[10n2010]

Hello all - This is my first post, but I've been reading your stories and all of the useful information thanks to the experiences and personal details you've shared. So, first and foremost, thank you to the entire community!

My history can be quickly reviewed down in my signature, but long story short, I've been suffering with lower lumbar DDD for 12+ years now. There is no single/specific incident or accident that I can recall, but rather just a life full of riding/racing motocross, snowboarding, surfing, running, etc that has contributed to my present state.

Back in 2016, I was very close to traveling to Germany for a 2-lever ADR procedure with Ritter-Lang (M6 @ L4-5 and L5-S1). I personally know four different people who have had successful procedures at Stenum with RL, so at the time, I was sold that he offered the most advanced option. Admittedly, I did not research other European surgeons back in '16 given the recommendations I had received from friends, and I was certain that 2-level ADR was lightyears better than a single level fusion at L5-S1, which is what multiple surgeons in the US recommended.

I took a break from the process and continued managing the pain for another 3 years, and now here I am. This time around I have done more research, sent my images to a few more surgeons, and even traveled to Texas Back Institute (from CA) for a consultation with Dr. Zigler.

Here are my current options:

Stenum/Ritter-Lang: I sent my latest images to RL, and his updated evaluation is the same as it was in 2016 (2-level ADR with the M6 @ L4-5 and L5-S1). We've gone back-and-forth with several rounds of questions, but he hasn't wavered on his recommendation. I was VERY close to booking my surgery date before the end of the year (2019), but as luck would have it (I think?), I received a recommendation from a surgeon here in the US to explore other surgeons in Europe if I was adamant about going overseas for the M6 (or other disc - ESP, etc). The "recommendation" was actually more of a warning against surgery with RL, so as you can imagine, I lost some of my confidence, despite the fact that I have friends who still recommend Stenum/RL 3-5 years post-surgery.

TBI/Zigler: Recommendation is for a Hybrid procedure (Fusion @ L5-S1 with ADR using the activL @ L4-L5). I really like Dr. Z, and trust that his recommendation is the best option here in the States, all things considered (finances, FDA-approved disc options, etc).

Dr. Clavel/Barcelona: After the recommendation to consult with other surgeons in Europe, I sent my info and images to Dr. Clavel. So far my experience with his team has been great. Olga has been very friendly and responds quickly, and I actually received my initial surgery recommendation within just a day or two of submitting my images. Clavel is also recommending a Hybrid procedure (Fusion @ L5-S1 with ADR using the M6 @ L4-L5). I have a Skype video consult scheduled with him in a little over a week to discuss in greater detail, but his initial reasoning is as follows: "I would recommend Hybrid due to the foramina stenosis, level of disc collapse and disc degeneration at L5-S1. Makes it better for an ALIF than ADR. Plus the osteophytes at the foramen don't make ADR safe."

To be honest, I was expecting a 2-level ADR recommendation from Clavel, so this caught me off guard. On one hand, I'm a little bummed, as I would like to avoid fusion if at all possible. On the other hand, it was somewhat refreshing and reassuring to receive the same recommendation as Dr. Zigler, whom I have a lot of respect for. The biggest difference, of course, would be the disc itself (Zigler/activL vs. Clavel/M6). And what about the 2-level ADR recommendation from RL… I’m thinking that must be a pretty aggressive approach given what Clavel had to say about my condition?

Dr. Desai: I also sent my info/images to Dr. Desai in Cologne, Germany last week, but I have not heard anything back yet.

So... That's where I currently stand. Any thoughts or advice?

Thanks for reading... Hope you're all feeling great today!