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  #1  
Old 07-28-2013, 04:15 PM
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LauraB LauraB is offline
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Default Need opinions of Dr. Bertagnoli and ProDisc

I know I've put this out there in other threads, but I've decided to go through with my ADR C4/5 & C6/7 which will sandwich my 2006 fusion at C5/6. I chose Dr. Bertagnoli mainly due to his reputation, experience and prompt response to my inquiries. Dr. Bierstedt was my only other choice, but I had concerns about the M6.

Most of the current blogs have been about Dr. Bierstedt and Dr. Clavel. Has anyone out there have prior experience with Dr. Bertagnoli and the ProDisc Nova?????? I just need a little affirmation to get me by while I wait for my surgical date (09/24/13). I know there are some, but I spend so much time sifting through the threads and trying to piece together opinions. My pain has continued to get worse this summer and I can only sit at my computer for 5-10 minutes at a time.

Also, has anyone experienced lack of coordination and a feeling similar to vertigo? In the past, my pain has mostly been confined to the upper extremeties - severe migraines, stabbing pains in the neck and shoulder blades, and tingling/aches in my arms. Now I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*
__________________
2006 C 5/6 discectomy and fusion
2008 Automobile Accident
C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess
C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing
C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina
Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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Old 07-28-2013, 05:16 PM
NJ Gene NJ Gene is offline
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Quote:
Originally Posted by LauraB View Post
INow I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*
Laura, Before my fusion at C4/C5, I had some of the above symptoms. Specifically, I had the stabbing pain in the heel which did run up the leg and lower back. I could actually create the pain by bending my neck extremely forward. I was told my surgeon that this was called "L'hermitte s Sign". You might want to Google it to get the exact definition. I suspect that this symptom will get better once that level is treated (regardless of whether by ADR or fusion).

Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4
1998 Larger Herniation and Cervical Fusion C3/C4
2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007
2008 - Foraminotomy at C6/C7 on left side
Feb, 2010 - Cervical Fusion C4/C5
Dec, 2010 - Lumbar Fusion L3/L5
2013 - Bulge on C5/C6; herniation C6/C7 right side
Mar 26, 2013 - Foraminotomy at C6/C7 on right side
May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
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  #3  
Old 07-28-2013, 06:45 PM
Conan26 Conan26 is offline
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Quote:
Originally Posted by LauraB View Post
I know I've put this out there in other threads, but I've decided to go through with my ADR C4/5 & C6/7 which will sandwich my 2006 fusion at C5/6. I chose Dr. Bertagnoli mainly due to his reputation, experience and prompt response to my inquiries. Dr. Bierstedt was my only other choice, but I had concerns about the M6.

Most of the current blogs have been about Dr. Bierstedt and Dr. Clavel. Has anyone out there have prior experience with Dr. Bertagnoli and the ProDisc Nova?????? I just need a little affirmation to get me by while I wait for my surgical date (09/24/13). I know there are some, but I spend so much time sifting through the threads and trying to piece together opinions. My pain has continued to get worse this summer and I can only sit at my computer for 5-10 minutes at a time.

Also, has anyone experienced lack of coordination and a feeling similar to vertigo? In the past, my pain has mostly been confined to the upper extremeties - severe migraines, stabbing pains in the neck and shoulder blades, and tingling/aches in my arms. Now I'm experiencing shaking hands, falling over (losing balance) when I look upward or down, and a stabbing pain in my heel which runs briefly up my leg to my lower back. Nothing is constant, but randomn. The pain surprises me at times - almost causing me to fall down a flight of stairs. Could this be connected to my C4 - C7 neck issues?
*Laura*
I personally meet with Dr Bertagnoli in 2011 and to be honest wasn't to impressed with his answers to my concerns over the prodisc design and why he uses it all the time and i am a mechanical engineer and i feel it overloads the facets and the size of the keel used

i am going with Dr. Bierstedt as i feel and through talks with him that he will use the disc which suits me, be it the active-L or M6 or whatever

and yeah it could be connected to your neck as i had nerves that were compressed that somehow effect adjacent ones which i found really odd but my surgeon said it can happen very odd
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Old 07-28-2013, 10:16 PM
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jss jss is offline
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Laura,

To my knowledge, Dr Bertagnoli hasn't had a patient on this site since ... 2009. While he has a couple of patients with bad outcomes whose stories have been widely circulated on the internet, if you are a good candidate for ADR, I know you're going to have a great outcome with Dr Bertagnoli. He was one of the European pioneers with the ProDisc-C and is probably second only to Dr Zigler at TBI/Plano with that device. If I were going to have a ProDisc-C implanted, Bertagnoli would be my second choice to do the surgery. With that device I believe you'll be in very good hands.

I never had the symptoms you're experiencing before either of my cervical fusions (2000 and 2002), but did have some such symptoms before my double cervical ADR (2009); extreme sensitivity of the scalp, numbness and tingling in the genitals and rectum, and my left knee giving out (resulting in a fall). Like Gene, I could exacerbate those symptoms by flexion of my neck. If it helps any, ALL of those symptoms were resolved when I woke up in recovery after the double ADR.

Good luck, Jeff
__________________
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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  #5  
Old 07-29-2013, 12:36 AM
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LauraB LauraB is offline
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Jeff, Conan, and Gene
Thank you so much for your feedback. I can't help second guessing every decision I make - I'm hoping that this will be the last surgery and it will a good outcome. When I had my fusion, I only experienced a constant ache, headaches (which I didn't know was associated) and numbness/tingling in my arms (which I could turn off with the turn of my head). With the two levels of "new" problems, the symptoms are more erratic. I was worried I was developing new problems; I'm somewhat relieved that (Gene) you have shared some similarities. I haven't found what is triggering it - I can't seem to locate a posture that triggers it....yet.
I started this venture when I discovered the website for the M6. Although it seemed like the "magical" cure - I did share some concerns regarding its efficacy over the long-term and the number of parts which made up the core. The ProDisc seemed to seem more simplified in its design. I am not an engineer, so I would be interested in your opinion, Conan. I did read some issues regarding the facet load and failure, but those who posted didn't divulge the surgeon - my assumption was it may not have been positioned properly or plate size incorrect. I felt that Dr. Bertagnoli would be the better choice as a surgeon for this device. Harrison expressed his opinion in regard to keel choice and felt the Pro Disc was less invasive. Again, I'm not an engineer and would like to understand the concern about keels and loads on the facets.

JSS - I had been in contact with Dr. Zigler during my quest for a surgeon, but was concerned about the number of multi-level ADRs he had performed. I had also been concerned about negative comments about TBI being a surgical mill (???) I thought the European experience would be the best choice for experienced surgeons. I originally started my quest based upon the names of successful surgeons brought up on this website. He was the only one that responded to my inquiries at the time (weeks went by before I heard back from Dr. Bierstedt and Dr. Clavel). When I researched Dr. Bertagnoli, I felt that he had the surgical credentials and experience I was looking for. I was hoping to have been able to read more updated outcomes than 2009. Perhaps mine will be (?)

Thank you again for sharing your concerns, opinions, and similarities. I do feel somewhat more at ease. However, still concerned about the ProDisc.
__________________
2006 C 5/6 discectomy and fusion
2008 Automobile Accident
C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess
C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing
C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina
Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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  #6  
Old 07-29-2013, 01:05 AM
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TPatti TPatti is offline
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Just my opinion, but a couple of weeks for a response is not a long time and should not play a part in your discussion process. I own a remodeling company and our standard time frame is 2 weeks to schedule an appointment and an estimate 2 to 4 weeks after that depending on the size if the job. If a doctor has 2 surgery days a week, 1/2 day or more for pre-op consults and the same for post-op consults, it only leaves 2 days for appointments with local patients and reviewing overseas cases.
__________________
*9/10: Unstable pelvis & SI joint, sore IT band. Chiro care, I would shift out hours to days after adjust
*12/10: PT & chiro
*4/11 to 11/11: 5 sessions prolo and 3 prolo w/ PRP
*12/28/11 ESI L L4/L5 - 1/13/12 ESI R L4/L5 - 1/24/12 L SI joint capsule - 3/8/12 TPI - 3/23/12 L L5/S1 - 4/11/12 ESI caudal - 5/23/12 TPI - 7/10/12 Facet inj L3/L4, L4/L5, L5/S1
*9/12/12: 30 - DRX9000
*12/21/12 schedule. for L4/L5 fusion-CANCELLED 1/7/13
*7/16/2013: 3 level M6(S1-L3) w/ Dr. Bierstedt
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  #7  
Old 07-29-2013, 08:31 AM
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LauraB LauraB is offline
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You are absolutely right. From my entry, it does sound as though my decision was based upon impatience (partitially so), but it seems that my husband had been listening (unbiasedly - as he is without pain) to the technical aspects of the devices. As I read him the various blogs and viewed the mechanics, he was concerned about the longevity of the internal components of the M6 (again, we're not medical/mechanical engineers). I was good with my decision until I kept reading all of the positive outcomes with Dr. Bierstedt as of late, and have not seen many responses about Dr. Bertagnoli (2009 from what I've been told).
I like what I have read (in research) about both surgeons, but doubt is always still there. I had made my arrangments for Sept. surgery, but can't help feeling uneasy about it (with regard to the device).
Really, I guess, my concern is......ProDisc or M6?????
__________________
2006 C 5/6 discectomy and fusion
2008 Automobile Accident
C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess
C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing
C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina
Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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  #8  
Old 07-29-2013, 09:02 AM
zenmunk zenmunk is offline
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I share your concerns about the longevity of the M6, LauraB. But that extends to pretty much all ADRs for varying reasons. The following two threads address the M6-L:

http://www.adrsupport.org/forums/f51...ng-data-11634/


http://www.adrsupport.org/forums/f51...-million-5198/

The general consensus on those threads is the testing data which Spinal Kinetics have released is insufficient, and it's unclear how it correlates to robustness and longevity in the human spine over long periods of time. Forum members (some of whom are engineers) find this incomplete data troubling. Some flat out predict M6 failure between 10 and 20 years. An important caveat to this is the forum members are also anxious spine patients without access to the full data and perhaps an inability to correctly interpret that data if they had it. Their logic or mathematical analyses are compromised by lack of crucial information and plain fear. Spinal Kinetics may have more data which would help patients understand longevity better, but, if so, who knows if they'll ever release it? Probably not. Also, it's reasonable to assume that not every M6 is made equal. There are unpredictable variables which could make one M6 weaker than another.

It would be wonderful if we had more incontrovertible scientific/testing data upon which to rely when making our ADR decisions, but ultimately it comes down to an act of faith. Follow your gut and hope for the best. Good luck.

____

TPatti - Hope you're having a smooth recovery. Can you tell me how much time passed between sending your diagnostic images/reports to Dr. Bierstedt and having the phone consultation? And, from that consultation to surgery day? Thanks.


__________________
1992: Bilateral bony fusion @ L5-S1
10/2013: M6 @ C5-6, C6-7 & L4-5
8/2014: Anterior Foraminotomy @ C3-4 & Posterior Lumbar Decompression (iO-flex)
1/2015: M6 @ C3-4
1/2017: Revision @ C3-4 (M6 replaced with new M6); M6 @ C4-5
4/2017: Posterior micro-decompression @ L4-5 & L5-S1
1/2018: M6 @ C2-3
8/2018: Revision @ C3-4 (M6 replaced with anterior fusion (no plate or screws))
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  #9  
Old 07-29-2013, 11:55 AM
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TPatti TPatti is offline
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Sent info and mailed images on 5/7, received diagnostic and treatment plan 5/23. The Skype consult with Dr. Bierstedt was about a week later. Remember that part of the time frame may depend on if your films arrive the day before or the day after Dr. Bierstedt's review day. My surgery was 7/16, there were earlier dates but my wife is a teacher and we wanted to wait for her to be on break.

Remember that with the Prodisk or any hardisk there is >50% wear to your facet joints. My facet joints at L4/L5 were graded at a hight 2 so a contraindications for a hard disc, M6 can be used up to a grade of 3. Even w/out facet wear a hard disc will definitely cause more wear-maybe facet joints wear out before your disc or M6? It might be worth scheduling a consult with Dr Bierstedt to discuss in more detail, he knows more than me
__________________
*9/10: Unstable pelvis & SI joint, sore IT band. Chiro care, I would shift out hours to days after adjust
*12/10: PT & chiro
*4/11 to 11/11: 5 sessions prolo and 3 prolo w/ PRP
*12/28/11 ESI L L4/L5 - 1/13/12 ESI R L4/L5 - 1/24/12 L SI joint capsule - 3/8/12 TPI - 3/23/12 L L5/S1 - 4/11/12 ESI caudal - 5/23/12 TPI - 7/10/12 Facet inj L3/L4, L4/L5, L5/S1
*9/12/12: 30 - DRX9000
*12/21/12 schedule. for L4/L5 fusion-CANCELLED 1/7/13
*7/16/2013: 3 level M6(S1-L3) w/ Dr. Bierstedt
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  #10  
Old 07-29-2013, 12:13 PM
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jss jss is offline
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Laura,

My views on some of your concerns are a bit different, so I'll go ahead and throw them out there for you to chew on...

  • On TBI being a surgical mill. I almost had a ProDisc-C implanted by Dr Zigler and know a few people that have been treated there. I never got the impression that they were a surgery mill. Some months ago someone on this site posted that their impression was that TBI was a surgery mill. As far as I can tell TBI has a reputation on this site as a surgery mill because that one statement grew legs. I don't know if they're a mill or not, but haven't had that impression from my numerous interactions with them.
  • On Dr Zigler's multilevel experience... I don't know how many he's done, but he is well published on his multilevel experience with the ProDisc, and there is one poster on this site in whom Dr Zigler implanted four contiguous ProDisc-L's. As of his last posting, he's doing great. His handle is david???? It starts with david and has some numbers after it.
  • On concerns about the M6... I am an engineer and share the concerns that it may be more prone to fail because it has more parts. I don't doubt that such failures will (and do) occur, but since in its 7+ years of service no one's posted on this site either of experiencing or reading of such a failure, my concern is not great. Compared with the ProDisc where there are documented cases of device failure; specifically the polyethelene sleeve sliding out of the bottom plate. My biggest concern about the M6 is its potential to house an infection.
  • On the M6 keels being too large... I don't share Harrison's concern. Yes, the M6 requires three keel cuts to the ProDisc's one. But the M6's keels are neither as deep nor wide as that required by the ProDisc. Because the quantity of bone removed for the ProDisc keel is so great, there are documented cases of the vertebral body splitting both during surgery and years after implantation. I presume this is why Synthes came out with the Nova; its smaller keel should fix that problem. Because I don't know the dimensions of the keels in question, I've never calculated the total volume of bone removal required for either device; but would bet that the ProDisc requires an order of magnitude more to be removed.

When I was selecting a disc, with two prior fusions and two pending ADRs, my biggest need was to have an ADR that would best preserve my two remaining natural discs. Because the ProDisc preserves motion in only unnatural ways, and was documented to cause facet problems, I didn't have a great deal of faith that it would not add to the stress of the two natural discs I had left The ProDisc had significant documented problems, and the M6 was new enough that its problems may have not yet had time to surface. (that's still true of the M6 BTW)

Given all that, I don't know which device you should receive. If you do get the ProDisc, Dr Bertagnoli is probably a very good choice of surgeon. As has been observed, there is no incontrovertible evidence that one device is better than the other. I chose a pair of M6's because, in my judgement, they gave me the best chance of preserving my remaining anatomy and avoiding future surgeries. So far it looks like it was the right call. Will they fail in 10-20 years? ... I sure hope not.

Good luck, Jeff
__________________
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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