[annapurna]

We know some of the stories, at least, are real. Laura had one cervical ADR put in by Bertagnoli only to have another level degenerate and require a second ADE surgery by him. The scarring from the first surgery made the second much more difficult but it was successful. We have talked, over the years, with others who've had success with multiple levels. As to whether your odds of having success are good, that's a harder call.

I'd suggest this: as yourself what happened with your spine to lead you to need multiple levels. This isn't a blame game but if you can honestly say that whatever happened to damage the levels at first has been resolved and isn't going to cause problems for ADRs at those levels, you stand a better chance of success.

A motor vehicle accident, for instance, is a good reason to say your natural disks saw unnatural loading and there's no reason to think that would happen to ADRs; unless you're a professional race or stunt car driver. If your disks "just went bad," then it's a lot harder to be sure your ADRs aren't going to be challenged. ADRs are inherently less stable than healthy disks (better than badly degenerated disks, though), so if some mysterious situation took out your natural disks, you may not get good long-term life out of your ADRs unless you work on trying to improve stability and strength in your c-spine.

As for 3-4 levels, the Bertagnoli of 15 years ago was the person I'd get to do the surgeries. He certainly has the skill and experience and I simply don't follow his work closely enough now to know if he lost any fine touch with age. All I could say there is to try to get a phone consult. Even if they don't do "official phone consults," you might be able to get an answer to the questions, "If I presented at your clinic with a need to have 3-4 c-spine disks replaced, do you still perform such surgeries? If so, when, roughly was your last one? How many have you performed in the past 3-4 years?" With those questions, you're not asking him to remotely diagnose you but answer questions about what he's been doing the last little while. A remote diagnosis would still be nice, if you could get films to his clinic but I don't know what they do now.

Bertagnoli was also pretty good at using a mix of ADR and fusion for a hybrid approach for the high-count multiple level repairs. That might actually work better and not leave you with a hypermobile c-spine where you're unable to protect the ADRs when you're not able to actively fire muscles to protect them (sleeping, for instance). I've never heard anyone officially use these terms but I tend to think of dynamic stability (what you get when you're awake and holding your head stable with muscles, tendons, and ligaments) vs. passive stability (what you get when you're not firing muscles). Fusions have high levels of both, for obvious reasons and ADRs have low levels. If you're diligent, you can do something to improve your dynamic stability but your passive stability is pretty much what you get after your surgery. Again, these are Annapurna terms to make sense of what we've been told using our engineering thought processes but it made sense to us.