Greetings! Lurking for a while, just introducing myself!
 

Hi Everyone,

First, let me say that although you don't know me, I feel like I know some of you. I've read quite a few lengthy threads on this site, and it has been very educational. I really appreciate all the information that people, often over the course of multiple years, have posted here.

I won't bother to repeat what's in my sig block, but I'll expand a bit by saying that I have to sit for my job, and of course, driving requires sitting. So, my lower back pain is pretty disruptive, and I'm in some level of pain nearly 24/7, although it is normally a level of pain I can deal with. I used to have a flare up where the pain would get bad enough that I essentially couldn't move maybe once a year or less. Lately it's been more like every couple months that I end up bedridden for a few days. And that's already with accommodating it more than I would like (e.g., by avoiding sitting -- which isn't easy).

I know what I'm describing isn't as bad as some of you have it. In fact, after seeing many doctors for this, probably the most frequent opinion I get is that I shouldn't do anything (I'm in the US -- I think this attitude is pretty typical here). They say that my symptoms aren't severe enough and point out that with surgery things can go wrong. When I asked one doctor why he didn't think I should do anything when I'm in pain on a daily basis, he said "Well, you can walk now. What if you can't after the surgery?" OK... that's scary. But is that really useful input? I don't know. Of course I know that anything can happen, but if horrible outcomes are, e.g., 0.1% of the time, personally, I'd risk it. Many doctors don't seem to agree.

Incidentally, I'm here because I'm interested in ADR pretty much exclusively (I know some of you have had fusions or hybrid surgeries). I did see one doctor (in the US) who said if he did anything, it would be fusion, not ADR. I had already done quite a bit of research at that point, and so I said "If I had a fusion done, my understanding is that it greatly increases the chances of problems in the adjacent levels down the road." He said "Oh yeah, if you get a fusion done, you'll be back to see me for the other levels." What?!? And yet he is still pushing fusions... At least he was honest, I guess.

It wasn't until I started reading this site that I realized that there seems to be a big dichotomy between doctors' attitudes in the US versus other countries. I've now had my situation assessed by Dr. Bertagnoli, Dr. Ritter-Lang, and Dr. Clavel (among other doctors who I don't see mentioned on this site, such as Dr. Bae at Cedars Sinai in Los Angeles). Without fail, anyone who is an ADR expert (and so isn't pushing fusions) says the same basic thing: Replace L4/L5.

Of course, the details aren't the same. In the US, or with Dr. Bertagnoli, it would be a ProDisc-L. With Ritter-Lang or Clavel, it would be an M6-L. And, while most say they would use an anterior approach, Bertagnoli said he would go posterolateral (which is interesting in that other doctors, even experts at ADR, seem firmly convinced that posterolateral for these discs is impossible due to not providing enough access).

So, that's pretty much it. Where I am now is having largely decided that no, I'm not going to put up with this pain in perpetuity, even though some doctors say that is exactly what I should do (and with the narcotic scare that is currently going on in the US, doctors don't want to prescribe them, I've never found muscle relaxers or NSAIDS to do anything, and so in essence the doctors here are truly saying "I can't do anything for you. Deal with it."). Assuming I do have ADR done, I'm more hazy on traveling abroad versus not. That really boils down to how much I want an M6 instead of a ProDisc. (I don't want to start any religious wars, but I'll probably be posting questions on that topic, just in case anyone has new insights or statistics I haven't seen).

Thanks for listening, and thanks for the great community.

Many options, many choices...
 

Hi LumbarSpine,

Welcome! Yes, your story has many similarities to mine. It is a big decision to choose the surgeon and the disc type. Every surgeon will have a different recommendation. It seems that you are thinking between Prodisc-L and M6-L. In my opinion, those are not the optimal discs to choose from. If you want to go with an UHMWPE disc, Activ-L is your choice (FDA approved in U.S.!). If you are going for elastomer, I would place my bet on LP-ESP, with possibly Freedom being relevant in the near-future. Just to add some more choices to confuse you even some more ;)

I agree with Blizzaga. In the US, you should be deciding between the Activ L and possibly the Freedom (should be approved soon). I know that Texas Back is using the Activ L now. I also think that at l4/l5 the debate is clearer than at l5/s1.

Thanks for the input. I had shied away from the ActivL for the same reason I might shy away from the Freedom (whenever it comes out): No surgeon is going to have that much experience with such a new disc. I assume that their skills from using other discs will largely transfer, but would rather be, e.g., Clavel's 2000th M6 disc, or someone else's (also of stellar caliber) 10th Freedom?

That's not rhetorical lol. I'd really like to know what people think about using the latest and greatest, assuming a great surgeon, but one who simply cannot have had many years of experience with the disc being used.

Edit: I just came across this when researching the Freedom disc: http://denver.cbslocal.com/2016/06/1...ed-incoherent/
This is the guy that's one of their spokesmen?? He seems to be officially associated with them: http://www.prweb.com/releases/2016/05/prweb13380881.htm

Keep in mind that there are UK doctors that have done thousands of Activ-l's in the UK and Europe with great success too. Dr. Clavel's web site states that he will use a Activ-l on occasion depending on the patients anatomy.. Also Activ-l has been around for alot longer and seems to have a proven track record. M6 is still fairly new and not as long term of a study.. I always go back to it's based on how good your doctor is.. Your right .. I would want a European doctor that has done thousands instead of a US doctor that has done 10 or even a 100.. For me it does come down to the Activ-l or the M6-l and lately I have been leaning towards the Activ-l..

I had 2 lower level M6-L done by Dr Clavel a montb ago and am doing very well.

If I can help you answer any questions, let me know

Hey LS,

In case you've not see the topics relating to Ritter-Lang and Stenum, pls see this forum, the 2nd and 4th topic:

https://www.adrsupport.org/forums/forumdisplay.php?f=51

Stenum's reputation early on in the 90s was to do ADRs as quickly as possible. And they bragged about it. Really bizarre thing to brag about; given it led to SO MANY complications, many of which were severe. They created the largest number of complications for the Charite than any other clinic. And yes, Ritter-Lang was front and center.

From there, they forged relationships in the U.S. (et al) with "patient advocates" who sold their services. These pinheads were unscrupulous and devious, as these topics documented.

There are so many other good surgeons, stay away from these crazies. And in the U.S., some surgeons have been doing ADR for 17 years now.

Hope this helps.

Thanks Harrison. I did read the Ritter-Lang stuff. Obviously not good. But, it sounds like they have cleaned up their act. Would you agree? I'm leaning towards Clavel regardless, but I'm wondering what the current thought on Ritter-Lang is.

For those who are pro Ritter-Lang, might I ask why? My assessment is pretty superficial, and goes like this: Ritter-Lang had problems, at least in the past. Maybe they are all 100% resolved -- I don't know. Everything I read about Clavel is positive -- no problems in the past. So, why not go with Clavel?

I'm curious about how your recovery went (I know it's ongoing, but I assume you are through the worst of it). One thing that I find confusing (if only there were just one thing) is that different doctors seem to have pretty different views on recovery time for what amounts to the same operation (regardless of the disc used, almost all are using an anterior approach).

I had one doctor say he could do the surgery as an outpatient procedure if I wanted (to which I said "Hell no!"), which sort of implies to me that it's ok to do normal movements immediately. I read that Clavel wants you to lay there and not move at all for a day. And at the more onerous end of the spectrum (not that this necessarily conflicts with the previous statements -- it's a different question), I've had doctors say that I probably won't be able to go back to doing a full day of work (at a desk job mind you -- no manual labor) for 1 to 3 months. That seems like a long time for just sitting at the computer.

Input from anyone that's gone through this would be great.

Why not go with a Euro surgeon? Of course, you can and may have good results. My argument has been consistent: you can achieve similar outcomes with the same or less money stateside. And avoid the agonizing travel and lack of follow-up care. If things get really bad post-operatively, you have no legal tools to employ for Euro-docs -- and I mean none. The Germans in particular make it impossible for patients to sue for malpractice.

Some Euro docs even try to sell "extra" insurance if there are complications, and some patients in this community have purchased it. I find that really unscrupulous, but that's just my opinion. Some of the Euro docs are getting between $60,000 - 120,000 for spine surgeries in cash.

Harrison is absolutely correct with the reasoning of the downsides of traveling, but I still want to partially argument for the other side :)

I would argue that there is a significant price difference. I paid ~30 k for a two-level lumbar. Sure, adding the travel and hotels will increase the price, but can you get a two-level lumbar by a top-surgeon in US for less than 40 k$? Of course, if you have an insurance that covers the cost, then it is a different story.

I fully agree with the no legal tools. But then again, I would cross my fingers for not having to need it in the first place... You put your life in the hands of the surgeon and then the outcome is what it is. No reimbursement is going to ever make up for a botched surgery. I don't know how successful lawsuits against US surgeons have been, maybe someone with more insight can weigh in on that.

So in the end, I would say that there are many factors affecting the choice. In some cases staying in US is the best, in other cases Europe may actually have both cheaper and better chance of success, but really, it is very situational.

Well said indeed. :wiggle:

I assume you meant "Why go with a Euro surgeon"? Not "Why not go with..."

The answer is simple: The doctors near me, at least one of whom is very accomplished, only use the ProDisc-L. I know you are anti-M6, and I understand your reasons, but theory aside (I think in theory the M6 seems like a better design, and I think you think it is too complicated and may have problems down the road), there are a couple proven points. I know one can take issue with these and say the studies were too small, the doctors weren't the best, etc. I am familiar with the issues with experimental design and all too aware that it is done very poorly in many medical studies. But still, the data I have, high quality or not, is that:

The M6 has a slightly faster recovering time that the ProDisc-L and another disc to which is was compared, I believe is has been shown to reduce adjacent level problems as compared to "hard" discs, and I know hard/unconstrained discs have been show to have a higher frequency of pedicle and facet fractures (which only makes sense as those structures then become the "hard stops" for twisting motions.

That's on top of lesser issues such as the particles that the MoP and MoM are known to produce (and which have been shown, at least histologically, to be inflammatory -- that issue might not rise to clinical significance), and that I believe the ProDisc-L is chromium steel, while the M6 is titanium -- which I suspect gives the M6 a slightly lesser change of allergic reactions. But again, these are tiny points compared to the fact that I fear eventually damage to adjacent levels and facets joints more with a MoP or MoM disc than a viscoelastic disc with graduated resistance.

I'd be happy to hear why I'm wrong. If I go with a ProDisc I have to travel 12 miles via Uber, as opposed to a flight of 1000+ miles. But, while the travel and expense are very unattractive, so is having a second rate disc in me for a few decades. I really wish I didn't feel that way. I'd go to Cedars Sinai tomorrow and get a ProDisc, but I just can't wrap my head around that making sense.

There's a video on youtube by Dr Rishke showing the pro disc against the axiomed freedom, that video alone showing how the pro disc moves would be enough to put me off the pro disc!

I could get the M6 fitted in the UK which would be less hassle than going to Germany for the LP ESP which is what I think is going to happen, as I feel better going for that.

It's nowhere near as far as the states to Germany, but I'd do the journey for a better disc.