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Old 11-05-2013, 03:25 PM
RWS Dave RWS Dave is offline
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Default Upcoming Surgery with Dr. Bierstedt

Hi everybody -- after a couple of years of sitting on the fence researching and debating ADR surgery, I've decided to go for it! I'm scheduled to have a two-level surgery next week (Nov 12) with Dr. Bierstedt. A big shout out to Harrison for creating and maintaining this site, and to everyone in this community for all of your many contributions. What a tremendous resource! If this community didn't exist, I'm pretty sure I wouldn't be going down the path to ADR surgery today (my fusion-centric US surgeons would have scared me off a long time ago).

A little background: I herniated L4/5 three years ago. Initially, I had excruciating back pain -- to the point where I couldn't stand for over 24 hours. A trip to the ER and a round of prednisone got me up and moving again. Over the next few weeks, the back pain slowly resolved and I regained mobility ... then the sciatic pain and foot drop (left side) kicked in. Good times. After 8 weeks of worsening sciatic pain and accelerating weakness in my left foot, I opted for a micro-discectomy. At first it seemed to work -- the sciatic pain abated, the strength began to return in my foot. I did have some residual numbness in my foot and toes and developed some new burning/tingling in my little toe and the side of my foot. If things had stopped there, I would have been a happy guy. Unfortunately, a few weeks after the surgery, my back pain returned on the left side. A few months after that, I re-herniated the disc simply by reaching out quickly to grab something -- since then, I've had constant pain on both sides of my back and in my hips and glutes. Some days are better than others, but overall, the pain has managed to really impact all aspects of my life (family, socially, work, recreation) and I am ready to put it behind me.

Over the past 3 years, I've consulted with a dozen or so surgeons and pain management docs in the US and Europe. US docs all over the map; Euro docs generally in agreement about ADR being the best option. I've also tried just about every conservative approach out there to reduce/eliminate the pain and avoid surgery: multiple ESIs, facet injections, medial branch blocks, acupuncture, intra-discal injections (Dr. Derby's "restorative solution" -- a cocktail with glucosamine chondroitin), PRP injections in my facet joints and intradiscally at L3/4 and L4/5, acupuncture, prolotherapy, neural prolotherapy, hypnosis, lots of PT, massage, daily stretching, walking, swimming, inversion table, chiropractors, and a bunch of different meds. I also managed to drop 30 lbs. None of the above did much for the back pain (it didn't help my wallet, either!). Walking, icing and mild doses of Percocet and flexiril have helped more than anything.

I initially thought the issue was coming solely from L4/5, but a discogram I had showed annular tears at both L4/5 and L3/4 (there was also concordant pain at both levels). On my MRIs, L4/5 is clearly degenerating, but L3/4 still looks OK. After discussing it with Dr. Bierstedt (and other surgeons), we've decided that we shouldn't ignore the results from L3/4 (even though discograms are known for false positives) -- since we are going to replace L4/5 for sure, the best approach would be to also replace L3/4 now rather than find out it's a pain generator after the operation and/or have it worsen down the road and have to go back in.

Question for those who have already traveled down this path: how nervous/scared/anxious were you before surgery? I gotta admit, after wiring the money yesterday (ouch!) and as the day gets closer, I'm scared sh*tless and am starting to second-guess myself. Had a hard time sleeping last and am doing my best not to let the doubt creep in any further...
__________________
Nov 2010: herniated L4/5 led to back pain, sciatica and foot drop
Dec 2010: back pain resolved, sciatic pain and foot drop worsened
Jan 2011: micro-discectomy resolved sciatic pain and foot drop; back pain returned
July 2012: discogram reveals L4/5 and L3/4 have grade 3 annular tears and produced concordant pain
Nov 12, 2013: 2-level ADR (L3/4 and 4/5) by Dr. Bierstedt
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  #2  
Old 11-05-2013, 03:42 PM
Rob Wilson Rob Wilson is offline
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Join Date: Mar 2006
Posts: 204
Default Decision

Be ready for a long battle but you will see immediate improvements. As Harrison always says, slow and steady wins the ADR race. You are making the right decision. In my case, I needed subsequent cleanouts from the posterior to get rid of the stenosis (bone) that the anterior ADR does not always take care of. But again you have to do the ADR regardless.
__________________
Rob Wilson
2/06 L4/5, L5/S1 ADR Stenum Hospital - Iliac vein cut w/ occlusion of iliac vein and hematoma
12/06 thru 8/07 Laser Spine Institute - 6 surgeries on L3/4 both sides, L4/5 both sides, L5/S1 both sides

4/08 Bonati Institute - redo of L5/S1 right
8/08 Bonati Institute - redo of L5/S1 left
12/08 Bonati Institute - redo of L4/5 right and left

9/09 Piriformis surgery to remove piriformis muscle causing sciatica
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  #3  
Old 11-05-2013, 10:08 PM
Stonewall_Boris Stonewall_Boris is offline
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Hi Dave,

I'm about 5 weeks to my one year back surgery anniversary. And yes, I did have concerns and worries, particularly since Dr. Bierstedt hadn't had many posts about him at the time and they seemed to be putting together their program. As a matter of fact they switched the post op accommodations to Medicos in the last week before we were to leave. There were a lot of emails between Malte and myself regarding that!
Take comfort for now that there are so many positive outcomes from not only Biestedt but other doctors as well. You'll take more comfort when you meet Dr. Bierstedt.
Once we took off on the plane, I felt a kind of relaxation, like I did the best research, made the best decision, and everything was on autopilot.
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  #4  
Old 11-05-2013, 10:23 PM
MikeC MikeC is offline
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Quote:
Originally Posted by Stonewall_Boris View Post
Hi Dave,

I'm about 5 weeks to my one year back surgery anniversary. And yes, I did have concerns and worries, particularly since Dr. Bierstedt hadn't had many posts about him at the time and they seemed to be putting together their program. As a matter of fact they switched the post op accommodations to Medicos in the last week before we were to leave. There were a lot of emails between Malte and myself regarding that!
Take comfort for now that there are so many positive outcomes from not only Biestedt but other doctors as well. You'll take more comfort when you meet Dr. Bierstedt.
Once we took off on the plane, I felt a kind of relaxation, like I did the best research, made the best decision, and everything was on autopilot.
Dear Stone, I am close to pulling the trigger on a two level ADR with Dr Bierstedt but it seems like the demand is much higher and they have less time for hand holding. Well success bring more success. I am glad to read about so many positive results and I look forward to reporting on mine in the near future. I am tentatively reserved for January 7, 2014. I guess I'll be rolling in the snow after surgery. Well there is always Barcelona! Best regards, Mike
__________________
Feb 2011; X-ray + diagnosis; Spinal Stenosis
Physical Therapy + Oral Steroids
March 2011: MRI
April 2011: 2 level laminotomy; L4/L4 & L5/S1
More PT, pain meds and injections.
...and 2014, still researching ADR.
February 2014: endoscopic foraminotomy, Dr Bitan
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  #5  
Old 11-06-2013, 02:10 AM
Stonewall_Boris Stonewall_Boris is offline
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Hi Mike,

Dr. Bierstedt and Malte are now working with a Dr. Illerhaus. Check out the website. Its one of those things, I went with Dr. Bierstedt, never speaking with him on a phone, asked Malte some hard questions that he answered and went with Dr. Bierstedt even without Medicos at the time. When I was there Dr. Bierstedt operated on another patient from Manitoba, (get this, 2 level ADR, 3 level fusion 1 hour for the docs to flip him as he had antireour and posterior surgery at the same time) as well as 2 from south america he had done prior to us. I also noticed a few Germans on the hospital ward. Don't know who did the surgery on them.
Dr. Bierstedt is human and needs his breaks, rests and vacation. I DO NOT BELIEVE THAT DR. BIERSTEDT OR MALTE would bring an inexperienced surgeon onboard with them. If you feel you need a earlier surgery date you might want to inquire about Dr. Illerhaus's schedule. And you might inquire about a lesser cost than Dr. Bierstedt since Dr. Illerhaus's reputation has not been globally acknowledged as Dr. Bierstedt.
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  #6  
Old 11-06-2013, 02:47 AM
Stonewall_Boris Stonewall_Boris is offline
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Posts: 547
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Mike,
Further to, I never contacted Dr. Clavel directly I went through the Ritter-Lang contact, perhaps nievly thinking the rep, well, represented both doctors. Ie. if I went with the Ritter-Lang organization I could choose the doctor I wanted to go with, which would have been Clavel. I ruled out Spain because of the riots over the austereiour measures. Didn't want the hospital staff go on strike while I was there.
And yes, I thought about going to a warmer climate, a romantic city, and great scenery, but it came down to, I need my back to get better, and that was my number one goal. I eliminated all those nice things and focused on what I needed done.
That being said, post op, with my recovery going well we spent a few days in Paris. If you think you might add a bit of a holiday to your stay, I think tpatti and laurab have great ideas. It was cheaper for us to do a side trip rather than rearrange our initial flight arrangements departing from Dusseldorf. Saw the eiffiel tower and went to the Luge. Although it wasnt easy. But we got through it.
Remember on your flights let the the airline know you are disabled. They will pick you up at the plane and take you to the next gate.
If you want IM me and I'll send you the pics I took of Hattegin and Medicos.
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  #7  
Old 11-06-2013, 02:24 PM
MikeC MikeC is offline
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Join Date: Jan 2013
Posts: 72
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Hi Stone! Well I really was not going to choose Barcelona for the tourism but I do hope that post surgery I would be in the mood to visit Paris; if my new back thinks it is a good idea! I am waiting to hear back from Dr Bierstedt's office for all of the details; I did not think to ask about Dr Illeraus although I did see him on the website. Have you heard about any of his success stories? And I hope that there are ONLY success stories!

Best regards, Mike PS, how do I IM you for the photos?
__________________
Feb 2011; X-ray + diagnosis; Spinal Stenosis
Physical Therapy + Oral Steroids
March 2011: MRI
April 2011: 2 level laminotomy; L4/L4 & L5/S1
More PT, pain meds and injections.
...and 2014, still researching ADR.
February 2014: endoscopic foraminotomy, Dr Bitan
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  #8  
Old 11-06-2013, 02:59 PM
heidi's Avatar
heidi heidi is offline
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Join Date: Oct 2013
Posts: 35
Default For RWS Dave

Dave
I have not got to the other side yet, but am going in for 2 level cervical surgery tomorrow after 13 years of trouble. The trouble has backed right down since being here, and I have had a few small patches of thinking 'what am I doing'! Especially when you sign the dotted line where you have to acknowledge the risks of the operation (albeit rare).
The thing that got me to this point and feeling good about it, is that I kept on asking myself this question "If I dont do this, what is the future?"

Always, the answer was that it will not repair itself now. If it fuses by itself, there is now spurs and osteophytes growing into the nerves that run out and into my arms/hands. And so this process will only worsen, if left unchecked, and it will squash the nerves in my arms as it does and I will lose use of my arms. I am an artist by profession. Its how I make a buck. Also the vertebrae have begun to bend into the spinal column. I have also pondered the potential catastrophic issues that could occur should I have a solid fall by accident, even slipping over. Things are too precarious, and spurs break off, and you can imagine the rest.

So I ended up counting my blessings that this medical technology was available to me, and that I could afford it. Two line crossers for me. That and of course to imagine a future if you DO NOT do it.

As for the surgeon? Dr Beirdstedt seems to be one of the best in the world, by his actions. Again like you, I am grateful for finding this forum so I did find out more about the finer points of ADR and the devices used, through the generous sharing of others here on the site.

Ill be posting in the post operative forum after tomorrow (as long as Dr Sleep wakes me up!)

You will be in hospital when I am at Medicos, by the sound of it. So hang in there and keep thinking of the consequences of not doing it! Sounds like you have nothing to lose except that serious pain.
Best Wishes
Heidi (helen)
__________________
C5/6 - disc markedly degenerate w very prominent left paracentral/foraminal component, producing mod-to-high grade stenosis right C6nerve root exit foramen + early facet joint degen. Some deformity & indentation on cord.
C6/7 advanced disc osteophyic complex, effaces anterior CSF space and posteriorly displaces the cord. Mod-to-high grade stenosis of both C7 nerve root exit foramina. Facet joints - minor degeneration.
2 LEVEL ADR Surgery performed by Dr. Bierdstedt - NOV 7th 2013
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  #9  
Old 11-07-2013, 02:36 AM
RWS Dave RWS Dave is offline
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Join Date: Sep 2013
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Thanks, everyone, for your encouraging words, sharing your stories and perspective. As my surgery date approaches, it really helps to keep the big picture in mind. There are so many inspiring stories on here -- definitely makes it easier to focus on a future with less back pain. And when I compare that future to doing nothing, going forward with the surgery seems like a no-brainer.

Heidi - hopefully, our paths will cross at Medicos. I'm scheduled to arrive there on Monday, Nov 18. Can't wait to hear/read all about your successful outcome!
__________________
Nov 2010: herniated L4/5 led to back pain, sciatica and foot drop
Dec 2010: back pain resolved, sciatic pain and foot drop worsened
Jan 2011: micro-discectomy resolved sciatic pain and foot drop; back pain returned
July 2012: discogram reveals L4/5 and L3/4 have grade 3 annular tears and produced concordant pain
Nov 12, 2013: 2-level ADR (L3/4 and 4/5) by Dr. Bierstedt
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  #10  
Old 11-10-2013, 03:25 PM
RWS Dave RWS Dave is offline
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Join Date: Sep 2013
Posts: 73
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We made it to Hattigen. Flew SFO -->ORD-->DUS. All flights went smoothly (even arrived a few minutes early). Taxi driver was waiting at the airport as arranged. It's about a 30-40 minute drive to Hattigen through a bunch of small towns on mostly one-lane roads. We got to the Avantgarde Hotel, took a nap and then went for a stroll through the old part of the town. Since we arrived on a Sunday, just about everything was closed except a few bars, restaurants and an ice cream shop.

We are getting picked up tomorrow to go to Recklinghausen for some pre-op tests and a meeting with Dr. Bierstedt. I've heard a lot of good things about Dr. Bierstedt and also had good conversation with him a couple go months ago. Looking forward to meeting him in person, which I hope will help put some of my lingering anxiety about the surgery to rest.

Once we're done in Recklinghausen, it's back to Hattigen where I will get checked in to the hospital for surgery Tuesday morning!
__________________
Nov 2010: herniated L4/5 led to back pain, sciatica and foot drop
Dec 2010: back pain resolved, sciatic pain and foot drop worsened
Jan 2011: micro-discectomy resolved sciatic pain and foot drop; back pain returned
July 2012: discogram reveals L4/5 and L3/4 have grade 3 annular tears and produced concordant pain
Nov 12, 2013: 2-level ADR (L3/4 and 4/5) by Dr. Bierstedt
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