Or perhaps I should say clashing prognosis since the bad discs are agreed upon(mostly). Clavel thinks he may need to go up one higher level than Bierstedt.
So, here's my latest round of email exchange:
From Yolanda(Clavel):
Quote:
I’ve checked with Dr. Clavel about your questions. Please find his comments below:
“Staliff will not be used for the L5-S1 fusion. An anterior lumbar cage + plate is a construction that offers proven better biomechanincal stability.
We use the pyramid anterior lumbar plate and the sovereign anterior lumbar cage. Both from medtronic.
Grafton as our bone graft substitute to fill the cage. ”
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From Bierstedt:
Quote:
Andrew, we rediscussed your case.
Our neurosurgeons Drs Bierstedt and Illerhaus recommend a 2 level disc replacement with the M6 device. Subsidence as mentioned by Dr. Clavel is not our experience, nor is the angulation shown at L5/S1 contraindicative for disc replacement.
We also do not agree that the chiseling for keel preparation of the M6 increases implant subsidence. The new implant generations only require small keels (not damaging the corticallis, ie natural vertebral endplates) as opposed to the previous generations eg Prodisc.
We understand that is conflicting your decision in regards where to go for surgery. We respect Dr. Clavel and his opinion. He has a very good reputation, good ethical principles - we just do not share his opinion fully, ie conclude that the dextra scan results or sacral angulation is a "deal breaker" for dual disc replacement.
Eventually it is your confidence that guides you.
Both surgeons have the goal for an optimal surgical outcome. Precsion, accuracy and experience matter together with the best postsurgical follow up, complication management and rehabiltation.
Very kind regards
Malte Petersen"
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Both great neurosurgeons, but two vastly different approaches. Its like Rodan clashing with Godzilla. You don't know which one wins in the end.
Clavel's approach. Fixation of the L5/S1 with a Sovereign PEEK cage filled with bone graft and Activ L over the adjacent level(perhaps two). Or, wait, build up calcium stock and in a few months go for M6 instead.
Bierstedt's approach. Go for a bottom two level M6 now. Doesn't agree about either subsidence risk or the need to fuse the bottom segment.
That's tough. I want the pain to go away, but I want the right long term solution.
Stability in my case is also something that may be what Clavel is going for since I'm a multilevel DDD and he wants to ensure that the upper levels aren't thrown off like the leaning Tower of Pisa later on down the road. Lost a slight bit of mobility, but then allow the muscles to rest on a solid foundation. Throw in ADRs above and retain enough motion. Make sense?
Comments welcome. Please, fill in the space below. Your thoughts are why I'm here and most of you have great research of your own.