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  #1  
Old 06-11-2015, 11:24 PM
Mrbaozi Mrbaozi is offline
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Default Bit confused (Bierstedt vs Clavel)

In mid May I received a reply from Dr.Bierstedt regarding my scans and this is what he recommended:

Drs Bierstedt and Illerhaus comment after reciewing your data :

Diagnosis

degenerative disc disease L4/5 and L5/S1 – spondylolisthesis (slippage of vertebrae)


Dr. Bierstedt:
ADVISE:

disc replacement L4/5: ROI-S cage and stabilization at L5/S1 (APLIF)

The advised surgery by senior neurosurgeon Drs Thomas Bierstedt or Dr Illerhaus includes

· M6 implant technology

. Nuvasive implant, Globus spine

· fluroscopic guidance for accurate placement of implant

I then contacted Dr.Clavel and received this:

“At L5-S1 only a fusion can be done due to the spondylolisthesis
It cannot be done from the front due to the steep sacral slope.
He then needs a fusión from the back.
What can be done is a lumbar arthroplasty at L4-L5, this one coming from an anterior approach, as we always do”


So, Dr. Bierstedt is saying he would do the fusion from the front (L5-S1), then put the ADR in at L4-L5. Malte called me to answer a few questions and said it would be a fusion from the front, then 2 tiny keyhole sized incisions in the back to put the screws in.

Dr. Clavel is saying due to my sacral slope, a fusion from the front can't be done, so it would be a PLIF and then flip me over and ADR it up from the front...

This is fairly confusing as one is saying it can be done and the other is saying it can't...

From what I've read, isn't the posterior approach bound to increase recovery time, as they'd be hacking through my back muscles to gain access?

Has anyone on here heard of anything like this before?

Thanks!
__________________
2010: Strongman training, felt a pinch.
2010-2012: Living in China at the time, pain worsened.
2012-2013(May): Received acupuncture treatment in Beijing and had 2 pain-free years.
-Very intensive kickboxing training during this time.
2013(May): Pain started coming back while training.
2013-Now: Diagnosed with Spondylolisthesis L5-S1 and ddd at L4-L5. Declined fusion less than 24 hrs pre-op. Began my research on ADR and alternative possibilities to fusion.

Last edited by Mrbaozi; 06-11-2015 at 11:26 PM. Reason: Added stuff
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  #2  
Old 06-12-2015, 12:08 AM
pittpete pittpete is offline
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Quote:
2 tiny keyhole sized incisions in the back to put the screws in
Sounds like a minimally invasive posterior fusion.
Sounds like Biersdedt would remove the disc from the front, place the interbody spacer then flip you and insert pedicle screws and rods...

What are the condition of your facets?
__________________
Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 facets shot/4/15 PLIF L4-S1 with facectomy
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  #3  
Old 06-12-2015, 12:10 AM
bwink23 bwink23 is offline
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Posts: 262
Default

Quote:
Originally Posted by Mrbaozi View Post
In mid May I received a reply from Dr.Bierstedt regarding my scans and this is what he recommended:

Drs Bierstedt and Illerhaus comment after reciewing your data :

Diagnosis

degenerative disc disease L4/5 and L5/S1 – spondylolisthesis (slippage of vertebrae)


Dr. Bierstedt:
ADVISE:

disc replacement L4/5: ROI-S cage and stabilization at L5/S1 (APLIF)

The advised surgery by senior neurosurgeon Drs Thomas Bierstedt or Dr Illerhaus includes

· M6 implant technology

. Nuvasive implant, Globus spine

· fluroscopic guidance for accurate placement of implant

I then contacted Dr.Clavel and received this:

“At L5-S1 only a fusion can be done due to the spondylolisthesis
It cannot be done from the front due to the steep sacral slope.
He then needs a fusión from the back.
What can be done is a lumbar arthroplasty at L4-L5, this one coming from an anterior approach, as we always do”


So, Dr. Bierstedt is saying he would do the fusion from the front (L5-S1), then put the ADR in at L4-L5. Malte called me to answer a few questions and said it would be a fusion from the front, then 2 tiny keyhole sized incisions in the back to put the screws in.

Dr. Clavel is saying due to my sacral slope, a fusion from the front can't be done, so it would be a PLIF and then flip me over and ADR it up from the front...

This is fairly confusing as one is saying it can be done and the other is saying it can't...

From what I've read, isn't the posterior approach bound to increase recovery time, as they'd be hacking through my back muscles to gain access?

Has anyone on here heard of anything like this before?

Thanks!

Do you know the grade level, 1 thru 4, of your spondylolithesis? What caused it, do you know? Any fractures in your spine? I too have a small Spondy, grade 1 at 2mm. I have a pars defect on my left side, L5 vertebra. Depending on how bad your slip is, its not uncommoon at all to do a 360 fusion. The posterior approach is an attempt to bring the vertebra into a more correct alignment. You have to do that to be able to correct the slip as much as it can be done. An anterior approach will not correct slip. I had an anterior fusion done without posterior instrumentation by Dr. Clavel, i presume cuz my slip is minor as far as spondy goes. He wasn't concerned with correcting my slip, more with stopping movement of the vertebra.
__________________
2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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  #4  
Old 06-12-2015, 12:18 AM
bwink23 bwink23 is offline
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I googled "RIO-S" and came up nothing, what is that? Is that an anterior cage? Are you sure Dr. Bierstedt is saying he wants to do an anterior fusion here? He may be saying a posterior fusion with cages.
__________________
2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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  #5  
Old 06-12-2015, 12:49 AM
pittpete pittpete is offline
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Posts: 307
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https://www.google.com/search?q=roi-...FUwyrAodLUMA7w
__________________
Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 facets shot/4/15 PLIF L4-S1 with facectomy
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  #6  
Old 06-12-2015, 02:44 AM
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scoop302 scoop302 is offline
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Posts: 193
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I have a question. Who is doing the surgery in Germany, Bierstedt or Illerhaus? My understanding is Illerhaus is better at damage and complications, and Bierstedt does straight forward ADR. That being said, my experience with them is not the best, and after a month of emails back and forth with Ken and Malte, this was my understanding. With Clavel, Yolanda set me his report, followed up with a request for a phone call/ Skype call with the doc. On this Skype call, he explained exactly what he had to do and why he needed to do it. Before you go any further, I would speak with the doctors directly and end the confusion, this is not where you want to be.
__________________
1979 car accident: rear ended
1980 ACDF C4-5
4/8/11 stopped, hit again
3 epidurals, PT, 2 MRI's,etc.
scheduled 3 times for C5-6, 6-7 fusion,
plus laminectomy at C3-4, and C 7, advised to do Bilateral lamino-foraminotomy C5-6, C6-7,a Percutaneous Discectomy L4 -L5
7/14 RFA on L3 to L5 (awake, local only)
C5-6,6-7 M-6 ADR with Dr. Clavel 9/17/14,
12/7/15 RFA L2-S1, Facet injections C2-7
6/3/16 RFA L2-S1, epidural L4,5, 8/26/16 RFA C1-7
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  #7  
Old 06-12-2015, 04:00 AM
Mrbaozi Mrbaozi is offline
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Join Date: Jun 2015
Posts: 5
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To answer some of the posts:

The doctor here said it was grade 1, but Malte told me it was grade 2 or possibly even 3, didn't look that crazy in the MRI, but I'm not the doctor.

Facets, I'm not sure how they are, perhaps it's something I should look into?

My doctor here said the CT scan showed a pars fracture, so that's what caused the slippage I'm assuming? Or perhaps it was fractured when I was younger and that heavy lift caused the vertebra to slide forward more and smush the disc?

My experience has actually been completely opposite, I had prompt responses from Bierstedt and it's been much slower going with Clavel (assuming he's pretty busy though).

As far as how much mine has slipped, I think I remember my doctor here saying at least 8mm and I'd gain a good half inch or more of height once my back was re-aligned.

I asked Malte about the procedure and he said the fusion would be done from the front, then the adr, and the keyhole incisions would be done from the back to finish things off.

Thanks a bunch for the input!
__________________
2010: Strongman training, felt a pinch.
2010-2012: Living in China at the time, pain worsened.
2012-2013(May): Received acupuncture treatment in Beijing and had 2 pain-free years.
-Very intensive kickboxing training during this time.
2013(May): Pain started coming back while training.
2013-Now: Diagnosed with Spondylolisthesis L5-S1 and ddd at L4-L5. Declined fusion less than 24 hrs pre-op. Began my research on ADR and alternative possibilities to fusion.
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  #8  
Old 06-12-2015, 08:04 AM
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jss jss is offline
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Posts: 1,411
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baozi,

It has got to be terribly confusing when you get different signals from different doctors. Each prefers a different method to the same end; fusion at L5/S1. In that sense, they are giving you the same prescription; ADR at L4/5 and fusion at L5/S1. Many sufferers that come to this site get opinions that are all over the map.

I don't know which approach to the fusion is best for your particular case; anterior or posterior. Good luck!
__________________
C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #9  
Old 06-12-2015, 01:21 PM
FranklySir FranklySir is offline
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Join Date: Jun 2013
Posts: 177
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baozi,

Haven't posted in a long while but had to when I saw this.

Take a logical approach here. How can an implant be properly placed in an improper alignment. The foundation needs to be corrected first then the ADR placed. I would seriously be concerned of pulling the vertebral body in alignment from the rear with screws after the implant is in place IMVHO. To me this could have a very high risk of implant migration down the road when you start to think of it. Both plans are very similar but the order of things are important.

At least ask the questions.

F
__________________
Lumbar issues 18 yrs
herniations lumbar L3-5 multiple Epis etc etc
Annular tears L3-5 cauda equina
Cervical herniation symptoms 2011
C5-7 M6C by Dr Clavel on June 5 2013
L3-5 M6L by Dr. Clavel on 12.18.13
Living life instead of living the condition
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  #10  
Old 06-12-2015, 06:22 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 836
Default i must agree

Quote:
Originally Posted by jss View Post
baozi,

It has got to be terribly confusing when you get different signals from different doctors. Each prefers a different method to the same end; fusion at L5/S1. In that sense, they are giving you the same prescription; ADR at L4/5 and fusion at L5/S1. Many sufferers that come to this site get opinions that are all over the map.

I don't know which approach to the fusion is best for your particular case; anterior or posterior. Good luck!
Same end result really; just differing oproach.
__________________
53 yr old female 5'7" 141 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
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