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  #1  
Old 04-05-2022, 05:39 PM
elorpar elorpar is offline
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Join Date: Apr 2022
Posts: 32
Default Hi from Barcelona

Hi,

I was operated by C5C6 Arthrodesis due to a disc herniation last may 2021.

I did not evaluate options at that time, my disc herniation was huge due to an accident 8 months earlier so the surgeons I visited at that time rushed me to do this operation in order to prevent any bone marrow injury.. I should had seeked alternatives but I was nervious and pained.. so I acceded to the operation.

The first six months after operation I was fine, but at the seventh I got neuropatic pain again on the left side of the neck and left arm, as well as muscular contractions and arthrosis in the zone.

I visited tons of doctors in my country (spain) and all of them told me everything was fine with the operation. The only doctor that has been aimed to reoperate me has been Mr. Pablo Clavel, with the possibility to make an ADR replacement.

I have a few questions that I would very glad to receive feedback:

- Do you recommend Arthrodesis replacement by ADR or it is better to keep the Arthrodesis? I am afraid it could be worse in short/middle/long term? Right now neuropatic pain is not so high but I am totally abstained to do any kind of physical exercise or sleep on my left side. I am also afraid about long term adjacent veretebral disks damage.

- Is there any time that I can wait further to make the revision? If I wait further Arthrodesis could fuse both vertebras and make impossible the ADR replacement?

- Mr. Pablo Clavel uses M6 and ESP, which one you think is better? I have read bad things about M6.. and also about the doctor Clavel itself

- Is there any specific disk replacement to prevent heterotopic ossification? Or any specific post-op procedure? I have read about COX-2 NSAIDs but during how many time?

- Do you recommend any specific exercise to keep in good health the rest of my back? I have been recommended so many things like yoga, swimming, musculation, inversion table.. I am totally lost already.

- What do you think about mother cells to prevent other veretebral disks degeneration?


Thanks a lot and congratulations for this forum


Elorpar
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  #2  
Old 04-06-2022, 11:08 AM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,655
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I don't have the knowledge to help with revision of a fusion to ADR. It used to be extremely difficult and chancy but that knowledge is at least a decade old and may be out of date now. To pick what I can help with:

-Adjacent disk damage next to a fusion is less likely with cervical disks. Not impossible but less likely than with lumbar disks.

- The M6 has some bad press recently as well as concerns that Rich (AKA Harrison on this board) and I have raised in discussions on this board. That doesn't mean it's a "bad" ADR, just that it has risks that were not being acknowledged when it first came out. Same thing with Clavel as a surgeon. Anyone who's been active for as long as he has will have bad outcomes. It's more a question of how much risk and what kind of risks you're willing to tolerate. Certainly, if you're local to Clavel, many of the concerns a medical tourist has with unavailability and difficult follow-up are mitigated by your proximity to his clinic

- Heterotopic ossification is much discussed on this board. I'd suggest searching here but the treatments all make it less likely, not impossible to happen. Back when Rich and Laura got their Charites, those treatments were hit and miss and both of them never had ossification, so it's a matter of improving odds on preventing something that only happens some of the time anyway.

-Exercises - any core strengthening exercise within the tolerance of your recovery status and current pain will likely improve things for you but I'd find someone who's willing to listen to your medical problems and tailor a program for you. Many of the exercises are good and healthy done "this way" but mess you up further done that subtly different "that way" so it's important to get training to get your muscle memory trained to do it right.

-Mother Cells - I'm assuming you're speaking about stem cells here? If so, you can find a lot of people who advocate using them to strengthen soft tissue around the spine. The idea is to reinforce the structures around the spine (exercise is needed for this as well), decrease instability in the spine, and make it less likely for disks to degenerate. It's very difficult to find anyone willing to inject stem cells into a disk to try to encourage it to regenerate. Notionally, it makes some sense but the costs and risks involved are sufficiently large that you're not going to see a lot of practitioners doing it, nor will you see a lot of data as to whether it works. I do know of one that does do it in the western US but, to my knowledge, he's not published results of his work. I know he's willing to talk through things on a phone consult. Should you be interested PM me and I'll point you in his direction.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - minor C5-6 instability and facet damage, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #3  
Old 04-06-2022, 01:16 PM
elorpar elorpar is offline
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Join Date: Apr 2022
Posts: 32
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Thanks for your kind feedback annapurna, it is such a privilege to have direct and sincere feedback from experienced patients like you. I have donated to the ADR support foundation and I hope I will be able to help others in a future.


- Regarding my revision of a fusion to ADR, Doctor Clavel was not afraid about the operation itself but about to change spine byodynamics from a fixed level to a mobile one again after a whole year.. the fusion is probably not consolidated yet so it should be take off the fixed disk and introduce the ADR.


- I insisted to Clavel that if there was any risk of being into a worse situation in the short/long term I would avoid to operate.. and that's why I think ESP disk fits better into my perspectives. Anyway I am aware all of this replacements are experimental but when you see some M6 accidents you become very afraid.. it seems ESP is more robust by design (also more stiff.. but I am already fixed so this would be better for my transition from fusion maybe..). I have also asked diagnosis to Dr. Bertagnoli, I am pretty frustrated about the first operation and I would not like to take a third operation if i re-operate now... it seems Bertagnoli uses Prodisc-C Nova as per answer received today.. is not better ESP?

- I haver read about short-term prevention for heterotopic ossification, 6 weeks post-op taking NSAIDs like ibuprofen or nonaprofen in usual dosis (2-3 per day) if I am not mistaken. But is there any long term prevention? Only mobility?

- Regarding exercice, my neck musculature is weak and contractures oftenly when I am sitted down a long time or so.. but I have residual/cronical neuropatic pain on there so I am relegated to soft exercices like stretching or yoga; I still do not find the one that fits better in my situation.

- Stem cells yes, but I would like to take them directly in adjacent disks in order to prevent degeneration as I have these disks somewhat degenerated. I also take daily SYSADOA.
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  #4  
Old 04-06-2022, 09:14 PM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,655
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Prodisc C Nova vs. ESP - I don't really know which disk is better for any given criteria of better. I know Bertagnoli's spent over a decade perfecting his technique with the Prodisc so it's likely to be a better choice if you use him as a surgeon. A different surgeon might give a different answer. Remember that, statistically speaking, we've seen more convincing evidence that good placement does a better job of ensuring good outcomes than using any given ADR. Certainly, bad placement almost guarantees a failure.

Exercise - one thought might be to work with a surgeon who's got a post-op physical therapist as part of their staff or at least on call and work through the exercise regiment you can use. When you select someone to talk with about your possible revision surgery, that might be an important question to ask. I've used prolotherapy to help tighten soft tissue around specific problem areas or repair partially torn ligaments and tendons but regaining full functionality always required careful strength training for me.

Stem cells and SYSADOSA - Two decades ago, the word on the components of SYSADOSA was that they'd help a bit but not a whole lot. I don't know if that's changed. Like I mentioned, I know of only one person doing stem cell injections into disks. Bertagnoli performed a similar stem-cell like procedure for Laura about 12 or so years ago but it only works if you have a damaged disk that can be harvested during a ADR or fusion surgery and nucleus cultured and reinjected in a subsequent procedure. I tend to get the acronym wrong but I believe it to be Autologous Chondrocyte Discal Transplantation, ACDT, though I may have it backwards and it's ADCT. You might check if Bertagnoli still offers that or has advanced to direct stem cell harvesting and injections.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - minor C5-6 instability and facet damage, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #5  
Old 04-07-2022, 10:43 AM
phillyjoe phillyjoe is offline
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Join Date: Jan 2013
Posts: 274
Default

So let’s see, maybe I can give some helpful opinion on your questions-maybe not.

As you can see from my signature, I had 3 level M6 with Dr Clavel almost 6 years ago. I think he is a great doctor, a very honest and good man, and I found him highly responsive to my post-surgery issues. He does great placement of cervical devices (not sure if he is so good at lumbar), and he will take all the time needed to answer all your questions. He helped me when no US doc would do anything but fusion. Following my surgery, my arm pain was gone, I could use my right hand again, I got my life back. I was able to return to work and finish out my career to normal retirement age. I thank God at least once a week for what Dr Clavel, as well as his Pt and support team, did for me.

BUT, he maybe too optimistic. My bottom disc has fused due to HO. For reasons I can’t explain, Dr Clavel kept telling me it was still mobile, causing me to chase more and more CT’s and US docs trying to figure out why I had problems with severe neck and shoulder pain when lying down at night. Perhaps he saw slight movement which US docs didn’t see. I am still trying to figure out how to address this issue, but have been sidelined with other, unrelated, medical issues. I am old, 66yo, so things happen.

All that said, please search my postings and you might find useful things. Dr Clavel did personally tell me years ago that he reversed a fusion into a successful ADR. I was impressed and wrote here about it. But he also told me it isn’t possible in all cases. He also told me that HO is likely to happen over time to many people, but for most, it would not cause problems. I loaded an article about that on this site. Yes, I took NSAIDs for a long time, due to a head crash I had just 2 weeks after my surgery, and it still did not prevent HO. You can read about that crash on this site, I had to have 8 staples to put the back of my head together….but the M6’s didn’t move out of place.

No doc will tell you that you might not be worse after surgery. My unscientific poll is that 1/3 are much better, 1/3 are the same, 1/3 are worse. But if surgery is needed, sooner is better, or for sure you will get worse. 2 of my 3 are good, and except for inability to sleep because of the pain, I am happy with the result. It is a lifelong commitment to staying fit however, as you are never as good as new. I think that as levels of replacement increase, chances go down. Single level people do great.

I think the M6 might have been oversold, but all discs have problems. The cases of bone deterioration or disc failure exist but I don’t know how widespread. I recall that there was a change in design of M6C early on, which no one seems to acknowledge, that seemed to have made it more secure in the attachment of the plates to the core. In the US there is a cervical disc replacement Facebook group that has many postings of failure of the Mobi C, with my conclusion being that if placement of that device isn’t perfect, there is a failure risk. Texas Back Institute is now using M6 and Simplify-because Simplify can allow mri’s. Please let me know if I can help you more. All this is only my uneducated opinion, so use it as you will. I am not a doctor.
__________________
Pre Surgery:
C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis.
C4-C5:Midline central disc protrusion, significant. Mild canal stenosis.
C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis.
C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis.
June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona

Last edited by Harrison; 04-10-2022 at 05:51 PM. Reason: Added paragraph breaks
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  #6  
Old 04-10-2022, 04:10 PM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,655
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Stem cell follow-up - I don't know how well your spoken English is (your written English is good) but there will be a meeting of the American Association of Orthopedic Medicine in early May, https://na.eventscloud.com/website/35031/agenda/, that includes discussion of specific treatments for the spine, albeit Lumbar. For previous meetings, AAOM has offered videos of their talks for purchase sometime after the meeting completes. I don't know if that would help you but it's a source of knowledge. I will admit that a review of the talks being given sounds like they're summarizing stuff we've discussed with our prolotherapists over the past decade and a half, so I have some reason to believe that the information presented at AAOM will be a long way away from cutting edge.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - minor C5-6 instability and facet damage, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #7  
Old 04-11-2022, 10:28 AM
elorpar elorpar is offline
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Join Date: Apr 2022
Posts: 32
Default

Quote:
Originally Posted by phillyjoe View Post
So let’s see, maybe I can give some helpful opinion on your questions-maybe not.

As you can see from my signature, I had 3 level M6 with Dr Clavel almost 6 years ago. I think he is a great doctor, a very honest and good man, and I found him highly responsive to my post-surgery issues. He does great placement of cervical devices (not sure if he is so good at lumbar), and he will take all the time needed to answer all your questions. He helped me when no US doc would do anything but fusion. Following my surgery, my arm pain was gone, I could use my right hand again, I got my life back. I was able to return to work and finish out my career to normal retirement age. I thank God at least once a week for what Dr Clavel, as well as his Pt and support team, did for me.

BUT, he maybe too optimistic. My bottom disc has fused due to HO. For reasons I can’t explain, Dr Clavel kept telling me it was still mobile, causing me to chase more and more CT’s and US docs trying to figure out why I had problems with severe neck and shoulder pain when lying down at night. Perhaps he saw slight movement which US docs didn’t see. I am still trying to figure out how to address this issue, but have been sidelined with other, unrelated, medical issues. I am old, 66yo, so things happen.

All that said, please search my postings and you might find useful things. Dr Clavel did personally tell me years ago that he reversed a fusion into a successful ADR. I was impressed and wrote here about it. But he also told me it isn’t possible in all cases. He also told me that HO is likely to happen over time to many people, but for most, it would not cause problems. I loaded an article about that on this site. Yes, I took NSAIDs for a long time, due to a head crash I had just 2 weeks after my surgery, and it still did not prevent HO. You can read about that crash on this site, I had to have 8 staples to put the back of my head together….but the M6’s didn’t move out of place.

No doc will tell you that you might not be worse after surgery. My unscientific poll is that 1/3 are much better, 1/3 are the same, 1/3 are worse. But if surgery is needed, sooner is better, or for sure you will get worse. 2 of my 3 are good, and except for inability to sleep because of the pain, I am happy with the result. It is a lifelong commitment to staying fit however, as you are never as good as new. I think that as levels of replacement increase, chances go down. Single level people do great.

I think the M6 might have been oversold, but all discs have problems. The cases of bone deterioration or disc failure exist but I don’t know how widespread. I recall that there was a change in design of M6C early on, which no one seems to acknowledge, that seemed to have made it more secure in the attachment of the plates to the core. In the US there is a cervical disc replacement Facebook group that has many postings of failure of the Mobi C, with my conclusion being that if placement of that device isn’t perfect, there is a failure risk. Texas Back Institute is now using M6 and Simplify-because Simplify can allow mri’s. Please let me know if I can help you more. All this is only my uneducated opinion, so use it as you will. I am not a doctor.
Thanks for your feedback, right now I am not so bad from my neuropatic neck pain (I am avoiding any kind of exercice and in spain it is not so cold now) so I am doubting to re-operate or not (there is a free spot in May). Dr. Clavel tells me that due to the fusion procesdure my vertebraes are now too flat to implant a cp-esp and the most secure implant would be an M6 if it is possible to reverse fusion at all.. but this freaks me out as I wanted an cp-esp and now I am plenty of doubts again..

- Can you provide me further information about the M6 change of design to avoid nucleus failures?

- Is there any model that provents more than others heteropatic ossifications?

- Is your pain directly related with your ADR or is related with residual pre-op neuropatic pain?

My main concern now is adjacent disks degeneration if I keep my fusion and also I have developed some artrosis on my neck in only one year.. as well as my little finguers get asleep when I sleep on a side position (no Doctor understands why).

Thanks for your feedback annapurna as well, I would appreciate also your feedback regarding these doubts.
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  #8  
Old 04-11-2022, 02:35 PM
phillyjoe phillyjoe is offline
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Join Date: Jan 2013
Posts: 274
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Well, I can't speak to Dr Clavel's advice, but you do want a secure implant. You don't want it to move. You can appreciate his honesty.
Unfortunately, I don't know much about the design change, other than it had something to do with making a more secure connection between the titanium plates and the core itself. If you look closely at the M6C, they are connected by the woven fibers threaded through the plates. Maybe it wasn't attached that way before.
If you do some reading about HO, I think the literature is showing that it happens after year 5. But for many, it is only a finding on images and doesn't matter. In my case, I got HO at C6-7, and that causes neck pain at night. Arm pain is gone. The neck just doesn't move right lying down.Basically I am fused by a non moving M6 at C6-7. I am still planning on getting it fixed. Why it happened? No one seems to know, but I suspect it is because the M6 comes in limited sizes and it had too small a surface area for my C6-7, there is less movement at 6-7, and it is by design a more constrained device. This is all my speculation, Dr Clavel did not speculate as to the causes. If I could sleep standing up or hanging upside down, life would be perfect.
__________________
Pre Surgery:
C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis.
C4-C5:Midline central disc protrusion, significant. Mild canal stenosis.
C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis.
C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis.
June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona
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  #9  
Old 04-12-2022, 10:37 AM
annapurna annapurna is offline
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Join Date: Dec 2004
Posts: 1,655
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Unfortunately, I don't has as much to offer about your questions. Some truisms to offer and then a speculative conclusion: (1) The cervical spine is less prone to adjacent segment problems than the lumber spine. (2) Even in the lumbar spine, it's not uncommon to go many years before seeing disks adjacent to a fusion begin to show problems. (3) It's really difficult to spot the early stages of disk impingement on the cord through imaging as the focus is on MRI & CT, where the patient is supine and the spine unloaded during imaging.

What I'm wondering is whether at least one, possibly, more disks in your c-spine was more damaged than everyone thought. The main pain generator was removed and the segments fused but the surrounding weakened disks were susceptible to any kind of overuse/overloading problems caused by the fusion because they were weakened to start. The reason why I think this is important is that you might revise to a ADR only to find that those weakened adjacent disks aren't up to the task of an ADR recovery.

Have you had the chance to get more recent MRIs? You might want to check the hydration state of the adjacent disks (white=good, grey=okay, dark or black=beginning to desiccate). That's an easier check for a layperson. Interpreting where nerve impingement is happening is harder. You might need a loaded MRI, where you're standing, or try to get by with flexion/extension x-rays of the c-spine and look for deflections of the smooth curve of the spine (other than the fused area). I've never seen the latter approach with a fused spine but it has the advantage of being simple (two flat film x-rays and some time with x-ray image analysis software).

To add: you might need a hybrid, current fusion and ADRs at adjacent levels, instead of a revision of your existing fusion to ADR. It's worth making sure of the adjacent disk condition before jumping to the revision surgery.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - minor C5-6 instability and facet damage, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog

Last edited by annapurna; 04-12-2022 at 05:37 PM. Reason: typo and closing point
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  #10  
Old 04-13-2022, 06:24 AM
elorpar elorpar is offline
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Join Date: Apr 2022
Posts: 32
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Hi again and thanks a lot for you wise feedback, I am learning a lot from you. I attach an MRI from december post-op:

https://ibb.co/R94jB2H

Doctor already told me c4c5 is dehidratated and c6c7 a little bit degenerated, but still good enough for a c5c6 revision and not causing significant problems right now. I asked how to rehidratate and regenerate that disks, and I was suggested to do stretching, musculation, drink watter.. I read also that SYSADOAs, PRP, stem cells.. may help but at this moment I am just doing some stretching, mild exercise and taking SYSADOAS with watter.

To be honest, c5c6 neuropatic pain is almost gone, I can sleep with no medication (3 months before it was heavy pain), but I am afraid about adjacents disks problems in a future as every time I turn my neck to the right it sounds really creepy and every time I carry some weight my shoulder becomes into muscular pain. Adjacent disks problems may come in 10-20 years so I would like to prevent them (is there any publication about % risk depending on lumbar or cervical fusion?). That's the only purpouse of my revision as pain keeps low like now if my physical activity is reduced.. but I do not know if I am doing a stupid thing.

Anyway if cp-esp is not proper to my case, I will tell doctor during my next visit to better keep like this.. this is the only Doctor willing to make such a difficult revision but as he only works with ESP and M& (not Axiomed) I am becoming paranoid but I do not trust M6 after reading over here and checking internet failures..
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