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  #11  
Old 01-02-2014, 01:20 PM
Wraspondy Wraspondy is offline
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Join Date: Nov 2013
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Quote:
Originally Posted by brattigans View Post
Thank you for the information. Are you not going to see Kropf because he did your last surgery? I have an appointment to see Regan this week. I have never heard of Lauryssen or Weinstein. I will take a look. Do you know which surgery you are going to be getting, and have you made your decision? Thank you and look forward to hearing from you. Happy NY!!
I re-read your post and that of Bwink23. We were/are almost all exactly in the same boat - although I am farther along than you two.

I had a very symptomatic spondy - bothered me for about 18 years - from 22 to 40 - and now I am having more problems above the fusion. I too was super active. My spondy was a 9mm slip (grade 1/2) and my operative report says it was very mobile. It was crushing the nerve to my leg and I was always in pain.

Actually, I did a marathon in 2008 or 09 that finally did me in. Apparently running is very bad for spondy. Went through very bad pain for a year and a half before I got to surgery with Kropf. I have known several people that went to him and no one I know got a bad result, although another guy and I have had subsequent problems from discs above/before the fusion. I was told I would get ten years out of the fusion and before I needed anything else, but no such luck. With respect to the surgery, it really wans't that bad. Coming off the drugs was harder than any surgical pain. It hurt when I laughed for a few days because they went through my stomach, but that healed up pretty good in a few days. They opened my back up pretty good, which never really hurt although it gets really sore now, especially after my herniation.

Weinstein is right down the street from where I work and very conservative, which I think is what you want. I have a friend who had surgery by him with good results, but it was only a disco.

I have not made any decisions yet. I have had several surgeons say no ADR at 4/5 and some say that they could do an ADR. My fear is that if I have an ADR and they go back through the front and something happens with the ADR, I could be in a really bad spot with respect to removal. As a result, I think I am going to play it safe and probably have a fusion at 4/5 and wait for 3/4. I have to dig into it a little deeper before I decide what to do. I want to do the most minimally invasive fusion that wont trash l 3/4 for an ADR if I need one down the road.

I am not sure any of this helps other than showing that researching this stuff can drive you mad and confuse you more than ever with what to do. Feel free to ask me any more questions and lets make it a pain free 2014!
__________________
2010 Spinal Fusion l5/S1 - Dr. Kropf SoCal
2013 l4/l5 18 mm herniation and ddd at l3/4
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  #12  
Old 01-06-2014, 02:48 AM
brattigans brattigans is offline
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Posts: 18
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Originally Posted by jss View Post
Barbara,

Dr Delamarter is an ADR research surgeon in the LA area (Cedar Sinai) whose name comes across this site periodically. Is there any chance that your stress fracture will heal in time for any ADR surgery?

Good luck, Jeff

Thank you, I've been looking into him too. So much wonderful info on this site. I've seen quite a few doctors about it, and the common information I have received is that the fractures are the cause of my back problems and happened in my early to mid teens. I am 39 now. Unfortunately there will not be any proper healing for me. Thank you for your info. Best, B
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #13  
Old 01-06-2014, 02:53 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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Quote:
Originally Posted by TPatti View Post
The "flexible fusion" you mentioned-this is not fda approved, but a member here had one installed by Dr. Clavel. The members handle is cfbugsbunny
thank you! I appreciate it. B
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #14  
Old 01-06-2014, 03:11 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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Quote:
Originally Posted by TPatti View Post
The "flexible fusion" you mentioned-this is not fda approved, but a member here had one installed by Dr. Clavel. The members handle is cfbugsbunny

Thanks for the referral. My good friends father had the flexible fusion done last year by Dr. Kropf. He has suffered from back pain since his mid 50's and he's now in his late 70's. I suppose it could have been a clinical, but he didn't mention it. His lower back had collapsed, and the doctor suggested the surgery, they did it, and the man I am referring too, stated it has been his most successful surgery. 3 over the last 20 years. I didn't ask him if there was a fight with the insurance, and he didn't say anything about it. The benefit he stated was that there is no bone fusion. It's just a unit that is attached to the spine, the outside of the spine. The benefit I suppose is, if it does not work, you can remove it. thank you again, and I'm not even sure if that would be something that would be an option for me. Best, B
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #15  
Old 01-06-2014, 03:28 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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Thank you Bwink - I had never heard that, 5-6% of people have this fracture. That is very eye opening to me. Thank you. I think your nerve pain is in more severity than mine. I understand the nausea but the minimal connection from you hand to your spine, setting off your sciatica, I am not familiar with. Wow, that is pretty intense. I'm sorry for that. My back is the main reason for my pain. Back is at about 50%, hips 30%, 20 my legs. The legs are so hard to deal with, especially when you sleep. There is no relief.

I thank you for your honesty and telling me about your own experiences. It's very helpful talking with people who are trying to make the same decisions I am. Wishing us both a comfortable and trusting choice for our surgeries. Best, B

I have been looking more seriously at the overseas doctors. I have read alot of positive info on him.
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #16  
Old 01-07-2014, 12:07 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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Thank you for taking the time to give me all the info about your own experience. I'm really sorry for the pain your in and I'm sure it's a grueling decision, especially since you've already been through a surgery. I ran a 1/2 marathon in 2010, and really got into the running before and after the run. I was running 5-10 mile runs at least 4 days a week on top of my normal work out of cross training and spinning. I think that is why I started to turn for the worse. About a year later was when I had to start turning to pain killers. I had in the past taken them when my back went out, but now it was where I was having to take them all the time. I could not handle the pills, anymore and would stop taking them, but I couldn't last more than 2 months, until I had to so I could make it into work, but I couldn't handle the emotional roller coaster that puts you on. I am now on a fentanyl patch, all the time, and no more pills, but I believe once you succumb to the pain killers it's all down hill from there. I've now seen 6 surgeons for my surgery. I've heard 4 different ideas for surgery.

Today, I met with Regan in Los Angeles, and I really liked talking with him. He spent almost an hour meeting with my father an I. His idea for surgery is different than the rest of the surgeons, in that he only wants to fuse L5-S1. He said I have a bulge in my L4-L5 but not enough to do fusion and that the adr's that are being used in US are creating issues. He actually made sense in suggesting to wait on the additional fusion. There could be options with Stem Cells and that there is one adr that he thinks is looking promising but is not FDA approved. He also talked to me about Germany and the work they are doing there. He stated there is a new adr that looks promising but is very new. May be the M6 that is being talked about allot. So that was my experience with him. I was wondering if you wouldn't mind sharing your opinions on him, and what your experience was because I am seriously considering him for surgery. I appreciate him not wanting to fix something because it might break, but waiting for it to break to fix it.

A couple of additional questions if you don't mind:
*How long did the fusion last for you? Were you pain free for the most part?
*What would you consider the most minimally invasive fusion?
*Where was the majority of your pain coming from, legs or back before your first surgery and now?
*What medications were you on? How did you wean? I'm super nervous about it and even contemplating a detox center. I have read that the Fentanyl is grueling to get off and I could barely handle getting off the small time I took the norco.

Thanks again.. B

Thank you for your time, I hope your able to make a decision that works for your L4-5, and that your L3-4 are not negatively effected.
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #17  
Old 01-07-2014, 10:53 PM
bwink23 bwink23 is offline
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Join Date: Nov 2013
Posts: 263
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Brattigans,

It's nice that you found a doc who gave you his honest opinions..it's amazing you see the same docs for the same issues and they come up with different treatments. Did the other docs recommend multi-level fusion?? Is your L4/L5 degenerated or just bulging? My L4/L5 is degenerated...one doc i saw also mentioned fusion also at L5/S1, which seems to be common practice with Spondies who have stress fractures at the same segment. But, he did not want to tell me multi-level fusion, even though he knew my l4/5 was bad. All this guy does is fusions, what does that tell you about the outcomes of multi-level fusions when he doesn't even want to perform his bread-and-butter on you? (Not like i would go for that if i couldn't help it)

I'm interested to know what the other proposals were that the different doctors gave you. You seem like a cut-n-dry type of case that doesn't leave room for many options. Is 7mm slippage still in the grade 1 level of Spondy? Did inquire about the different types of fusions they could perform? Did you ask about the need to realign the vertebra ? Fusions raise a few questions just as ADR does. I'm more concerned with the fusion aspect of my issues than the ADR. I would bet there is a breaking point in the amount of slippage as whether you'll need a to have a anterior/posterior combo to properly align the segment again and keep it there to encourage a strong fuse.

From what i've read, a posterior fusion is more risky for nerve damage as opposed to anterior. I don't know how much disc space you've lost, but you will regain some alignment through an anterior approach when they open the space back up to normal. How much i don't know. 7mm slip is quite a bit more than mine comparatively, but i have just one pars defect, so the other side must be keeping it from getting much worse. But still, it seems on the low end of the spectrum, you may be able to get away with having just an anterior or posterior fusion. If the slip is too bad, for sure they will brace it from both ends. Let me know what the options they gave you were.

I've recently had a "pars defect injection" performed on the area to see if the fracture was causing my pain...it did no good at all. Most likely it is not the pain generator. i've had several injections in different areas in my spine, and none of them did any good. The one i had at L5/S1 though did not take away the pain, BUT it did make it worse. Possibly the slight slippage is putting excessive pressure on the innervated disc.

The fusion doc told me i had to have 2 pars defects for slippage to occur. Until he looked at my CT scan, which report states i have one. The scan shows one side. Maybe i had 2 at some point and only one side healed properly, i don't know. I do know he wasn't gonna let "2-level" fusion fly out of his mouth despite the DDD above the Spondy. He just wanted to fix the Spondy really. If i had to choose, i would take my chances with the Spondy and just have the DDD at L4/L5 replaced. Unfortunately, that's not possible, is all or none. What worries me even more, is the bulging at L3/l4 that i can feel. It doesn't cause significant issues that i know of, but i do feel it bulge out if i slump in my chair a little....don't know if Dr. Clavel will find it necessary to address that issue. Imagine that, hybrid fusion with 2-level ADR? ugh

At this point, i'm waiting for Clavel's response and see what he recommends and ask the necessary questions about whatever he proposes. It's time to take a leap of faith and hope for the best.
__________________
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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  #18  
Old 01-13-2014, 03:08 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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Thank you for all of your info. I can imagine your feeling as exhausted as I am researching all of this.. I think you are doing the best thing for the best outcome, especially if it does come to a fusion, with multi-level ADR. The pilates studio next to my work, the instructor got me in touch with a guy that had multi-level ADR in Germany. He was 27 at the time of the surgery. Anyway, he had an excellent experience and outcome. He said he was with his family skiing a little over a month of the surgery. They stayed for awhile because his wife is German. This is 2 years later, and he has his whole life back. He had suffered for years, I believe he said from his teens, 16? I think. I think it's so interesting to take the leap of faith to fly to another country and have surgery. Very brave. I hope that you not only enjoy the outcome of your surgery but also the journey.

So, too answer a few of your questions:

Yes I had multiple doctors tell me I needed a multi-level fusion. I had one doctor tell me a hybrid, or possible multi-level ADR. I had 2 doctors tell me multi-level fusion, and something for my hips (facets?) In all honesty, when I heard him say another part of my body he wanted to work on, I checked out. The doctor I'm going with is doing a L5-S1 minimally invasive fusion, through the back. My L4-5 is degenerated. The multi-level fusion wasn't anything I wanted to do and I was hoping I would get a hybrid, but it looks like that can be difficult to get approved.

7mm is a grade 1. I feel more comfortable with the prospects of ADR as well. There is something more comforting about a prosthetic disc, then nuts and bolts in your spine. All of my doctors have stated they would go through the front for the surgery. The surgeon (Dr. Regan) that I'm going with through the back. I'm happy I'm not going to have my stomach muscles cut, but because I've been so focused on the ALIF, I don't know all the info on the PLIF, so I'm trying to get in the pro's and cons.

What has been the consensus on you, back, or front?

What's the injection you had on the defect? I've never heard of that before. You know, I did not have any luck with my injections either, and I had enormous pain on my last injection. I don't remember what it's called, but it's basically an epidural, but it's not as focused. I was in worse pain to the point where I though, wow, I don't have any pain killers and this is getting really bad. It went away after a night, and then sore for about 4 days. Have you ever had RF? That did work for me on the left side, for about 6 months. Not to where I had no pain, just dulled it. When it came back, it was night and day how I felt. But after that, I never got that same relief. Maybe in the interim of your surgery. Please keep me posted on everything. I will the same. Surgery in 2 weeks. Can't wait to get back to the gym, running, my family, playing with my daughter, even things as stupid as grocery shopping. I miss doing normal stuff without counting the seconds to get home and lying down so I can be out of pain.
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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  #19  
Old 01-13-2014, 07:02 PM
bwink23 bwink23 is offline
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Join Date: Nov 2013
Posts: 263
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Congrats on your course of action...the Pars defect injection was nothing more than your standard flouroscopic injection to test the fracture site for pain. I got nothing from it. So are you doing a one level or 2-level fusion? I'm working my way over to Spain. I received a Hybrid fusion/ADR recommendation from Dr. Clavel in Spain, fusion at S1 and ADR at L4/5. No surprise there as that was what i was expecting. But, i also have cervical issues which i'm getting addressed right now. I will see a couple docs about that this week, one that does fusions, and one that does both, and get their recommendations. I will also forward my films to Dr. Clavel for his recommendation. If he says it's a go, I'll be going over for a cervical/lumbar procedure in one trip. I asked and he does do both procedures in one time. It's a lot to take on at once, but i'll do my best with it.

The fusion approach he would use is an anterior one, seeing is my lithesis is small and i would already be opened up for an ADR. Until i arrange the conference call, i won't have much more information than that. I called my insurance, and the lady said my insurance bennies are the same here or if i go overseas, but covered at an out-of-network percentage, which for me is 70%. Better than nothing. That's not to say they won't try to bite me on going over there for ADR surgery though.

There have been a couple posters here who had success getting it covered through Dr. Clavel if you have WorldWide BlueCard on your BCBS policy, which i do. Funny thing is, the lady at our office who deals with eligibility, said she is 90% sure i'm only covered for things like "colds", not major surgery. She then transferred me over to a different department for verification. That department made it clear that my benefits did not change going overseas, other than it being out-of-network, and all costs i would have to cover myself, then submit for reimbursement. I am convinced insurance companies are extremely disorganized and mildly retarded.
__________________
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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  #20  
Old 01-18-2014, 04:18 AM
brattigans brattigans is offline
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Join Date: Dec 2013
Posts: 18
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First, I would have to say, yes insurances companies are mildly retarded. That's fantastic if it gets approved. A guy I spoke with a couple weeks ago, went to Germany for his surgery and BCBS ended up covering the full amount. You would think insurance companies would be happy that we are saving them all this money going overseas for these hundred thousand dollar surgeries if performed in the US.

I'm so happy that you are working with Dr. Clavel and sounds like some really positive things. I think you are doing the right thing. The discs are better pieces of equipment and you will be benefit from that technology for your back and neck. Do you have someone that will go with you? Please keep me in the loop on your journey to a new back in Spain.

My surgery is scheduled for the 29th with Dr. Regan. I am very happy with him and my decision. It's a minimally invasive surgery, PLIF. I'm happy it's going to be conservative and not aggressive. We are going to wait to deal with the L4-L5 until we absolutely have too, and hopefully by then we will have better ADR's in the US or stem cells. Dr. Regan said that there is alot of progress with stem cells.

Thank you for sharing you info with me, and your choices. If I can help in way in your decision making or you just want to bounce ideas, or frustrations off of me, shoot me an email.

Thanks, Barbara
__________________
Back, Leg, Hip pain 16 years
2007 Surgeon says I need fusion
2010 My pain increases very quickly
2013 Time for surgery
multi-level DDD L4-S1
L5-S1 pars defect, chronic instability of L5-S1, spondylolisthesis
moderate spinal stenosis
Hybrid? flexible fusion system?
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