No Surgery... Yet

[drewrad]

Originally Posted by Jerry5

Yea, your spine looks bad, but you got more stuff than I do.

If I figure out how to post, I will send mine to you in a private.

At any rate, I may be looking at 3 level, I submitted my BC international, 10 Mar, have not heard from them yet.

Yeah, Jerry, I'm getting real obsessed with images lately. I'd love to see your MRIs also. I'm looking at everybody else's. Might as well take a gander at yours too. I find it helpful in helping me to base my own decisions.

[drewrad]

Originally Posted by FranklySir

D,

What I can say for me is I avoided MLD's like the plague. I know its difficult to get to the final decision but for me reading all those that tried MLD they never seem to last and now you are stuck with scar tissue and bone buildup that is all close to the nerve roots. Read other posters herein that finally have made the choice to get ADR done and it seemed to me unfortunately for them they have issues even after ADR. I went whole hog on both neck and lumbar. Clavel did both per my sig line. My L5S1 is also bad but close to being naturally fused. It was Clavel's choice to not touch it due to that. I am very happy I left it in his hands since I am 3 months right now and I am fantastic. I read also same results from Dr. B.

Look at this way. you see a truck with a loose piece of tread, they clip off the tread, DO you think the tire will last another 10 miles? No it won't. It will blow out right up the road.

For me I help off for 14 years to get done and am 47. Waiting actually helped in that L5S1 fused on its own.

I feel for you in trying to make the choices. You have two great surgeons looking. Clavel was hosting an Int symposium this week for Cerv and lumbar ADR.
If I were you I would pay him and Dr. B to review your stuff again. It;s your back and you have to live with it the rest of your life and hopefully without nerve damage and pain. I had wonderful experiences on both occasions but that was me.

I wish you calmness of mind and unfettered thought in making your choices. As always feel free to PM me and I can make myself available if you would like to talk.
Frank

Yeah, I'm the same way. The anterior approach doesn't scare me as much as the posterior. Not sure why. All that back meat seems like trouble.

I've also thought the same thoughts about MLDs, but I do like your comparison to tire treads though. It makes sense. You can get as much carved off as you want. It still ain't gonna fix the disc and pretty soon, you're going bone on bone. I"m already there on my bottom two anyway. What are they going to do with an MLD at this point? Makes no sense.

Our brains seem similarly wired in our thought processes. I'm whole hoggy as well. Just trying to sort out the discrepancies between both Clavel and Bierstedt and whys and wherefors.

[drewrad]

I knew Dr. Clavel was at the symposium. I was also interested since partially it had to do with challenging the orthodoxy on sacral slope and placing an ADR at the L5/S1 specifically due to increased sheer stress over the life of the implant. Something I also intuited as a potential issue.

Here's the response back from Nicci, related from Dr. Clavel.

Dear Mr Radakovitz,



Thanks for your patience and sorry for the delay but we have been hosting the International Symposium of Cervical & Lumbar Arthroplasty so this has taken us away from the office over the last few days.



I now have Dr Clavel’s responses for you.



Did you receive & review Mr Radakovitz 2012 MRI as well as the 2014?

No Nicci, only the 2014 MRI.



Are you able to assist Mr Radakovitz in completing a prescription form for allergy testing & also check the results?

Nicci there shouldn’t be a problem but let me first take a look at the site and the prescription.



Dr. Clavel mentioned a 3 level lower lumbar ADR. I also would like to know if that changes to another idea, say a hybrid surgery, a STALIF at one level with a two M6 above that, does that change the cost or not?

L5-S1 fusion may be also performed. No change to the quote.



I am worried about facets. I want Dr. Clavel to make sure ADR is my most suitable option at the L5/S1 rather than a fusion. Then, placing two M6's above that. The reason is that I have been feeling strange mechanical motion at the very bottom of my spine. I don't want to put an M6 there if a fusion is more appropriate, however, if that's not an issue and my facets are good then I definitely DO WANT an M6 there on the bottom.

Hybrids are working well.

Facets look fine.

My criteria is the angle of sacral slope and pelvic incidence. The sacral slope angle seems high.

Best seen on full spine X-rays we may order upon arrival in Spain.

Mr Radakovitz seems to be a candidate for both. Fusion may be better.



Looking at my L2/3 and considering the retrolisthesis and the size of the anterior spurring, I wonder if I have some level of instability at that level. Has that possibility been ruled out? I know that instability is a strong contraindication for ADR so I'm just checking. I worry that 3 additional ADRs below that L2/3 level would potentially apply pressure(read, squish) that disc as the spine is extended into newer distraction over time. I worry that my body might be split in half. The good half below with the M6s separated by the good half above the L2/3. But if that L2/3 is unstable, then what? Also, the descending aorta branches and the inferior vena cava joins somewhere around that level. If either of those or their very large branches are damaged during surgery, my survival is questionable. I remember discussing this with Dr. Bierstadt and he only recommended a two level ADR(L4/5 and L5/S1) but then said if I needed to come back again later, he could to a Triumph disc postero-laterally.

The retrolysthesis at L2-L3 may actually improve after a 3 level lumbar ADR. No extra pressure on that disc.

If that disc becomes finally symptomatic down the road, I agree on a lateral approach with the triumph disc.



Kind regards,



Nicola




He's obviously a very busy man and was nice enough to get back to me despite being caught up. I appreciate this man's dear heart.

Interesting how his brain works and how it discerns and deciphers. He's able to switch gears on his thoughts quite easily, which is good and bad, but probably more good than not.

I like that he's not so opinionated that he can't change his mind. Most doctors I know are not like that. On consult, he's always open for new ideas and discussion.

[drewrad]

From Dr. Bergnatoli's screener, Andrea, after viewing my images.



Dear Mr. Radakovitz,

Permit to introduce myself: I am Dr. Andrea Fenk-Mayer, spinal surgeon and consultant with Prof. Dr. Bertagnoli.


I am responsible for preparing your medical evaluation as an international patient with him.

And due to your kind cooperation and Mr. Vicknair`s comprehensive profiling Prof. Dr. Bertagnoli could already view your medical data. I am here to pass on his surgical recommendation.

Your imaging shows moderate degeneration more or less in your whole lumbar spine to the same extent. Positively without major secondary deformity. There is no signs of rheumatoid/systemic inflammatory disease out there (still I may ask you whether CRP and HLA B27 have ever been tested due to your history and typical age group).

Surgery is of course possible, but would have to include l2-s1. Either you go for a (maximum) fusion, which fully eliminates mobile function, and disc and facet triggers. But the dorsal and ventral tissue damage can produce pain by itself, so can muscles and ligaments.


Or you go for an ADR L2-S1. Still major surgery, still certainly not reducing your pain sources to zero (a spine is more than discs).


The expectation can be pain reduction and less restrictions in an uneventful case.

This is important, because your report doesn`t give maximum non-surgical therapy so far. Degeneration is a slow process, so you do have all the time to add these:


e.g. adequate pain meds (daily basis, slow release opioids)
e.g. facet and/or peridural injections with local anesthetic and corticoid. You sure can have this locally.
e.g. light bracing for “bad spells” or major activities.

Multi-level ADR is possible and successful in very experienced hands. The more it is important to keep in mind, that it is not out there to avoid a Naproxen once in a while, if this is all that`s needed. In such a constellation the gain always would be smaller than the risk.


We are aware, that a written history can mis-judge your suffering. So I suggest you comment and//or parallelly have a non-surgical trial see above. Pro-spine`s mission is always to find the optimum treatment for the individual problem of you as our spine patient.

We thank you for your confidence into our work and are looking out for your reply.

Yours respectfully

Dr. Andrea Fenk-Mayer
Fachärztin für Orthopädie und Unfallchirurgie
spinal surgeon
Pro Spine - Dr. Rudolf Bertagnoli

[drewrad]

So now I have so many different recommendations its starting to get a bit confusing.

Dr. Bierstedt, firm with a two level ADR L4-S1 with M6.
Dr. Clavel, more open with a three level ADR L3-S1 with M6.
Dr. Zeegers, firm with a two level hybrid, L5/S1 ALIF, L4/5 Activ L.
Dr. Bergnatoli, do nothing, or do a 4 level ADR L2-S1 with Prodisc.

This is getting to be like a crapshoot.

By the way does anybody know what Bergnatoli means by a CRP or HLA B27 test even are?

[drewrad]

Okay, so I just read up on those two. Got it.

[pittpete]

dre if you want my advice i would say find out which level HNP is causing your sciatica/legpain. Be 99% positive by checking dermatome charts and diagnose yourself. Then go to the most experienced neurosurgeon you can find after researching them all. Get rid of the legpain and then strenghten your core and stretch. Multi-level ADR with or w/out fusion is a massive surgery...Especially if you're going overseas. Many athletes have had successful microdiscectomies and have continued to even play NFL football...I understand the sparetire analogy, but everyone is different...If you work hard to keep fit and avoid heavy lifting i'm sure you might be better off.
Just my 2 cents

[WNB175]

Wow that is confusing. Those are 4 of the world leaders in the field! I wish you could somehow get them together to figure it out......which I know you can't. You sound like you are doing a really thorough and exhaustive research of what to do. Following your story.....Wendy, neighbor in Berkeley

[Stonewall_Boris]

Drew,

Do you assume their is only one correct answer to your back surgery? Do you think investigating everyones MRI will provide you with more insight? Are you a doctor that can access those MRIs that you are requesting from so many?
When we spoke you said that you were looking for a doctor that was an artist. I told you that I considered Dr. B. to be more meticulous than an artist. So now you have four opinions from doctors/artists. Each choosing their own material and technique, choosing to paint the canvess their way. And now your upset they don't agree to paint it the same way with the same material?
The best doctor and procedure is the one that gets you better. I'd take the worst doctor, worst procedure that works for me over the best doctor, best procedure that doesn't work for me. Unfortunately, that's all 20/20 hindsight. The best you can do is put your money on the best bet.
You mentioned that you have the luxury of being able to review the posts of many here before you choose surgery.
Here's a secret, I didn't choose back surgery, it chose me, the only choice I had was with whom.

[drewrad]

Oh, its choosing me more and more everyday. And everyday I am becoming a little less independent as it chips away at my freedom and turns me into a dependent. The pain does not immobilize me, but I don't think it has to in order to base a decision. And I hate VAS score ratings. They are subjective, to each their own. For me, its about what kind of limitations one is willing to subject themselves to in order to cling to a life that is increasingly slipping away before they make any irreversible decisions.

I cannot drive a car anymore. I cannot sit down at all, now for well over a year. I stand kind of sort of but then my feet grow cold after awhile. I can feel the L5/S1 disc in my back, what's left of it, kind of float around like a wet dishrag. I can feel the L4/L5 on the other side make groans at me. How do I know it is these two discs? Because I know. I can feel them. And if anything else gets stripped off of them, well... I doubt I'll be able to do much more at all as they are near bone on bone anyway.

So, its getting close to making up my mind, but that is hard too. For there is the fear of the knife and the fear of failure and also the fear of success and the fear of doing nothing. In the end, it comes down to pain. Bergnatoli says I must go on opioids first. Nah. F that. Steriod shots. Nah. F that.

You see, I can feel the spongey nature of the remaining debris on my bottom two 'discs'. I can feel how wierd they are. Some days the L5/S1 juts out(lower right side) and screams hello. Some days its floating around somewhere else, again, mechanically. Some days the L4/5 is doing screwy crap(lower left).

And I wonder how much strain this does to the entire skeleton over time.

There is an argument to be made that when one has a spine like mine at my age that you want to take care of it in order to spare the other discs above as well so that they don't get taken down like dominoes in the cascade effect of further and further rigidity. I look at pittpete, and despite the darkness, he has great height still. I don't. That will and does affect lateral foraminal space issues as well as facets(grinding) eventually. I know my answer. It is being made. Increasingly, I am merely an observer.