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  #1  
Old 01-02-2015, 01:39 PM
Wombatcat76 Wombatcat76 is offline
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Join Date: Dec 2014
Posts: 8
Default Need help RE: 2-level ADR

Hello,
I am in need of some help and direction. I live in the US and have dealt with back problems since I was 25 years old. Due to a car accident, I sustained a herniated disc, and the tests revealed DDD. In 2010, I had an emergency microdiscectomy with significant left leg nerve damage, which required 6+ months of rehab. Currently, I'm in need of a 2-level ADR at L4-5:L5-S1. I Just turned 38, and want to regain what's left of my somewhat youthful life. Unfortunately, that time has come where I need to do something (ADR or fusion) and the US will only do a single ADR. I am, in no way am interested in a fusion surgery! I found the best ADR surgeon I could get to and made an appointment. It was heart breaking to hear that I am the perfect candidate for a 2-level ADR, but unfortunately it is not allowed in the the US. I found him extremely honest, knowledgable, patient, and he actually provided me with useful information so I could get started on trying to make the best decision for my problem.
Dr. Ritter Lang (Sternum Hospital in Germany) and Dr. John Sutcliffe (London Spine Clinic in London, UK) are 2 of the doctors and facilities I was given by my doctor here in the US. It seems there is also some debate over which is the best device on the market,Freedom,M6,Prodisc -L, etc... Then there is cost, facilities, insurance, travel arrangements, and contact info.,etc....
I honestly, thought I was knowledgable about my medical issues. Currently, I find myself in uncharted waters. I would truly appreciate any information an/or personal experience anyone is willing to share with me.
In my own self-researching on surgeons/facilities outside the US that perform 2-level and beyond ADR's, Dr. Bierstedt (of German Spine Specialists), was one of the main professionals in this area that really stood out for me with his patient success stories, facilities and number of years in the industry.
Living in pain, is no way to live. Regaining my quality of life is my goal.
Thanks to anyone willing to take the time to read and share.
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__________________
Nov.2000-Car accident resulted herniated disc.& in discovery of DDD.
10 years of pain management: Numerous injections, PT, Chiro, etc..
Dec.2010-Emergency Microdisectomy, resulting in left leg nerve damage and 6mos. rehab.
Last 18mos. increased flair-ups and leg pain.
Not interested in fusion, actively seeking better quality of life.
At present constant pain with daily activities.
Need 2-level adr L4-L5, L5-S1, just turned 38.
Surgery with Dr. Pablo Clavel, 3/25/2015, 2-level
L4-L5-S1.
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  #2  
Old 01-02-2015, 06:55 PM
jss's Avatar
jss jss is offline
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Join Date: Nov 2009
Posts: 1,411
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Wombat,

Condolences on your condition, but welcome!

Count yourself blessed that you have an ADR friendly doctor.

Kuddos for researching your condition and options. You are doing exactly the right thing in this situation. I hope you'll continue researching doctors and treatments. The more you know the more likely you'll find that your options will begin to converge on a single treatment.

A thought ... I would encourage you to not be too hasty to poo-poo a fusion at L5/S1. My observation has been that ADR friendly surgeons seem to be less likely to recommend ADR at that level than they used to be. I don't understand all of the issues of an ADR at that level; but would strongly encourage you to not pursue any treatment until you do. A fusion at that level is not a life ending event. A year ago I did an Ironman race and ran part of the marathon visiting with a woman who had a fusion at that level four years prior.

Good luck!
__________________
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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  #3  
Old 01-02-2015, 08:28 PM
Kelly4ADR's Avatar
Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
Posts: 259
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Wombatcat,

Welcome to the forum! You will find plenty of helpful people here.

I concur with Jeff. I am first and foremost a cervical patient and I will be having a two level cervical ADR done here in the states next week, but I also have an L4-5 rupture (that left me with numbness, weakness and a loss of reflexes at the knee in my left leg.) as well as a bulge at 5S1 and L2-3. My surgeon won't touch my lumbar because my cervical isn't stable enough to endure the procedure. Once I heal with the neck, we will move forward with the lumbar plan.

That being said, from what I have gathered, a fusion at L5-S1 is not a bad option by itself or with an ADR above it. From what I understand, a disc failure is mostly caused by poor disc placement or inaccurate sizing at any level) but secondly, it seems as if we are seeing lumbar discs that fail at the L5-S1 level. I am not an expert on this but from what I gather, the movement an artifical disc provides at this level MAY not be appropriate if it is too much movement. Our natural disc at this level has some, but not as much as the others. Make sense? Many many people on this forum have hybrids, and Im sure they will chime in. I will be eager to see what they say as well, since I may be in the same lumbar boat as you.

I hope this helps
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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  #4  
Old 01-02-2015, 08:49 PM
NJ Gene NJ Gene is offline
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Join Date: Feb 2013
Posts: 376
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Wombatcat,

Welcome to the forum!! I would agree with the suggestions that Jeff and Kelly gave you. I just wanted to add something, since you mentioned Dr. Ritter-Lang. There is a lot of negative press about him on these boards. I'm sure that Harrison, the moderator, would agree. If you search "Nightmare in Stenum", you will get a lot of information about other members experiences with him.

I would first look to get opinions from U.S. surgeons who perform ADR. If you consider the hybrid (one level ADR and fusion at L5/S1), insurance might cover it completely. Just as an aside, I had two levels of lumbar fusion between L3/L5. This was just over 4 years ago (Dec, 2010). I haven't had any lumbar issues since that surgery. I have more issues with my neck, which is what brought me to this forum. While I'm in no way suggestion fusion, my understanding is that L5/S1 is one of the best levels for it. That same level also has some devastating failures with ADR. Don't get me wrong, 95% of people who get ADR at L5/S1 are ok. It's those 5% that suffer badly and often need revision surgery. There is a member named Vicki_In_Florida who you might want to look up.

Good luck!!

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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  #5  
Old 01-04-2015, 01:25 PM
Harrison's Avatar
Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
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Nice posts from everyone -- thanks Gene, Kelly, Jeff.

WBC, I am really surprised that ANY doctor would mention let along refer a patient to Ritter-Lang. Pls read and fee free to forward:

http://www.adrsupport.org/forums/f49...utation-10308/
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #6  
Old 01-04-2015, 05:27 PM
drewrad drewrad is offline
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Join Date: Jan 2014
Posts: 629
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Sacral slope doesn't look too bad at all for an ADR at both levels. Sheer load can be greater at L5/S1 but in many cases it is a non issue. That was not the case with me. My slope was too sleep, much so.

Dr Clavel did a three level hybrid with me in July of last year.
__________________
Weightlifter since 12 years old, now mid-40's and figuring out this wasn't such a good idea.

Chronic back pain started in 2010 while shrugging weights that a 40 yr. old shouldn't even try.

MRI in 2012 showing L4/L5, L5/S1 herniations and L2/L3 bulge.

L5/S1 taking on new shape, chronic sciatica, etc.

DEXA bone scan performed 5/7/14 showing mild osteopenia.

Surgery performed July 9th, 2014, Dr Clavel, hybrid three level lumbar.
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  #7  
Old 01-05-2015, 03:03 PM
Optimistic Optimistic is offline
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Join Date: Mar 2014
Posts: 81
Default

WBC, You are connected with a forum that has many, many members who have used surgeons from most continents (exception of Antarctic), many different medical device products and different operating procedures. While the information can be overwhelming at times, I think you will find answers to most if not all of your questions here.

I agree with the people who posted before me. There are probably ~8 - 10 surgeons overseas who specialize in ADR surgery and have performed more of these procedures that anyone else in the world. There are also a handful in the US that are quite familiar with ADR. However, the fact that FDA as well as insurance coverage limits these procedures domestically might also weigh into the decision. Please feel free to ask additional questions and research the experiences of people who have walked in your shoes before you.

I agree wholeheartedly that living in pain is no way to live.
__________________
1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.

New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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  #8  
Old 01-06-2015, 02:05 PM
Wombatcat76 Wombatcat76 is offline
Junior Member
 
Join Date: Dec 2014
Posts: 8
Default Titan Fusion

Thanks for all of your replies guys. And Harrison about the information on Sternum. I am thankful to have found this sight.

I am struggling with making the right decision with surgery. And, my hope in having any surgery, is that it is successful and to stop my suffering. I try not to think about how long this problem has been present in my life, and how its currently effecting me daily, and forcus on research. But, I'd be lying if i said its overwhelming and frustrating.

Can anyone share their experience with hybrid. Titan fusion at L5-S1, ADR at L4-L5. Its my understanding Titan fusions are fairly new, so there may not be many of you guys out there. My hope is that insurance would absorb most of the cost and I could get it done here in the US.

Thanks for all the support!!!
__________________
Nov.2000-Car accident resulted herniated disc.& in discovery of DDD.
10 years of pain management: Numerous injections, PT, Chiro, etc..
Dec.2010-Emergency Microdisectomy, resulting in left leg nerve damage and 6mos. rehab.
Last 18mos. increased flair-ups and leg pain.
Not interested in fusion, actively seeking better quality of life.
At present constant pain with daily activities.
Need 2-level adr L4-L5, L5-S1, just turned 38.
Surgery with Dr. Pablo Clavel, 3/25/2015, 2-level
L4-L5-S1.
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  #9  
Old 01-30-2015, 02:30 PM
Romakis's Avatar
Romakis Romakis is offline
Senior Member
 
Join Date: Jan 2015
Posts: 197
Default

I am in almost exact sutuation: DDD of L5-S1, microdiscectomy of L4-L5 in 2014. Looking at 2-level fusion or 2-level ADR. Did not want to create a new post since yours pretty much covers all my questions and concerns.

One thing I wanted to add is that I am also looking at Dr. Feil from ATOS clinic. Has anyone had any experience with him?
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  #10  
Old 02-02-2015, 10:56 AM
colorado babe's Avatar
colorado babe colorado babe is offline
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Join Date: Aug 2014
Posts: 345
Default

I had an anterior fusion of the L5/S1 and am doing really well. I am 3 1/2 months post op and have 95 percent mobility back. The Charlie horses in left leg have stopped as well as sciatica and spasms in my feet. Don't give up, keep searching for a surgeon who you feel confident in.
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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