 AM

Unfortunately, I don't has as much to offer about your questions. Some truisms to offer and then a speculative conclusion: (1) The cervical spine is less prone to adjacent segment problems than the lumber spine. (2) Even in the lumbar spine, it's not uncommon to go many years before seeing disks adjacent to a fusion begin to show problems. (3) It's really difficult to spot the early stages of disk impingement on the cord through imaging as the focus is on MRI & CT, where the patient is supine and the spine unloaded during imaging.

What I'm wondering is whether at least one, possibly, more disks in your c-spine was more damaged than everyone thought. The main pain generator was removed and the segments fused but the surrounding weakened disks were susceptible to any kind of overuse/overloading problems caused by the fusion because they were weakened to start. The reason why I think this is important is that you might revise to a ADR only to find that those weakened adjacent disks aren't up to the task of an ADR recovery.

Have you had the chance to get more recent MRIs? You might want to check the hydration state of the adjacent disks (white=good, grey=okay, dark or black=beginning to desiccate). That's an easier check for a layperson. Interpreting where nerve impingement is happening is harder. You might need a loaded MRI, where you're standing, or try to get by with flexion/extension x-rays of the c-spine and look for deflections of the smooth curve of the spine (other than the fused area). I've never seen the latter approach with a fused spine but it has the advantage of being simple (two flat film x-rays and some time with x-ray image analysis software).

To add: you might need a hybrid, current fusion and ADRs at adjacent levels, instead of a revision of your existing fusion to ADR. It's worth making sure of the adjacent disk condition before jumping to the revision surgery.

elorpar 04-13-2022 05:24 AM

Hi again and thanks a lot for you wise feedback, I am learning a lot from you. I attach an MRI from december post-op:

https://ibb.co/R94jB2H

Doctor already told me c4c5 is dehidratated and c6c7 a little bit degenerated, but still good enough for a c5c6 revision and not causing significant problems right now. I asked how to rehidratate and regenerate that disks, and I was suggested to do stretching, musculation, drink watter.. I read also that SYSADOAs, PRP, stem cells.. may help but at this moment I am just doing some stretching, mild exercise and taking SYSADOAS with watter.

To be honest, c5c6 neuropatic pain is almost gone, I can sleep with no medication (3 months before it was heavy pain), but I am afraid about adjacents disks problems in a future as every time I turn my neck to the right it sounds really creepy and every time I carry some weight my shoulder becomes into muscular pain. Adjacent disks problems may come in 10-20 years so I would like to prevent them (is there any publication about % risk depending on lumbar or cervical fusion?). That's the only purpouse of my revision as pain keeps low like now if my physical activity is reduced.. but I do not know if I am doing a stupid thing.

Anyway if cp-esp is not proper to my case, I will tell doctor during my next visit to better keep like this.. this is the only Doctor willing to make such a difficult revision but as he only works with ESP and M& (not Axiomed) I am becoming paranoid but I do not trust M6 after reading over here and checking internet failures..

annapurna 04-13-2022 10:01 AM

To take this to an extreme: if you don't revise your fusion to an ADR AND you do, at some future time, end up with adjacent segment damage, you can get those adjacent segments replaced with ADR for a hybrid spine. There's risks of second operations in the c-spine area due to scarring. Laura lost partial function of one iris and has never fully regained it and had a partially paralyzed vocal cord resolve after time; both caused by the surgery for her second Prodisc in her c-spine. Those risks aside, what I'm getting at is that you're not in a position where choosing to not revise your fusion now places you in an irrevocable situation. There are other options available to get you functional in the future.

I wish I could help more on the questions of stem cell injections into the disks. They aren't well vascularized so I don't think that there's many people attempting it but we've been looking exclusively within the US for regenerative injection practitioners. If you're willing to risk COVID and the myriad problems of a vacation in the US, I could point out who we talk with here. For that matter, if you feel your C-spine is hyper-mobile at C4/5 and C6/7, getting standard prolo or PRP in the soft tissue around the spine might help your overall strength training. That hypermobility is what's been the culprit for most of Laura's problems and we've been using prolo to mitigate that problem, poor static stability, while struggling to allow her to regain strength to improve dynamic stability

elorpar 04-13-2022 10:44 AM

Quote:

Originally Posted by annapurna (Post 119351)
To take this to an extreme: if you don't revise your fusion to an ADR AND you do, at some future time, end up with adjacent segment damage, you can get those adjacent segments replaced with ADR for a hybrid spine. There's risks of second operations in the c-spine area due to scarring. Laura lost partial function of one iris and has never fully regained it and had a partially paralyzed vocal cord resolve after time; both caused by the surgery for her second Prodisc in her c-spine. Those risks aside, what I'm getting at is that you're not in a position where choosing to not revise your fusion now places you in an irrevocable situation. There are other options available to get you functional in the future.

I am sorry to hear about Laura's case.

Besides my quality of life being at 50% right now (and right now I am not bad at all), what also obsesses me is the perspective of having the whole spine fixed in a long-term future (c4-c5 and c5-c7,.. and so on if degeneration comes to other adjacent disks) with all unconvenients and pains related to this.

Man, I wish I never took that heavy weight in 2020.

Thanks for your wise feedback

elorpar 04-13-2022 10:57 AM

Quote:

Originally Posted by annapurna (Post 119351)
To take this to an extreme: if you don't revise your fusion to an ADR AND you do, at some future time, end up with adjacent segment damage, you can get those adjacent segments replaced with ADR for a hybrid spine. There's risks of second operations in the c-spine area due to scarring. Laura lost partial function of one iris and has never fully regained it and had a partially paralyzed vocal cord resolve after time; both caused by the surgery for her second Prodisc in her c-spine. Those risks aside, what I'm getting at is that you're not in a position where choosing to not revise your fusion now places you in an irrevocable situation. There are other options available to get you functional in the future.

I am sorry to hear about Laura's case.

Besides my quality of life being at 50% right now (and right now I am not bad at all), what also obsesses me is the perspective of having the whole spine fixed in a long-term future (c4-c5 and c5-c7,.. and so on if degeneration comes to other adjacent disks) with all unconvenients and pains related to this.

Man, I wish I never took that heavy weight in 2020.

Thanks for your wise feedback

phillyjoe 04-13-2022 09:20 PM

I tore my extensor tendon 75% off the elbow bone. PT took away the pain but did not restore strength. Did one round of PRP, very painful for a week. Pain resolved, but strength did not come back. As said above, tendons, like discs, don't have much blood circulation. But I am told it works great for rotator cuff tear and knees.

annapurna 04-14-2022 09:36 AM

Yes and no. I ended up with partial tears to a ligament in back of both hands. Surgery was said to be about 25% successful repair full tears and much less at improving the condition for those with partial tears. It took about a dozen prolotherapy treatments spread over a couple of years to regain full function. That was normal prolo, prior to the days where PRP is the solution of choice.

I also had AC joint shoulder surgery nearly ruined by an overly aggressive physical therapist who had me doing exercises that strained the growing scar tissue needed for the joint to heal correctly. It took about 10 years of intermittent prolotherapy, sometimes using PRP, sometimes not, before I hit the right combination and sequence of prolo and strengthening exercises to regain full function. PRP is a great tool used correctly but it's also snake oil when the practitioner promises the sun, the moon, and the stars with it.

Harrison 04-18-2022 09:36 AM

You may have seen this topic:

Spinal Kinetics M6 Failures

https://www.adrsupport.org/forums/sh...ad.php?t=14153

elorpar 04-19-2022 08:21 AM

Thanks Harrison

It is clear that M6 has had many failures but it is also fair to say it is the most implemented 3rd generation replacement, and % of failures is proportional to the number of total implementations.

Anyway, in your opinion, and assuming the surgeon is competent enough, which is the best replacement for cervical disks? ESP? Axiomed? Why?

phillyjoe 04-19-2022 09:01 AM

So you are asking a very important question, but it might be the wrong question. Maybe you should be asking yourself "what is the right disc for me"? You will see many, many failures and malfunctions/ migration of Mobi C on the facebook ADR groups. I speculate that it needs perfect placement and isn't too forgiving. Texas Back does M6 but now is pushing Simplify. They claim Simplify is great because it allows imaging without distortion. But aren't we all hoping that after surgery, we live life without endless imaging. Imaging ability makes life easier for the doctors.

I have read some medical journal articles about the M6 failures and posted here. But if there are many such failures as you say, please post copies or references to your recent sources for this position. I am trying to distinguish among poor patient selection, poor placement, vs something actually wrong with the manufacture of the M6.

elorpar 04-19-2022 09:32 AM

I didn't state any M6 failure but Harrison, and of course I agree surgeon expertise is a also a key factor.

Cheryl0331 04-19-2022 12:22 PM

I echo that Phillie
 
Quote:

Originally Posted by phillyjoe (Post 119348)
Well, I can't speak to Dr Clavel's advice, but you do want a secure implant. You don't want it to move. You can appreciate his honesty.
Unfortunately, I don't know much about the design change, other than it had something to do with making a more secure connection between the titanium plates and the core itself. If you look closely at the M6C, they are connected by the woven fibers threaded through the plates. Maybe it wasn't attached that way before.
If you do some reading about HO, I think the literature is showing that it happens after year 5. But for many, it is only a finding on images and doesn't matter. In my case, I got HO at C6-7, and that causes neck pain at night. Arm pain is gone. The neck just doesn't move right lying down.Basically I am fused by a non moving M6 at C6-7. I am still planning on getting it fixed. Why it happened? No one seems to know, but I suspect it is because the M6 comes in limited sizes and it had too small a surface area for my C6-7, there is less movement at 6-7, and it is by design a more constrained device. This is all my speculation, Dr Clavel did not speculate as to the causes. If I could sleep standing up or hanging upside down, life would be perfect.

If he just cared about the money, he would do whatever. Dr. Clavel is and was still a wonderful surgeon and human being. He has always been there for me post-op! I have an M6-C and an ESP-C, and doing great now. My M-6 did not fail, I developed HO behind it was the only reason I had to have a revision. Dr. Schmitz in Germany happen to be the best for the job at the time during Covid at it worst, Spain had shut down their borders and Germany was allowing Medical travel. Dr. Clavel is right about the ESP may not be right for you. It has a curved plate and since it's not as flat as the M6 it may not fit well in your disc space.

elorpar 04-21-2022 01:50 PM

I have to decide tomorrow wheter to reserve operation spot for 4-5 or not, and I am just getting crazy and very depressed.

- Dr. Clavel tells me that a fusion reverse should be made as soon as possible, maximum within 6 months counting by now in order to try to recover mobility on that level
- My pain level right now is tolerable, if i do a minimum physical activity.. but it depends on the day and it is fair to say I am not working since 6 months ago so my physical requirements are very low
- Everytime I seem to be decided I read a new thing that causes me 1000 new doubts. Today I talked with Dr. Clavel about HO and he told me in my case may not appear.. but when I was coming back at home I read about osteolysis in elastomeric replacements. Are these ADR really aimed to last more than a few years?? https://link.springer.com/article/10...86-021-07094-7
- I am pretty obsessed about adjacents disks damage due to fixation, but there a lot of studies that suggest that ADR does not prevent that either.. it pisses me out the perspective to have all my spine fused in a future.. really worried

I would appreciate any feedback, my mind is getting crazy already

----

Elorpar

c5c6 fused in 2021
Thinking to replace fusion to cp-esp

annapurna 04-22-2022 09:24 AM

Quote:

Originally Posted by elorpar (Post 119368)
when I was coming back at home I read about osteolysis in elastomeric replacements. Are these ADR really aimed to last more than a few years?? https://link.springer.com/article/10...86-021-07094-7
- I am pretty obsessed about adjacents disks damage due to fixation, but there a lot of studies that suggest that ADR does not prevent that either.. it pisses me out the perspective to have all my spine fused in a future.. really worried

Osteolysis was a hotly debated and much-monitored topic when the Charite and Prodisc were the only disks available. Basically, the theory that says it should be happening with ADRs but the practical experience (listening to this and earlier boards like it) is that it isn't or is happening so rarely that it's not a major factor. Rich/Harrison and Laura both have ADRs that are nearing 20 years old and Laura had hers checked with x-ray and MRI last year only to find that it was performing extremely well with no signs of degradation or adjacent level problems.

I think most everyone's convinced that ADRs decrease the chance of adjacent segment problems compared to surgical fusion or self-fusion. There are some who argue against that but the ones that I've seen are quoting results of theoretical biomechanical models. While I use similar models all of the time and like to use them, they're also a really efficient way to lie to yourself if you get caught up in the theories and the models and ignore the data. So far, there have been few posters complaining about adjacent segment problems next to well-placed ADRs.

phillyjoe 04-22-2022 09:50 AM

Yes, you are driving yourself crazy, as we all have done in making the same choice.
Maybe this helps you? It came out a few days ago.
Spinal Tech

2-level data out on NuVasive's artificial disc: 4 details
Carly Behm - a day ago Print | Email
Share Listen
TEXT
A study published in the Journal of Neurosurgery: Spine supports the effectiveness of NuVasive's Simplify cervical artificial disc at two levels compared to spinal fusion.

Four things to know:

1. The FDA investigational device exemption trial followed up with patients for two years and compared disc replacement patients with anterior cervical discectomy and fusion patients.

2. Researchers found the overall composite success rate was statistically significantly greater in the artificial disc group compared with the fusion group after 24 months. The mean neck disability index for both groups improved significantly in both groups, and the disc replacement group had lower scores at follow-up points.

3. Rates of subsequent intervention was 2.2 percent in the disc replacement group and 8.8 percent in the fusion group.

4. Data from this trial was used in the FDA pre-market application for two-level indication approval, according to an April 21 news release.

phillyjoe 04-22-2022 09:56 AM

1 Attachment(s)
And attached here is a recent article. (If my meager tech skills did not fail) . Good luck in your decision. Only you can decide what is best for you, given the available info at this time. The future is always uncertain

elorpar 04-22-2022 01:17 PM

Thanks Jim and Joe, I will answer to Doc on monday.. I need to meditate this weekend.. also my operation is a fusion reversal so this extra-panics me and Dr. Clavel does not assure me 100% he will be able to implant an ESP over an M6 (wit all respects to M6).

Anyway I feel grateful for finding this forum, you guys are super wise about back medicined and I feel very happy to find friends like you over the way. I do not like Facebook groups so far, so much noise..

If you come to Barcelona someday, I owe you a dinner.

---

Elorpar

c5c6 fused in 2021
Thinking to replace fusion to cp-esp

phillyjoe 04-23-2022 01:25 PM

I'm sorry that I haven't followed your whole thread. Have you made sure that whatever is causing the (neck/arm) pain from the fusion can be fixed with ADR/revision? Or are you suffering a fusion that failed to fully fuse? Have you had nerve conduction tests to identify the source of impingement?

elorpar 04-24-2022 12:13 PM

Quote:

Originally Posted by phillyjoe (Post 119373)
I'm sorry that I haven't followed your whole thread. Have you made sure that whatever is causing the (neck/arm) pain from the fusion can be fixed with ADR/revision? Or are you suffering a fusion that failed to fully fuse? Have you had nerve conduction tests to identify the source of impingement?


In the fused level there are soft osteophytes -> Maybe to be solved by doing a revision

Fusion is completed, causing cronical stiffness and trap pain like a normal fusion does -> Maybe to be solved by ADR

Neuropatic pain is cronical, resiudal from the former herniatic impigment -> not to be solved by ADR

I am obsessed by adjacent disk damage in a future -> Not a current problem, but maybe to be prevented by ADR

These are the things are what are making me to consider a revision, are they enough? This is the decision I need to make

phillyjoe 04-24-2022 09:09 PM

Not sure where the osteophytes are located, can Dr Clavel do some kind of anterior microforminotomy (assuming that is where the osteophytes are there) without disturbing the fusion? PT -intensely, can help the muscle stiffness and trap pain. Elastic band workouts. Fusion isn't always a terrible thing -adr at new levels can come later if needed

elorpar 04-25-2022 02:12 AM

Osteophytes are located in c5c6 posterior, probably generated by cage position (a little bit displaced to the frontside), I assume the best way is to take out the cage and clen the area.

Stiffness is also causing like a really creepy sound when I move my neck.. maybe caused by extra pressure in adjacent levels/facets and really concerning when you have 36 years old and have to carry this all neck your life.

As you say in a future I could take ADR on other levels and fusion is not that bad compared with an herniated disk, but it is not good enough to ponderate if it is worth to try to prevent neck health and to have a maybe better functionality at this point.

I thing I will go on with operation next week, and also try PT after that operation if the outcome is still not good (maybe better PRP?).

annapurna 04-25-2022 09:02 AM

If you do go forward with the operation, I'd strongly suggest a very careful rehab plan. Any muscle attached or working through the fused level that's being revised to an ADR will have spent a year idle and generally losing strength. You're then going to switch that level to an ADR that requires a degree of dynamic stability from strong muscles.

Take it slow and easy but plan on a long careful rehab with lots of strength-building. Of that sentence, the "slow and easy" part is definitely more important than meeting some pre-determine mark for strength at a given pace. Don't let the physical therapist push you too fast or too far. I don't know if you have the problem in your country but here in the US, there's a lot of poorly qualified therapists who are doing a lot more harm than good.

elorpar 04-25-2022 02:28 PM

Thanks Jim. I am aware that my situatiom is a life career, I am planning to do soft nordic walking and very soft and oriented yoga/stretching.

I have already tried musculation but it didn't work for me, lots of neuropatic and trap pain every time I tried to push a little for gaining muscle.

For the moment I have all my fingers crossed for the operation, I am already really nervious.. 4-5 is the day. After that I will think about NAIDs, rehab, the scar.. if operation goes well...

phillyjoe 04-25-2022 03:26 PM

Jim is right. If Laia is still with Dr Clavel, she is very good and knows how to teach you. If you can buy private time with her , that would be wonderful for you. The anterior and often posterior collateral ligaments are removed by Clavel during ADR. So you lose even more support. That is why the scapula muscles get tight in the traps to make up for it.
Anyway, I wish you well and will say a prayer for you. Report back when you can. Oh....if Clavel at times seems uninterested - don't be fooled. He just has a very calm attitude which find to be good.

elorpar 05-04-2022 05:32 PM

Operated

No idea about how operation was, even if ADR was implemented, tomorrow doc will visit me.

I am in tramadol so no pain, an I can move extremities so worst disaster did not happen.

Thanks Jim and Joe, I just wanted to notice you I am still alive.

phillyjoe 05-04-2022 09:26 PM

This is great news. Can't wait to hear about your good progress and discussions with Dr Clavel and Olga. My guess is if you have a soft collar, then you got adr but that is just a guess. Move slowly!

elorpar 05-05-2022 03:45 AM

Quote:

Originally Posted by phillyjoe (Post 119381)
This is great news. Can't wait to hear about your good progress and discussions with Dr Clavel and Olga. My guess is if you have a soft collar, then you got adr but that is just a guess. Move slowly!

Thanks for keeping in contact Phil, you have been a great psyological support for me. I think Olga does not work with locals, I have been talking with Sonia.

Today another doctor from the team (woman, I do not remember the name), told me that fusion cage was removed very easily in a single and strong pull out movement.. that suggests me that I could have suffered a kind of pseudo-artrosis due to that weak "fusion".

Also some osteophytes were generated in my posterior cervicals and erased now.

I have soft neuropatic pai on the right arm, the side from where I have been incised, hoping is just related with related inflamation and only temporal.

I have been medicated with nolotil, tramadol and paracetamol. I asked to the female doctor about HO, she told me do not worry, but I am worried (osteophytes is a kind of HO made in a made place.. so I am wondering wether taking Celebrex 200mg by my owm twice a day, or enantyum is enough for prevention? I have read studies where celebrex (selective NAIDs) is the most effective so I bought a box... but maybe too aggresive combining it with other medication already. Anyway I check out tomorrow from hospital and I will keep taking celebrex since then at least during 2-4 weeks? Is it convenient to keep taking my habitual sysadao doses? Finally a ver secondary issue, any recomendation for the neck scar, I am planning CO2 laser after suture is retired

I only pray God this new operation keeps me better that the other for many years after.

Sorry for my bad writting, I am in bed

annapurna 05-05-2022 09:03 AM

It's great news that things went well and you got the revision to ADR you wanted. With the mix of drugs you're currently on, I'd be careful about adding Celebrex to it, especially on your own. That's quite a mix and can lead to gastrointestinal upset; not something I'd be willing to chance this early post-op. Maybe it's something you could ask about as they step down the level of painkillers and you get a chance to speak with the doctors a bit more?

The Nolotil also seems to have anti-inflammatory properties so maybe it will serve in the place of Celebrex right now? It's speculation as I don't know enough about it and exactly how Celebrex seems to inhibit HO.

phillyjoe 05-05-2022 11:44 AM

I took NSAID for 6 weeks or more due to the head accident I had just 2 weeks after my 3 level surgery. It didn't seem to make much difference for formation of HO at my at C6-7. But no HO so far at the other two levels. So who knows. But as stated, be careful of bleeding from taking without supervision.
I have emailed Sonia. She is also quite good, although her English may not be as good as Olga but it doesn't matter in your case. Finally, don't worry about the scar. Clavel placed mine in a neck crease and can't see it. Stay out of the sun and get Trofolastin Reductor de Cicatrices patches at the Farmacia and start using in a few weeks, as directed by Clavel. Oh, the arm is likely no issue. just stretching of the nerves to put the adr in. We are not doctors however!

elorpar 05-05-2022 01:34 PM

Quote:

Originally Posted by phillyjoe (Post 119384)
We are not doctors however!

Sometimes Phil and Jim, the best support come from colleagues like you. Of course for critical decisions there is the Doctor.

elorpar 05-07-2022 03:54 AM

Post-op day 3

- 2 celebrex 200mg per day (pretending to be during one month)
- Glucosamine, ccondotirne sulfate, calcium, magnesium, etc.. one per day
- Soft stretching of my neck, my c5c6 articulation seems to regain movement again
- 30 min per day walking
- cleaning scar with betadine one per day
- In one month we will see with Doctor (ray-X) if the cp-ESP is still aligned, my vertebraes were flatted during my former artrodesis and I am afraid that could move sooner or later


I think that part of my problems were caused by the ostheophytes generated on my c5c6 backside through the intersomatic fixation cage, that compressed my damaged nerve again. Now I do not feel that pain but I am not sure if ADR and one month NAIDs will help to prevent HO/osteophytes to come back again.. I hope so, otherwise I will be in the same problem in a future!

phillyjoe 05-07-2022 07:56 AM

Vitamin C is also said to assist in soft tissue healing. I am curious....is this surgery covered under your health insurance in Spain? assuming you have health insurance. I think I paid around 42K Euro more or less for mine with dr clavel. Be patient with your recovery but in beautiful Barcelona you can easily walk more than 30 min a day!. Good luck


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