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#1
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Prepping for c5/c6 decompression - surgical choices
Hi Folks,
So after almost 14 years of conservative therapy it seems I now require surgery at c5/c6 to protect/preserve nerve function. This is mainly due to the exhaustion of free space around the right nerve in conjunction with related symptoms. A local consult suggests M6-c ADR at c5/c6 (if viable) to give adjacent segments the best chance as neither are in the best condition. Previous consults have suggested fusion or ADR at c5/c6 or c5..c7. I was feeling quite happy (well, as happy as one can be) with the latest consult but just recently heard of some M6-c failures. It seems there have been at least 2 cases requiring revision due to the nucleus becoming detached with related radiculopathy and incipient myelopathy. Maybe with the number of M6s implanted these numbers are not so significant compared to other issues requiring revision but they've got me concerned. Does anyone have any additional information on this topic?, or suggestions for alternative ADRs? Thanks to everyone here for the wealth of shared information.
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Age 52 2005 L4/L5, L5/S1 bulging disks, responded well to conservative treatment 2005 Car crash - Acute neck problems started 2006 Spring - Large hard broad based herniation c5/c6 with rightward bias 2006 Autumn - Left biased prolapse C6/c7 Physio etc since car crash, PRT since 2009 2019 - symptoms (arm, hand) worsen, "no space" left for right nerve root c5/c6, minimal cord compression 2019 Dec - 2 level ADR C-ESP SANA Köln (Dr. Biren Desai), C5/C6, C6/C7 |
#2
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I personally would not feel comfortable with either the M6-L or the M6-C... Due to reported failures.
I'm considering both the LP-ESP and the CP-ESP. Neither have been on the market as long as the M6's, but it seems more and more physicians have been moving to them... As (apparently) no device failures have been reported.
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L4-L5 Broad Diffuse Bulge, mildly contacting left L5 nerve root L5-S1 Broad Central Disc Protrusion mildly impinging left S1 nerve root "Mild scoliosis of lumbar spine". Four central disc protrusions in thoracic spine. C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good. Successful CP-ESP's placed in Oct 2019 by Dr. Desai. Delayed lumbar surgery to work on bone density. Considering options now, some but minimal bone density improvement. Will only use LP-ESP. |
#3
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A "few" failures
Some of which have not been substanciated and let's face it, all devices have had a failure or complication. There are risks with every surgery. But once you fuse, there is no other recourse.
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54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed 2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor 2008 revised C4-6 donor bone, plate & screws 2009 fusion with Roi-C @ C3-4 2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain 2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal. 2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany |
#4
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It's a tough call - the only truth I currently see is that all surgical options are to some extent a gamble and one should weigh the risks against the potential outcome. There appear to have been two reported cases of m6-c failure in German publications. If these are outliers then probably not significant compared to the reported ca. 30 .. 50k(?) implanted m6-cs. I read the latter numbers somewhere so hopefully they're correct, this may make the m6-c the most widely used cervical ADR? I heard about these (failures) just as I was planning a date for surgery, I've now put that on hold and hope to find further clarity via additional consults.
__________________
Age 52 2005 L4/L5, L5/S1 bulging disks, responded well to conservative treatment 2005 Car crash - Acute neck problems started 2006 Spring - Large hard broad based herniation c5/c6 with rightward bias 2006 Autumn - Left biased prolapse C6/c7 Physio etc since car crash, PRT since 2009 2019 - symptoms (arm, hand) worsen, "no space" left for right nerve root c5/c6, minimal cord compression 2019 Dec - 2 level ADR C-ESP SANA Köln (Dr. Biren Desai), C5/C6, C6/C7 |
#5
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Jacks back
JackBauer
"I'm considering both the LP-ESP and the CP-ESP". Jack why would you consider the CP-ESP , when your concern is your lumbar spine?? Thanks............... |
#6
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Quote:
Because I do have neck concerns as well - occasional pain (not constant / frequent like lumbar)... But the imaging looks pretty bad and it won't get better. Unfortunately I'm currently "hung up" on the elastomer within the ESP and the chemicals it can degrade into... Search for "salted" in the LP-ESP 7 year study. (I also made a post about it in the manufacturer sub-forum)
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L4-L5 Broad Diffuse Bulge, mildly contacting left L5 nerve root L5-S1 Broad Central Disc Protrusion mildly impinging left S1 nerve root "Mild scoliosis of lumbar spine". Four central disc protrusions in thoracic spine. C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good. Successful CP-ESP's placed in Oct 2019 by Dr. Desai. Delayed lumbar surgery to work on bone density. Considering options now, some but minimal bone density improvement. Will only use LP-ESP. |
#7
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My M6-C 's
Mine were done in May of 2015 and still look great!
Placement is key too!
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed 2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor 2008 revised C4-6 donor bone, plate & screws 2009 fusion with Roi-C @ C3-4 2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain 2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal. 2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany |
#8
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And long may they continue I'm getting the impression surgical skill is possibly more important that technique (ADR type, fusion, etc).
__________________
Age 52 2005 L4/L5, L5/S1 bulging disks, responded well to conservative treatment 2005 Car crash - Acute neck problems started 2006 Spring - Large hard broad based herniation c5/c6 with rightward bias 2006 Autumn - Left biased prolapse C6/c7 Physio etc since car crash, PRT since 2009 2019 - symptoms (arm, hand) worsen, "no space" left for right nerve root c5/c6, minimal cord compression 2019 Dec - 2 level ADR C-ESP SANA Köln (Dr. Biren Desai), C5/C6, C6/C7 |
#9
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Interesting
I also find it interesting that these reports are from Germany, where two prominent surgeons are devoted to Pro disc or Mobi.
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54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed 2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor 2008 revised C4-6 donor bone, plate & screws 2009 fusion with Roi-C @ C3-4 2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain 2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal. 2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany |
#10
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Germany
Maybe because the majority of ADR surgery has/is been done in Germany?, possibly just a numbers game in that case. I have to concede it's hard to obtain reliable outcome/revision/failure data, disappointingly so.
__________________
Age 52 2005 L4/L5, L5/S1 bulging disks, responded well to conservative treatment 2005 Car crash - Acute neck problems started 2006 Spring - Large hard broad based herniation c5/c6 with rightward bias 2006 Autumn - Left biased prolapse C6/c7 Physio etc since car crash, PRT since 2009 2019 - symptoms (arm, hand) worsen, "no space" left for right nerve root c5/c6, minimal cord compression 2019 Dec - 2 level ADR C-ESP SANA Köln (Dr. Biren Desai), C5/C6, C6/C7 |
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