Tomas L4L5 and LS1
 

Hello!
My name is Tomas and after ski fall I found out that I have badly damaged L4L5 and L5S1 disc. They lost quite lot of original height and suffer severe DDD. Of course both have herniations. My life of course changed radically. I joined this forum with hope to help me with decisions. I already was thinking about 2 level ADR 3 years ago but changed mind but now situation worsen and Im back here. I have big concern about my facets I have moderate artritis on some of them at least this is why Dr Zeegers refused me 3 years ago and also surgeon in Czech republic did nor recommend ADR because of that. On other end Prof Bertagnoli and Dr. Biersted are opposing this opinion and recommend 2 level ADR. So where is the truth, how is possible to have totally different opinions? I feel I need to ask other doctors to have more opinions I guess but who? I already have date for discectomy which is probably not good solution lasting forever. Dr. Bierstedt thinks its not good idea because it will speed up progress of degeneration.

Welcome to the board


Yes it is not easy to determine what to do. I have talked to about 10 doctors in total and lucky for me they all think I need the same work done, which for me is 3 level ADR. only one doctor mentioned hybrid but he was being cautious saying there was only a 10% chance of that.


Every doctor has their own methods, their different discs types and different experiences that they have learned throughout their years of doing ADR. It is no surprise to me that some say they can do it while others can not. I have had doctors tell me dont use this disc than have had other say we should use this disc.

We are not doctors so we can only make educated guesses by research, forums, listening to what other people say that have had the operations and so forth. I have changed my doctor and disc a few times over the last year and finally think I have found the one for me I am going to go with the LP ESP and Dr Rischke in Switzerland.


I am not saying he is the best doctor, I am just saying with my research, my talks and so forth he is the best doctor for me at this stage. I think many of the doctors are very good and would probably do a great job but one has to pick someone to do it.

You say some doctors tell you not to do it, well ask them why and then take that to the doctors that will do it and challenge them, ask them why can you do this procedure that others say they will not. Then it will be up to you if you think their answers are good enough for you. I really do believe there are more skilled doctors out there and some can do things that others cannot or repair things that other doctors have messed up.


It took me 15 months to decide on a doctor and with each new doctor I talked to I learned more and had more difficult questions.

Welcome
 

Tomas, any updates? Any progress towards your next milestone?

And (ahem!) your homework, sir:

http://adrsupport.org/forums/showthread.php?t=11053

:jacks:

decision?
 

I contacted Dr. Bierstedt and he would replace both disc recommending ESP LP discs. I also went to radiologist here in czech republic who confirmed that my facets are quite good still. Yesterday I also got confirmation that my facets are OK from neurosurgeon in czech republic who also did just 150 ADR. But he would do fusion but my impression was that reason is his limited experience with ADR since he mentioned that 2 level is difficult thing.
So now soon I must decide what to do.. If to go to disectomy or spend fortune and go for ADR.

Tomas, Dr Bier has long used M6 for C and L. ESP has also been around for some time. Did he say why he recommends ESP over M6L in your case? In any event good luck with your decision and I hope you focus on the longer term solution. I have 3 levels in C- in the right doc's hands, it isn't so difficult.....

If you are concerned about your facets, especially at the L5-S1 level, have you looked into the Activ-L?

It is the only artificial disc designed specifically for the L5-S1 level. It is designed to take pressure off your facets with a core that shifts forward as you bend at the waist. It is also the closest size of any artificial disc at the L5-S1 level to the original size of your disc, further helping preserve your facets.

Not to say that you'll have an issue if you opt for any other disc, just that I've read that the Activ-L is designed this way and slightly less likely to cause facet issues in these ways.

I just had one put in two weeks ago. It feels great! I dont think they're as popular in Europe, but it is the latest FDA-approved device here in the US. I had mine put in by the co-developer of the disc, Dr. Rolando Garcia.

ESP disc
 

Bierstedt did not explained why he recomends ESP LP, I feel he prefers this one now. Guessing that its better then M6 for L5S1.
I was considering ziegers 3 years ago with ActiveL but he refused me. He explain because of the facets and also probably because my spine shape is not the best one. There is not so much lordosis (straight spine) and I have primary stenosis (12mm).
But Bertagnoli and Bierstedt claims my facets are good enough and thats why I went around doctors here in Czech rep. to doublechecked facet status and they also said they are not bad.

if you read some old stories on here, dr z was sometimes a bit of character, though there is no doubt he was a great surgeon. sometimes it was hard to figure out if he was being really conservative or just moodly...I actually contacted him so long ago, when he only corresponded in German. Maybe Dr Clavel breaks your deadlock? He for sure is conservative and above all else, very honest and caring

Sorry to hear about the stenosis. I hear that can be an automatic disqualifier. Another clinic you can check with is the Texas Back Institute. They do complementary consultations over the phone and by e-correspondance.

They were my second choice in the United States. I would recommend to consult with Dr. Blumenthal there. As far as I've read, he was the first physician to bring European ADR techniques to the US.

And like Phillyjoe said, definitely consult with Dr. Clavel. He was my first choice in Europe.

Clavel
 

I have contacted Clavel 2 weeks ago. Hes got my images and now I am waiting for response. I am curious about his opinion.
I have also been reading that primary stenosis was not accepted. Bertagnoli or Bierstedt did not even mentioned it. They dont take it as problem looks like.