Mr. David Harrison and the M6-L

[afhstock]

This is basically a copy of my first post and intro here to adrsupport. I'm gonna try and keep a running thread of my progress for those folks interested. Excuse me as I am knew to posting but not to the wonderful forum (thanks Harrison).


Hello everyone,
I have been quietly scouring this site for about a year but only wanted to post when I was about to proceed with surgery. I am planning an L5-S1 M6-L ADR with Mr. David Harrison (spine surgeon) in the UK at BMI-Princess Margaret Hospital. He's hardly mentioned here but he's had decades of experience with the older type discs and has done approx 70+ M6's both cervical and lumbar. He has also performed an M6-L on Retief Goosen (Interview Link is below) who's a pro golfer at the L3-4 level. He returned to pro golf tours at 5 months amazingly. Of course that level is not as stressed as the lowers.
I was also considering Dr. Clavel or Mr. Dare who are also fine surgeons. After doing research, I personally can't see why you would choose outside of those docs if planning on going overseas. Cost is about the same, slightly higher in the U.K. If you'd like to know details just email me at afhstock@hotmail.com

I'm planning for surgery on April 16 2013. He's busy but not so busy as to feel overlooked. Of course only post-op will I give you a real outlook ...but his PA has been wonderful.

Must read. pro-golfer M6-L ADR by Mr. David Harrison (U.K.):
ASAP Sports Transcripts - Golf - 2013 - AT&T PEBBLE BEACH NATIONAL PRO-AM - February 6 - Retief Goosen

Praying for a pain-free life for everyone.

[krossi201]

Hi,
I have been considering two level cervical (C4/5 and C5/6)ADR as i am starting to lose strength and dexterity. It seems like I have been down the same road as you. I have seen several US docs who dont want to talk about ADR. I have scheduled an appointment with Dr Laurrysen next month to consider m6. I have seen many posts about Dr Clavel and a few about Dr. Harrison and Dr. Dare as well that are very positive. I have been in email contact with one of Dr. Clavels patients who speaks very highly of her experience and results. I then saw the report about Retief Goosen. I also saw an excellent US doc at Virginia spine institute in Reston Virginia who suggested a hybrid fusion with Bryan disc at one level and fusion at the other. He felt there was a chance insurance would pay for this hybrid fusion. He also had an excellent PA and seemed to have a more open mind than most other US docs I consulted with. I have not spoken with any of the European docs you mentioned but was very pressed by positive comments about Dr Clavel! Could you please advise me about your experiences with Dr Laurrysen and other European Docs? I have also been looking at axiomed freedom disc. They recently wrapped up lumbar trials in US and Europe

[Lillyth]

I have not heard of a single insurance company that would pay for a hybrid. You should ask if they have been successful at that before with your particular insurance company.

[Lillyth]

Originally Posted by afhstock

This is basically a copy of my first post and intro here to adrsupport. I'm gonna try and keep a running thread of my progress for those folks interested. Excuse me as I am knew to posting but not to the wonderful forum (thanks Harrison).


Hello everyone,
I have been quietly scouring this site for about a year but only wanted to post when I was about to proceed with surgery. I am planning an L5-S1 M6-L ADR with Mr. David Harrison (spine surgeon) in the UK at BMI-Princess Margaret Hospital. He's hardly mentioned here but he's had decades of experience with the older type discs and has done approx 70+ M6's both cervical and lumbar. He has also performed an M6-L on Retief Goosen (Interview Link is below) who's a pro golfer at the L3-4 level. He returned to pro golf tours at 5 months amazingly. Of course that level is not as stressed as the lowers.
I was also considering Dr. Clavel or Mr. Dare who are also fine surgeons. After doing research, I personally can't see why you would choose outside of those docs if planning on going overseas. Cost is about the same, slightly higher in the U.K. If you'd like to know details just email me at afhstock@hotmail.com

I'm planning for surgery on April 16 2013. He's busy but not so busy as to feel overlooked. Of course only post-op will I give you a real outlook ...but his PA has been wonderful.

Must read. pro-golfer M6-L ADR by Mr. David Harrison (U.K.):
ASAP Sports Transcripts - Golf - 2013 - AT&T PEBBLE BEACH NATIONAL PRO-AM - February 6 - Retief Goosen

Praying for a pain-free life for everyone.

What great news. On both fronts. I now have one more professional athlete to refer to as going back to their sport. Good luck on your upcoming surgery!

[Slackwater]

Originally Posted by Lillyth

I have not heard of a single insurance company that would pay for a hybrid. You should ask if they have been successful at that before with your particular insurance company.

Insurance is a valid point. Cigna as an example has a coverage statement / policy that includes single-level lumbar ADR/TDR, but not a "hybrid" (adr+Fusion). Cigna might cover two (2) level fusion w/supporting paperwork. Hybrid in this instance is defined as:
L5-S1 = Fusion
L4-L5 = ADR/TDR

Success is based on patient outcomes and some biomechanical studies. ADR/TDR placement will affect the surgical success and clinical outcomes.

Fusion at the bottom-level of a lumbar operation as above avoids the wedge effect at the bottom level of the spine. The biomechanics articles describe it as compressive shear at L5/S1 because of the natural/normal angle of the vertebrae. The powerpoint from Dr.LeHuec/France on hybrid lumbar surgery was on the hard disk, but I can't find it now. Dr.LeHuec was president of the ISASS.



adrsupport Hybrid Lumbar Patients:
HGrantnz http://www.adrsupport.org/forums/f47...grantnz-11134/
M1013828 http://www.adrsupport.org/forums/f47...age-bmp-11716/
JStuckey Healthy Back 2011
valandguin L4-L5 ProDisc L5-S1 ALIF (anterior fusion)


Kinematics of a selectively constrained radiolucent anterior lumbar disc: comparisons to hybrid and circumferential fusion.
Clin Biomech (Bristol, Avon). 2012 Oct;27(8):759-65. doi: 10.1016/j.clinbiomech.2012.05.010. Epub 2012 Jun 27.
Daftari TK, Chinthakunta SR, Ingalhalikar A, Gudipally M, Hussain M, Khalil S.
Resurgens Orthopaedics Spine Center, 270 Chastain Rd, Kennesaw, GA
Kinematics of a selectively con... [Clin Biomech (Bristol, Avon). 2012] - PubMed - NCBI

Hybrid construct for two levels disc disease in lumbar spine
European Spine Journal February 2010, Volume 19, Issue 2, pp 290-296
Stephane Aunoble, Robert Meyrat, Yasser Al Sawad, C. Tournier, Philip Leijssen, Jean-Charles Le Huec
Hybrid construct for two levels disc disease in lumbar spine - Springer

PubMed: Hybrid disc replacement
Hybrid disc replacement - PubMed - NCBI

2012 BritSpine
P235 COMPLICATION RATES IN THE ANTERIOR LUMBAR RETROPERITONEAL APPROACH: A SINGLE SURGEON SERIES IN A TERTIARY REFERRAL CENTRE
http://www.adrsupport.org/forums/f50...-2012-a-11654/

2011 UCSF CME {Continuing Medical Education, cervical}
http://www.adrsupport.org/forums/f50...-2011-a-11648/

2012 ISSLS Annual Meeting
P309 Hybrid: TDR + Fusion (ALIF) 385 Patients, Combined Arthroplasty and Anterior Lumbar Interbody Fusion (Hybrid Procedure) in 385 Patients with a Minimum of 2 Years Follow-up
http://www.adrsupport.org/forums/f50...-2012-a-11608/
MAVERICK™ (17.9%) (A-Mav: Medtronic) and
In Motion Lumbar Artificial Disc™ (40.8%) (Depuy Spine), and
CHARITÉ® (Depuy Spine) (41.3%).

2010 ISSLS Annual Meeting
GP176. HYBRID COMBINED TOTAL DISC REPLACEMENT AND FUSION PROCEDURES IN THE LUMBAR SPINE: CLINICAL AND RADIOGRAPHIC OUTCOME
Retrospective
http://www.adrsupport.org/forums/f50...stracts-10667/

2009 NASS North American Spine Society, Annual Meeting,
Poster #158. The Hybrid ADR: Long-Term Analysis of Sagittal Motion and Clinical Outcome after Concurrent ADR + ALIF (Minimum 2-Year Follow-Up)
Alexandre Rasouli, MD 1, Rick B Delamarter, MD 2, L.E.A. Kanim, MA2, Nomaan Ashraf, MD 2, Brandon Strenge, Sr., MD 2;
1 University of California, Irvine, Newport Coast, CA, USA;
2 The Spine Institute at Santa Monica, Santa Monica, CA, USA

Biomechanical comparison of two-level Maverick disc replacement and a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion,
The Spine Journal 2009
http://www.adrsupport.org/forums/f50...-2009-a-10162/

2009 Spine Arthroplasty Society
http://www.adrsupport.org/forums/f51...-program-9928/
Abstract: 536 Hybrid Surgery: Fuson and Disc Arthroplasty Is Superior to Two Disc Arthroplasties in the Lumbar Spine
J.C. Le Huec1, S. Aunoble2, P. Leijsen2

EuroSpine 2008
SP 3 Hybrid construct: fusion L5S1 and disc arthroplasty L4L5 for DDD.
3 years follow up
• JC Le Huec MD PhD, S Aunoble MD, R Meyrat MD, C Tournier MD,
http://www.adrsupport.org/forums/att...4-l5-3-yrs-pdf

2008 German Spine Congress
P 50 Clinical outcome in primary bilevel cervical intervention with disc replacement, hybrid supply or fusion
M.G. Detzner1, F. Weber1
1 Städtisches Krankenhaus Köln-Merheim, Klinik für Neurochirurgie, Köln
Objective: Safety, clinical outcome and complications of 105 bilevel cervical interventions with disc replacement, hybrid supply or cage interposition for fusion are compared.
Methods: The patients data were obtained retrospectively from 882 patients operated for cervical disc herniation or combined cervical stenosis between 2004 and 2007 at the department for neurosurgery in Cologne-Merheim. Primary interventions in two cervical levels were necessary in 105 Patients. Clinical follow up occurred on an average of 7,6 months.

AANS / CNS 2008 Annual Meeting (Link)
AANS = American Association of Neurosurgeons
CNS_ = Congress of Neurosurgeons
Abstract: 321
Outcomes Analysis of Hybrid Disc Arthroplasty (Lumbar 32 patients)
Pablo R. Pazmino, Rohit Verma, Todd Hopkins Lanman, John J. Regan
http://www.adrsupport.org/forums/f50...g-2008-a-7279/
http://www.adrsupport.org/forums/f50...1-2008-a-4757/

2007 AANS / CNS
http://www.adrsupport.org/forums/f50...s-2007-a-6744/

Hybrid Constructs
2005 Orthopaedic Clinics N.America
Rudolf Bertagnoli, MDa,*, Patrick Tropiano, MD, PhDb, Jack Zigler, MDc, Armin Karg, MScd, Sandra Voigt, MScd

Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: a finite element analysis.
Eur Spine J. 2012 Jun;21 Suppl 5:S663-74. doi: 10.1007/s00586-010-1382-1. Epub 2010 Apr 2.
Schmidt H, Galbusera F, Rohlmann A, Zander T, Wilke HJ.
Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany
Effect of multilevel lumbar disc arthroplasty on... [Eur Spine J. 2012] - PubMed - NCBI

We hypothesise that:
(1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension;
(2) deviations from the optimal implant position lead to strong instabilities.

Charite' - specific testing
The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition. Deviations from the optimal implant position lead to unfavourable kinematics, to high facet joint forces and even to lift-off phenomena.

[afhstock]

Hi Krossi201. Yes, I agree that losing strength in your arms is an indication for neck surgery (only my opinion, not medical advice). I have only been web post browsing for almost a year before I contacted Mr. Harrison after long rational thought. Like I said, you can't go wrong with any of those 3 but I like Mr. Harrison since he has about 2.5 decades of implanting all types of discs including the lates M6-L which is less surgeon-dependant on errors. And yes, operating on a pro-athlete only confirmed my decision. When there is unlimited resources and Mr. Harrison is picked, someone getting paid a lot did their homework.
As for other personal reasons for picking Mr. Harrison...I like that he noted he hasn't had a case of retrograde ejaclation complication (can happen to any male in the lumbar, a 2-5% risk), he uses a barrier between the disc and the great vessels and he doesn't use a vascular surgeon- takes his approach all the way down to the spine himself since he is educated in both vascular and orthopedic spine.
Dr. Clavel would be my second choice since he seems to have done the most M6-L's with success after the late Mr. Boree (who was my original hope-God bless his soul). Mr. Dare I don't know too much about but sounds very promising.

Good luck and oh..btw Dr. Lauryssen is the best neurosurgeon in L.A. IMHO. He did do the first U.S. M6-L in a trial and plans on doing more in Dubai but since I was on a running list and didn't know when his first batch would be sent there I had to look elsewhere for now. He will be on the hot list once he starts internationally. Very caring and wants what's best for YOU (rare these days).

As for the discs, don't know too much about the Bryan disc. Freedom disc sounds like they use the latest polyurethane core too but not sure since they only say 'proprietary polymer' on their site--fishy. M6-L doesn't hide anything...a polyurethane core and UHMPE outer 'annular' fibers. BTW polyurethane is used in 30 yr hips now and is the latest in mimicking cartilage.

Good luck!

[afhstock]

Lillyth,
You are a brave woman.. wishing you the best on your 3 level M6-C and 3 level M6-L ADR's. Please keep us posted!
oh wait....you just had it YESTERDAY!! wow.

Speedy recovery

[krossi201]

Hi afhstock, thank you for your answers. It sounds like we did a lot of same research. I am assuming you met with Dr Lauryssen in person. I was considering phone consult but I think in person would be better. Did you tell him you were considering these other surgeons( Dr Clavel and Dr Harrisson). If so was he willing to give you advice without being offended? ( as many others surgeons I have met do).
I believe the polymer is mixture of silicone and polyurethane and possibly one othe ingredient for freedom disc. I had the papers but they are not in front of me now. My concern for freedom disc is the bonding between the titanium and the polymer. If it should fail it seems like could be catastrophic. Also I almost wonder if the wedge design helps or hurts? Would it be more physiologic or would it create more facet problems? There are less pt reports since it is newer.
I have spoken via email to Dr Burkhard Rishcke in Zurich Switzerland and he is doing first cervical cases with freedom trial in Europe. He has used M6 as well and says he prefers the Freedom. But I know that is just one mans opinion.
The M6 seems to have best track record but there is small concern of wear debris from the polyethylene annulus fibers rubbing together and they could be released if the outer sheath were to break.
All in all both look like good products and right now I am leaning toward the m6 due to more experience with it both pts and surgeons.
Two level cervical for Freedom with Dr Rishcke is between 30,000 and 40,000 as preliminary quote. Did you get any figures from Harrison versus Laurryssen versus Clavel? Thanks

[afhstock]

Hello there again Krossi201, yes I certainly did meet Dr. Carl Lauryssen in person and he interviewed me in full and did a quite thorough physical examination. He is not absolutely offended at all with seeing other surgeons outside the US. I don't want to make a private conversation public but he did say that he is not a litigious person however he feels people should have the best disc possible and if he were to have an Opportunity to take U.S. insurance companies to court because of all the ADR fuss and non-repayment he would! I said sign me up and put me on the list LOL.
He knew time was of the essence in relationship to my ADR/pain and stated he would have me on a running list to be the first batch of disc replacements in Dubai sometime in July or later. After I contacted his team they were not sure when exactly everything will be finalized so I told them I would go with an international Doctor. Even at that point he was helping me by getting the necessary CT scans and imaging to have it done overseas.. so he is totally on your side. Anyone would be lucky to have surgery by him.
I agree that the freedom disc has a mix of polymers in there and possibly silicone. Yes I agree with you that the junction of titanium and polymers is not supported by anything else. I will take my chances with the small residual debris release hoping the M6 L-sheath will hold it in place. There is a link with all the testing of M6L on another post.. if you have not seen it let me know and I will send it to you. There is a video on YouTube of the freedom disc, Just type in the name and you will see them testing it at the extreme angles.

The cost in total for my surgery and discogram (under sedation) not including flight and hotel will run approximately USD $37,000 at the time due to the conversion of the pound and dollar. That is for 1 level lumbar.

Apologize for the spelling errors, I am using Siri on my iPad
Thank you for your posts. They do really help. I'm grateful to this forum Altogether!

[krossi201]

Thank you for your responses, they are very helpful and insightful. I am looking forward to meeting Dr. Lauryssen next month. I am also going to see Dr. Coric in Charlotte next month as he has worked on trials of both M6 and Freedom discs. I too felt the same that if Mr. Goosen picked Dr. Harrison he must be great. If I were lumbar I would probably go with Dr. Harrison also. An added bonus is there would be no language barrier! Does Dr. Harrison do neurological monitoring during the procedure? Do u know if Dr. Clavel does? Keep me posted on your spine journey. I wish you well.