New Member introduction - Robustness of M6C ?

[bwink23]

From a well respected surgeon's opinion who doesn't have a specific tie to the Activ-L like Zeegers does.....Dr. Clavel stated to me himself he has done a few Activ-L discs for specific cases and confirms it to be a quality lumbar disc. He wasn't going to pick sides even as the majority of his experience lies in the M6. He even admitted the M6 wasn't perfect, since it hasn't yielded a perfect outcome in 100% of his patients. His experience lies in the M6, but would go with Activ-l if he felt the M6 wasn't suitable. A little off topic, but in regards to placing an artificial disc specifically at the L5-S1 level, Clavel mentioned there will a reevaluation as to whether implanting an ADR there is suitable at all, due the slope of the spine at that level and the sheer forces it takes. I know Activ-L boasts a design that addresses the S1 level specifically, but it seems that segment may be heading down the road to contraindication for an ADR. Food for thought. Until then, it's still up to the surgeon to decide. If your issue is with this S1 segment, it may be of greater benefit to go with the Activ-L. For patients seeking Clavel, it would be wise to mention this to him. Clavel has experience with it and would probably use it if you preferred, but Zeegers would be a better choice for this disc, his history with it is vast. It's amazing how much you need to be informed and be your own advocate when it comes to spinal care.

[bwink23]

Harrison,

I'm not gonna pretend to be an expert on the Activ-L, but isn't the "myriad of configurations available" for the Activ-L kind of tit-for-tat with the M6's greater number of parts? In contrast, the Activ-L doesn't match up to the M6's ability to mimic what it's replacing, it appears to me that variety of dimensions only improves the surgeons ability to find that holy grail of "center of rotation". The extra configurations available only prove useful in highly experienced hands would they not ? At the end of the day, it's still ball and socket. As far as limiting HO, the occurrence of that in lumbar spine from what I have read is very rare, never to the extent of mechanical failure. I do fully understand the reasoning behind "Less is more", but if that were the case, then the first generation devices would have been all one ever needed for high rates of successful outcomes. A guy like Zeegers would have no problem finding a customizing a disc or placing it. I just wonder level of expertise the surgeon must attain to get significant improvement with all those configs available in the Activ-L...Law of Diminishing Returns. I do believe though it's a better alternative to the Prodisc-L, and nice to see it's in clinical trials in the U.S. but finding a quality, experienced surgeon in the U.S. to use it would still prove difficult. Would be nice not to have to jump ship overseas to better ensure quality work is done.

[drewrad]

Originally Posted by bwink23

From a well respected surgeon's opinion who doesn't have a specific tie to the Activ-L like Zeegers does.....Dr. Clavel stated to me himself he has done a few Activ-L discs for specific cases and confirms it to be a quality lumbar disc. He wasn't going to pick sides even as the majority of his experience lies in the M6. He even admitted the M6 wasn't perfect, since it hasn't yielded a perfect outcome in 100% of his patients. His experience lies in the M6, but would go with Activ-l if he felt the M6 wasn't suitable. A little off topic, but in regards to placing an artificial disc specifically at the L5-S1 level, Clavel mentioned there will a reevaluation as to whether implanting an ADR there is suitable at all, due the slope of the spine at that level and the sheer forces it takes. I know Activ-L boasts a design that addresses the S1 level specifically, but it seems that segment may be heading down the road to contraindication for an ADR. Food for thought. Until then, it's still up to the surgeon to decide. If your issue is with this S1 segment, it may be of greater benefit to go with the Activ-L. For patients seeking Clavel, it would be wise to mention this to him. Clavel has experience with it and would probably use it if you preferred, but Zeegers would be a better choice for this disc, his history with it is vast. It's amazing how much you need to be informed and be your own advocate when it comes to spinal care.

I think you've tapped into my own thinking here. Zeegers asked me what I thought the best course of action for my back should be. Interesting, a doctor treating you like a colleague is new for me. I'm not a doctor, but he's treating me like one. I like that. Anyway, I told him I thought 'a hybrid solution might be the best bet.' He wanted to know what I meant by that. I told him that I felt a movable device in the sloped L5/S1 puts it at risk for long term mechanical failure. Not a certainty of course, but 'more at risk'. Then, I told him I wanted ADRs stacked up over a fused L5/S1 since they would lay flatter without an angle.

We'll see. I'm still in the early innings here and I have to get his final thoughts as well as half a dozen other opinions cobbled together. I think the best course of action will be to take all the opinions and find the exact center of all of them. Wisdom in crowds thesis there.

[pittpete]

One thing with the Activ L implant is the ability to place it on an angular approach. I'm assuming implantation of the disc this way can prevent the vein from scarring/adhering from the direct frontal approach?
I've been researching all discs and surgeons.
Clavel has mentioned the ALIF L5-S1 fusion for the steep sacral slope to me personally.
I mentioned this to Dr. Zeegers as well and said it is something to definitely be concerned about. I also asked about his preference of discs and he told me he does use both the Activ L and the M6 but it depends on the person and his personal diagnosis. He did say that the M6 has many moving parts and he has NO financial interest in any ADR's.
Now this is just my opinion, but wouldn't any person with DDD(like myself), benefit more from having a fusion at L4-L5 and and L5-S1 and ADR at L3-L4?
Motion is preserved at the higher level, no segmental disease from fusion areas, no chance of increasing facet joint hypertrophy at the lowest level and no chance of revision surgery for ADR failure/wear at the greatest weight bearing levels.
I'd like your opinions.

[bwink23]

Originally Posted by drewrad

I think you've tapped into my own thinking here. Zeegers asked me what I thought the best course of action for my back should be. Interesting, a doctor treating you like a colleague is new for me. I'm not a doctor, but he's treating me like one. I like that. Anyway, I told him I thought 'a hybrid solution might be the best bet.' He wanted to know what I meant by that. I told him that I felt a movable device in the sloped L5/S1 puts it at risk for long term mechanical failure. Not a certainty of course, but 'more at risk'. Then, I told him I wanted ADRs stacked up over a fused L5/S1 since they would lay flatter without an angle.

We'll see. I'm still in the early innings here and I have to get his final thoughts as well as half a dozen other opinions cobbled together. I think the best course of action will be to take all the opinions and find the exact center of all of them. Wisdom in crowds thesis there.

Drewrad ,what has been your recommendations thus far? Do they feel L2/L3 needs addressed? If it's not showing DDD or stenosis, they may not touch it without a discogram...bulges don't indicate pain generators generally unless they are encroaching on nerve roots. They do have to justify medically necessary procedures for insurance reimbursement purposes. What have you got thus far?

[bwink23]

Originally Posted by pittpete

One thing with the Activ L implant is the ability to place it on an angular approach. I'm assuming implantation of the disc this way can prevent the vein from scarring/adhering from the direct frontal approach?
I've been researching all discs and surgeons.
Clavel has mentioned the ALIF L5-S1 fusion for the steep sacral slope to me personally.
I mentioned this to Dr. Zeegers as well and said it is something to definitely be concerned about. I also asked about his preference of discs and he told me he does use both the Activ L and the M6 but it depends on the person and his personal diagnosis. He did say that the M6 has many moving parts and he has NO financial interest in any ADR's.
Now this is just my opinion, but wouldn't any person with DDD(like myself), benefit more from having a fusion at L4-L5 and and L5-S1 and ADR at L3-L4?
Motion is preserved at the higher level, no segmental disease from fusion areas, no chance of increasing facet joint hypertrophy at the lowest level and no chance of revision surgery for ADR failure/wear at the greatest weight bearing levels.
I'd like your opinions.

Pete, the fact that Zeegers has also used the M6-L in patients which you stated shows that even with the so-called "many moving parts", he still has enough confidence in the longevity and durability of the disc. Otherwise he wouldn't use them at all, I WOULD HOPE. Bierstadt of Germany, another highly respected surgeon, almost exclusively uses the M6. The biggest concern with the M6 is the life of the compressible material and the strength of the chemical bonds that hold the woven annulus in place. I by no means am an engineer, but to me it appears the only significant fundamental difference between M6 and other ball and sockets such as the Activ-L is that woven annulus and the sheath that trap wear particles. That sheath has no mechanical value so the chances of that failing due to stress is extremely small. Let's say after several years(hopefully DECADES), for some stupid reason that bond to the woven annulus fails, what do you have left?? Essentially a ball and socket disc right? So now the annulus has failed, and you no longer have the restrictive motion properties that mimic that of a natural disc. So now you have a Prodisc in your back lol. Can or will that annulus interfere with the motion of the nucleus? Possibly, but since most discs don't even have a compressive nature, many designers felt it not terribly important. WHY? Maybe the compression is minimal at best after disc height is established and the disc is crunched by your back muscles and ligaments. In my eyes, the forces in your spine would keep that failed annulus in place, but wouldn't move in the on the nucleus and impede it's work. This many moving parts thing is really just the annulus isn't it? I'd have to look further into it, but it's realy a moot point for me right now since i already have one M6 in my spine and 2 in my neck.

In regards to having a 2 level fusion below a single ADR, i would avoid that completely, because YOU CAN. If your not an active person and don't mind having some a bit of disability when bending over, go ahead.....i saw a fuse-only doctor and even he was hesitant on wanting to fuse my bottom 2 levels. I saw a fuse/ADR doc for cervical and wanting to fuse one level and ADR the other simply because he could get insurance to pay for it. I asked him if he would do 2 level ADR if he wasn't restricted by that, and he said YES. Aside from the controversial L5/S1 level, i wouldn't get a fusion EVER if an ADR was acceptable...it's possible to convert a failed ADR to a fusion, but a fusion is there for life, the absolute last ditch effort. Docs can do things in addition to a fusion, but 95% of the time, fusions are the solution to failed back discs that contradict an ADR. Hopefully in years to come, even ADR's will go back the wayside and be replaced with another more suitable technology...3-D printing of spinal discs seems very promising but is a long ways off.


If i was you, i would consider a fusion at L5/S1 if your sacral region is in good shape (or grill the doc about an Activ-L, and 2-level ADR at the others...L4/L5 is the most active segment in the low back, you fuse that, your just gonna make the L3/L4 work that much harder as well, because now it's taking the job of both the bottom segments. With 2 ADRS, at least you can distribute those forces across them. Remember your spine is one continuous machine, you have to consider the consequences of what you choose, WILL have an indirect impact on surrounding structures. Luckily i don't have to make that decision, i was a contraindication at L5/S1 to begin with due to a pars fracture at that level, so i'm fused there. M6 at L4/L5. M6 claims there devices hold up under normal conditions for 80 years without failure...Their defination of that is up for debate. But even you cut that down to 40 years if your active....i'm 37 and have no one in my family that makes it that long. RISK vs. REWARD. Like anything in life, it's all about your risk level tolerance. You have to be pretty ballsy to accept an ADR in your spine to begin with. The well-documented long term consequences to your remaining healthy discs after fusion was more than i needed to know to take the dive.

[drewrad]

Originally Posted by bwink23

Drewrad ,what has been your recommendations thus far? Do they feel L2/L3 needs addressed? If it's not showing DDD or stenosis, they may not touch it without a discogram...bulges don't indicate pain generators generally unless they are encroaching on nerve roots. They do have to justify medically necessary procedures for insurance reimbursement purposes. What have you got thus far?

Kaiser's a joke, so we'll by-pass them for now.

Here's the latest from Zeegers re my spine:

"You contacted me after you found me at the adrsupport forum.

You told me in your first email that you were a weightlifter since the age of 12 yrs old.

During the day, you back pain changes in degree and since 1 year sitting is nearly impossible.

You feel burning sensations in your right buttock and right upper hamstring, with numbness.

These symptoms restrict you in driving a car.

Also your feet can get numb and sometimes you have a sharp, stabbing pain in your right calf.

Your lower back feels strange when lying down, in bed or on the floor.

You are desperate and want your normal spine life back.


Your history is extraordinary and it is absolutely necessary to have a perfect unbiased diagnosis on your symptoms based on combination of your message, the questionnaires and real images.

You have already sent me an MRI L-Spine, in contradiction to my protocol, I already looked at some pictures.

The CD contains X-rays and an MRI, dated February 7th 2014, but the quality of the X-rays is poor, too much light.

You are right, it seems a very multisegmental, from L2 to S1, with bone spurs on L3/L4 and retroposition L2 over L3 and disc height loss of L4/L5 and L5/S1.

There seems to be an instability on L2/L3, which is likely to be one of the causes of your pain, so your own vision was likely to be true.

On the MRI, the films are concordant with the X-ray, multisegmental from L2 to S1.

The disc L4/L5 is most damaged, the disc of L2/L3 is bulging into the spinal canal and maybe entrapping the foramen L3/L4.

The facet joints at L2/L3 are grade III/IV, causing foraminal stenosis.

The facets of L3/L4, L4/L5 and L5/S1 are looking quite normal."

I'd love to get some help on my situation. Anyone who wants to offer advice, I'm all ears.

[pittpete]

Thanks Bwink, i agree with a lot of what you said.
I apologize for hijacking this thread

[bwink23]

Pete, there is no such thing around here. All questions are good ones no matter what thread they are posted in

[pittpete]

Ok, b then i'll continue.
One thing i'm afraid of is having an ADR at L4-L5.
I first injured it in 1995, had a disco in 1996 and have moderate arthritis there.
Movement there will only worsen my facets i think.
I'm gathering all my info to have a diagnosis from Dr. Zeegers.
Paid consultation, but what other Dr. calls you on a Saturday and talks to you for 45 minutes?