Recommended ADR Surgeons/Clinics
 

Hello ADR support folks,

I talked with my decompression surgeon and he agreed that degenerative changes have left me with two choices: multi-level fusion or ADR with or without stabilization. He also suggested that Germany was light-years ahead of the USA in this area of ortho reconstructive surgery.

Annapurna suggested Doctors Clavel and Bertagnoli as two excellent options. I wondered if folks had other suggestions or warnings. Dr. Ritter-Lang gave me a consultation some years ago, but the fusion portion of the option is not my first choice.

Best regards and wishing everyone health, mobility, and limited pain.

To be honest, I suggested those two because, if remember correctly, both offer remote diagnosis through film review and phone call/Zoom/whatever. I wouldn't fear to have either work on my back but the remote diagnosis is what I was thinking of for them.

We just had another member on the board have everything ready to go and was about to board the plane to see Clavel for a revision only to have Spain refuse to allow her to enter the country. I was thinking that getting a remote diagnosis might, stress might, allow you to argue with whatever country you need to travel to that you need the surgery and only a world-class surgeon could do it.

The explanation is to head off any arguments over merits of individual surgeons - if you're going overseas, you're going to have to work around COVID travel restrictions. That adds a layer of requirements onto an already complicated task of picking a surgeon who you'd trust.

As for Ritter-Lang - there was a time that anecdotes shared about him were flat-out scary. You can probably find them here or elsewhere online. I've not heard much about him lately so I can't tell if he's cleaned up his act or all of the spine patients that come to this board have chosen to exclude Ritter-Lang based on what's been shared here.

Medical Restrictions in Germany
 

Hi folks,

Just got a response from the German consulate with a link to their travel exclusions. With regard to medical, it reads:

Urgent medical reasons may exist if a treatment can only be performed in Germany or at least cannot be performed in the person’s country of origin or has already begun in Germany and if failure to receive the treatment would be life-threatening or could cause considerable long-term damage. This is to be proven through relevant documentation. The person may enter with up to two necessary accompanying persons.

Here's the link: https://www.bmi.bund.de/SharedDocs/f...html#f13919566

Best regards all. Thank you Jim for the kind thoughts.

I just came back from Germany
 

Thank God Spain denied me entry.
Through another member here; I found Dr. Schmitz at Clinic Bel Etage in Dusseldorf Germany.

His skill and experience with revision is amazing! My HO had attached itself to my dura. I had revision surgery on Sept 21st. I had a spinal fluid leak that would not stop on it's own, so on the 25th he had to go back in a seal it
Dr. Schmitz has a special mesh and gel that he uses. He also has an ultrasonic bone scalpel that minimizes milling. He has been interviewed by Jamie Litrun on TDR/ADR Support Group on Facebook. You can find the interview on You Tube. He also is partner in the clinic. It's a private hospital too. He was 5000 euros more than Clavel, but worth every penny.

I received the best care here. I pray you contact tehm!

Their International Patient Coordinator sent me a Letter of Certificate that I carried with me. I also did a Health Declaration Card from the German Border Police website. I took a covid test least than 48 hours prior to departure

Thanks Cheryl
 

Thank you Cheryl!

Pardon my ignorance, what does "HO" mean? Is it a complication for all ADRs, or specific areas or disc replacement types?

Good luck with your recovery, appreciate the advice.

Heterotopic Ossification. It doesn't happen to everyone or only with any particular adr. You can develop HO even around a fracture or hip replacement.

Hope you continue to recover well. Aside from the plumbing patch, any other issues with removal of the M6? Did you get ESP or Prodisc on the revision?

Hi Philly
 

Thankfully Dr. Schmitz was able to place a cp-ESP. He wants a 6 week and 12 week Post-op X-rays with flexion extension. So around Nov 6th, I will get my first series.

The pain from traction during surgery and having to lay in bed for 48 hours was really rough. Revision surgery due to HO as advanced as mine is very complex. I should have had it done a year earlier. If its obvious that it is encroaching a nerve or going in to the spinal canal; one need to monitor closely and determine if benefit out weighs the rush. It did in my case.

Europe / Germany
 

Cheryl0331
Hello Cheryl just a quick question , I know you said Spain would not allow you to enter but when you entered Europe / Germany were you required to quarantine / isolate for 14 days before proceeding with your medical treatment ?

Thanks !

Reply to Beav.
 

Yes and no. I went direct from the airport to my room at the clinic. Masks worn at all times except when in my room alone. You are not really able to go out to a local shop or anything like that. Keep in mind; you must have a negative covid test 48 hours or less prior to departure. If you are going for medical reason it's different from going for other reasons. You have to carry the Passenger Locator Card at all times. I check in for admission on 9/18 and surgery was 9/21 and I was discharged on 10/4

Spain / Germany
 

Cheryl0331

Hello Cheryl thanks for the reply, sounds like everything went great with Dr. Schmitz ! Probably a dumb question but in regards to being denied entry to Spain , did you actually make the flight there before you were denied only fly home then turn around and come back to Germany ? If so WOW , what a hassel and expence. Take care !

Gosh no!
 

Spanish border police made it very clear if you flew there; you could be held in detention until you could get a return flight back to the US on the same airline!
I could not afford to loose the airfare or time.
Their government told me out right; entry denied!

Do not go with....
 

Do not go with the premise that it's better to ask forgiveness than permission either!
You do not want to be in detention around a bunch of people and be dealing with your spine issues.

Limitations of a Teleconsult
 

Hi folks,

I just recieved the response below for Dr. Berhard Meyer, who is well regarded by the German medical establishment. Notice that he suggests that a tele-consult is not viable (for him anyway) and goes against German rules. That seems at odds with other clinics and info?

Also, this is the first I've heard that 2-level lumbar ADR is no longer a common prescription? Any thoughts? Looking for some clarity.
__________________________________________________ __________

"1. in case of a degenerative spine problem a remote diagnosis and coupling is not possible and not recommended by the guidelines in my country
2. in principle i do perform 2 level TDR but as a very very rare indication nowadays (opposed to 10 years ago)
3. yes we do treat many foreign patients; however due to local travel restrictions some problems may occur

best wishes

BM

Univ.-Prof. Dr. Bernhard Meyer"

I can't say but Laura and I've found many US doctors of various types who hide behind guidelines and "rules" to avoid tasks they do not wish to do. The telediagnosis you're seeking isn't 100% possible but it would be possible for a surgeon to write something like "Presentation of symptoms and imaging indicate that an in-person evaluation is necessary in an expeditious fashion in case further intervention is necessary to address condition before symptoms intensify."


Offering something like that to get you to their clinic might be something they'd buy into. On the other hand, COVID lockdowns have intensified in Germany in the past few days so it's unlikely you'd have an easy time getting in regardless of what was written by a surgeon

More common now
 

Because of the pandemic, many doctors around the world have been doing telamedicine. My PCP and my GYN both for example.
If one had to fly all the way to other counties to be evaluates first; this would be an expensive process. Okay, so this doctor is a German doctor.
Well, I would reach out to others; because it's being done all over Europe.

I will add my two cents for whatever it is worth. It looks like Dr Meyer is a well regarded nuero in Munich who teaches at the Uni Med Ctr. Many, if not most, of the European docs we see on this forum may have much more control or influence on the institutions where they do surgery. The German docs also seem to be from Northern Germany. Even some are in private hospitals. That may be a difference that causes Dr Meyer to raise hurdles. Or simply, like AP says, he doesn't really want to get involved.

Invoice
 

HI Cheryl

A quick question. Did the clinic supply a detailed quote prior to surgery so you knew what to expect and detailed invoice after surgery?

Thankyou

Hi Cheryl! I've been following your posts recently and I'm happy to hear you found Dr. Schmitz and got the right procedures done. I was wondering if you could share your knowledge and opinion on my situation.
I had 3 level c4- c7 M6 done in 2016 with Dr Bierstedt. perfect results. great execution, alignment, even the post op care was superb. last month the c4/5 level M6 device core seems from the xray to be failing.
I would like to do the revision with the same Dr., bu ss everyone here has experienced its very trying to communicate with Dr Bierstedt bc there's only one contact point and it can take forever to hear back if at all. I was told in a brief email I need a replacement device or possible cage.
I've been trying to reach the Dr to further discuss all the options but again communication channels are impossible.
So Im considering Dr Schmitz instead.
Is there any advice or knowledge you can share with me about Dr. Schmitz from personal experience?

Also how is his accessibility before and after the procedures when you have questions or concerns?
Thank You

Yes
 

The gave me a quote for a one level adr revision that included the hospital stay, meds, and food for patient. Quote was in Euros.

Hi Seifty
 

I sent you a PM. Hope that helps give you some informed insight. I would highly suggest another ADR than a cage. A cage is very ridged and cannot be easily removed later. I would be concerned with it putting more stress on the M6-C below.
Dr. Schmitz can use a CP-ESP which would also provides a more controlled cushioning like the M6 but with less over engineering. I have become less of a fan of more than two levels with the M6 for this reason.