[Antifragile]

Hi,

My story is complicated and I would love to get some advice or opinions on overseas ADR.

I train and teach wresting and martial arts and injured my neck last December (12/2013). I have likely had a bad neck for a long time. MRI from that time revealed myelopathy and cord compression at c6/7 and some compression at c5/6 with foraminal narrowing. My symptoms were transient parasthesias in the feet and numbness in my left hand. I got several consultations with surgeons at the hospital for Special surgery in NYC and they all agreed with two level fusion or a hybrid mobi-c ADR/fusion (the head surgeon there had only done one two-level replacement with the Mobi-C.) I also consulted with Dr. bierstedt and Dr. clavel at the time and they both agreed on two level ADR with the M6. I even met with Dr. Beirstedt in NYC in January and felt him and his crew were very knowledgeable, and that if I were to do the surgery, it would be with them. However, I decided at the time not to have surgery. After 3 months the symptoms subsided and I continued training with caution.

I was fine until this past September when things got bad again. After attempting to lift weights and do gymnastics, the grip in both my hands started to give out. A day or two later I was getting parasthesias again all over my body, including burning in my right forearm and fingertips. I saw my doctor and another MRI was ordered which revealed that the problem in my neck was unchanged, in fact, c5/6 may have gotten worse. Few weeks later, I started getting chronic headaches that came everyday. I have been getting them for about two months now.

I tried contacting Malte in September and setting up the surgery, but for some reason he did not respond after 2 weeks of emails. So I called the Canadian rep, Ken, who is very nice, and he said to resend the emails and copy him on it. My emails included a few questions, information about my new MRI, and a request to speak again with Dr. bierstedt either by phone or email. There was still no reply from Malte. A week later I follow up with Ken and he said to resend again and Malte finally replied but to an older email that didn't have all the questions. No chance to speak with Dr. bierstedt was offered. The communication has been very frustrating. On top of this, I had recommended a friend of mine in Georgia to contact them for his back surgery around the same time - he had the same problem: it took several multiple attempts and over a month for a reply. Needless to say, this does not inspire me with confidence. They don't even have my money yet and it's that hard to get in touch with them? I did not have this problem with them with communication back in January of 2013. I had heard about them losing a patient last spring due to the patient lying about his drug history, but I don't know the full details. Maybe it had an effect on the program? Something changed and communication is now very poor.

So, I consulted with two other overseas surgeons: Dr. Peter Hamlyn out of London (he did my friends 2-level cervical M6's 4 years ago, and he has been able to train and compete in high-level martial arts completion again) and I also consulted with Dr. Clavel. Here are the opinions:

Six US orthopedic surgeons and one neurosurgeon said to do a two level fusion. One US neurosurgeon said to do a one level fusion or replacement at only c6/7.

Dr Hamlyn out of London only received my recent MRI out of some staff error (it's a poor quality image), and based on that, recommended a one level ADR with the M6 at c6/7. He didn't think c5/6 was necessary based on the MRI.

Dr. Clavel said pretty much what everyone else said: two levels were necessary and he told me that even my posterior ligament was enlarged and contributing to my problem. He wouldn't even do one level, only two.

My experience with staff communication and skyping with both Dr. Hamlyn and Dr. Clavel were excellent. I had to pay, but I have no problem with that as they took 45 minutes of their time and did not rush me at all.

So, I have decided on getting the surgery and would like to get it done before the new year. My options are Dr. Hamlyn, Dr. Bierstedt or Dr. Clavel.

Dr. Hamlyn is great and I have another skype appt with him to go over the second MRI he didn't get (staff error), however, the system there with the NHS is not really set up for US citizens. They couldn't exactly tell me how much it would cost, only a ballpark figure, close to the price of the others in Europe, and said I would get 3 separate bills. Also, he said one level, which is confusing, since the majority of surgeons say two levels.

Dr. Beirstedt seems extremely knowledgeable, I like him, and think he's very skilled because people have had good outcomes overall from what I see on here. However, communication is poor, even post-op from what I have read on here. This I don't like. If I have an issue and need to ask a question, I would like to have access to speak with him either via phone or skype, even if it costs money. I have no problem with paying for his time and would expect to. However, reading about other peoples experiences on here, it doesn't seem like it's an option. I would rather not have to relay everything through Malte who didn't even answer my emails until after 3 weeks and several attempts. Also, the issue there last spring that I heard about worries me, but I don't know the full details.

Dr. Clavel is a really great guy. Wonderful personality and also seems extremely knowledgeable and skilled. I have heard people also have good outcomes. Dr. Clavel spent time with me via skype, answered all my questions, was very nice and informative, and communication with his staff is good. However, someone mentioned the outcomes not being as good as of recently, (someone said it on a thread here). Also, while Germany has an outstanding reputation for medical technology and surgery, I am unfamiliar with Spain and haven't heard anything about their hospitals, etc.

Any thoughts?