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-   -   Bit confused (Bierstedt vs Clavel) (https://www.adrsupport.org/forums/showthread.php?t=13179)

Mrbaozi 06-11-2015 10:24 PM

Bit confused (Bierstedt vs Clavel)
 
In mid May I received a reply from Dr.Bierstedt regarding my scans and this is what he recommended:

Drs Bierstedt and Illerhaus comment after reciewing your data :

Diagnosis

degenerative disc disease L4/5 and L5/S1 – spondylolisthesis (slippage of vertebrae)


Dr. Bierstedt:
ADVISE:

disc replacement L4/5: ROI-S cage and stabilization at L5/S1 (APLIF)

The advised surgery by senior neurosurgeon Drs Thomas Bierstedt or Dr Illerhaus includes

· M6 implant technology

. Nuvasive implant, Globus spine

· fluroscopic guidance for accurate placement of implant

I then contacted Dr.Clavel and received this:

“At L5-S1 only a fusion can be done due to the spondylolisthesis
It cannot be done from the front due to the steep sacral slope.
He then needs a fusión from the back.
What can be done is a lumbar arthroplasty at L4-L5, this one coming from an anterior approach, as we always do”


So, Dr. Bierstedt is saying he would do the fusion from the front (L5-S1), then put the ADR in at L4-L5. Malte called me to answer a few questions and said it would be a fusion from the front, then 2 tiny keyhole sized incisions in the back to put the screws in.

Dr. Clavel is saying due to my sacral slope, a fusion from the front can't be done, so it would be a PLIF and then flip me over and ADR it up from the front...

This is fairly confusing as one is saying it can be done and the other is saying it can't...

From what I've read, isn't the posterior approach bound to increase recovery time, as they'd be hacking through my back muscles to gain access?

Has anyone on here heard of anything like this before?

Thanks!

pittpete 06-11-2015 11:08 PM

Quote:

2 tiny keyhole sized incisions in the back to put the screws in
Sounds like a minimally invasive posterior fusion.
Sounds like Biersdedt would remove the disc from the front, place the interbody spacer then flip you and insert pedicle screws and rods...

What are the condition of your facets?

bwink23 06-11-2015 11:10 PM

Quote:

Originally Posted by Mrbaozi (Post 111135)
In mid May I received a reply from Dr.Bierstedt regarding my scans and this is what he recommended:

Drs Bierstedt and Illerhaus comment after reciewing your data :

Diagnosis

degenerative disc disease L4/5 and L5/S1 – spondylolisthesis (slippage of vertebrae)


Dr. Bierstedt:
ADVISE:

disc replacement L4/5: ROI-S cage and stabilization at L5/S1 (APLIF)

The advised surgery by senior neurosurgeon Drs Thomas Bierstedt or Dr Illerhaus includes

· M6 implant technology

. Nuvasive implant, Globus spine

· fluroscopic guidance for accurate placement of implant

I then contacted Dr.Clavel and received this:

“At L5-S1 only a fusion can be done due to the spondylolisthesis
It cannot be done from the front due to the steep sacral slope.
He then needs a fusión from the back.
What can be done is a lumbar arthroplasty at L4-L5, this one coming from an anterior approach, as we always do”


So, Dr. Bierstedt is saying he would do the fusion from the front (L5-S1), then put the ADR in at L4-L5. Malte called me to answer a few questions and said it would be a fusion from the front, then 2 tiny keyhole sized incisions in the back to put the screws in.

Dr. Clavel is saying due to my sacral slope, a fusion from the front can't be done, so it would be a PLIF and then flip me over and ADR it up from the front...

This is fairly confusing as one is saying it can be done and the other is saying it can't...

From what I've read, isn't the posterior approach bound to increase recovery time, as they'd be hacking through my back muscles to gain access?

Has anyone on here heard of anything like this before?

Thanks!


Do you know the grade level, 1 thru 4, of your spondylolithesis? What caused it, do you know? Any fractures in your spine? I too have a small Spondy, grade 1 at 2mm. I have a pars defect on my left side, L5 vertebra. Depending on how bad your slip is, its not uncommoon at all to do a 360 fusion. The posterior approach is an attempt to bring the vertebra into a more correct alignment. You have to do that to be able to correct the slip as much as it can be done. An anterior approach will not correct slip. I had an anterior fusion done without posterior instrumentation by Dr. Clavel, i presume cuz my slip is minor as far as spondy goes. He wasn't concerned with correcting my slip, more with stopping movement of the vertebra.

bwink23 06-11-2015 11:18 PM

I googled "RIO-S" and came up nothing, what is that? Is that an anterior cage? Are you sure Dr. Bierstedt is saying he wants to do an anterior fusion here? He may be saying a posterior fusion with cages.

pittpete 06-11-2015 11:49 PM

https://www.google.com/search?q=roi-...FUwyrAodLUMA7w

scoop302 06-12-2015 01:44 AM

I have a question. Who is doing the surgery in Germany, Bierstedt or Illerhaus? My understanding is Illerhaus is better at damage and complications, and Bierstedt does straight forward ADR. That being said, my experience with them is not the best, and after a month of emails back and forth with Ken and Malte, this was my understanding. With Clavel, Yolanda set me his report, followed up with a request for a phone call/ Skype call with the doc. On this Skype call, he explained exactly what he had to do and why he needed to do it. Before you go any further, I would speak with the doctors directly and end the confusion, this is not where you want to be.

Mrbaozi 06-12-2015 03:00 AM

To answer some of the posts:

The doctor here said it was grade 1, but Malte told me it was grade 2 or possibly even 3, didn't look that crazy in the MRI, but I'm not the doctor.

Facets, I'm not sure how they are, perhaps it's something I should look into?

My doctor here said the CT scan showed a pars fracture, so that's what caused the slippage I'm assuming? Or perhaps it was fractured when I was younger and that heavy lift caused the vertebra to slide forward more and smush the disc?

My experience has actually been completely opposite, I had prompt responses from Bierstedt and it's been much slower going with Clavel (assuming he's pretty busy though).

As far as how much mine has slipped, I think I remember my doctor here saying at least 8mm and I'd gain a good half inch or more of height once my back was re-aligned.

I asked Malte about the procedure and he said the fusion would be done from the front, then the adr, and the keyhole incisions would be done from the back to finish things off.

Thanks a bunch for the input!

jss 06-12-2015 07:04 AM

baozi,

It has got to be terribly confusing when you get different signals from different doctors. Each prefers a different method to the same end; fusion at L5/S1. In that sense, they are giving you the same prescription; ADR at L4/5 and fusion at L5/S1. Many sufferers that come to this site get opinions that are all over the map.

I don't know which approach to the fusion is best for your particular case; anterior or posterior. Good luck!

FranklySir 06-12-2015 12:21 PM

baozi,

Haven't posted in a long while but had to when I saw this.

Take a logical approach here. How can an implant be properly placed in an improper alignment. The foundation needs to be corrected first then the ADR placed. I would seriously be concerned of pulling the vertebral body in alignment from the rear with screws after the implant is in place IMVHO. To me this could have a very high risk of implant migration down the road when you start to think of it. Both plans are very similar but the order of things are important.

At least ask the questions.

F

Cheryl0331 06-12-2015 05:22 PM

i must agree
 
Quote:

Originally Posted by jss (Post 111145)
baozi,

It has got to be terribly confusing when you get different signals from different doctors. Each prefers a different method to the same end; fusion at L5/S1. In that sense, they are giving you the same prescription; ADR at L4/5 and fusion at L5/S1. Many sufferers that come to this site get opinions that are all over the map.

I don't know which approach to the fusion is best for your particular case; anterior or posterior. Good luck!

Same end result really; just differing oproach.


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