No Surgery... Yet
 

New here. Hello everyone.

I've been a weightlifter since I was 12 years old and haven't stopped at 44 years old. There's plenty of public service announcements about drugs, HIV, heart disease, stroke, breast cancer, smoking but nada for being careful for one's spine. I would have listened to that one. At least I think I would have.

Last MRI in Feb. 2012 showed two herniations L4/5 & L5/S1 as well as a L2/3 bulge. I don't lift weights anymore. I still do pullups though and plenty of machines, but no direct load bearing on spine weight lifting, only pulling.

I am in the process of getting another MRI soon to see the latest 'look' of things in the lower back. I have had a recent bad turn with what feels to be the L5/S1 with chronic sciatica now along with some right foot numbness. This is now a month.

I've done plenty of traction and paid a chiropractor $5k this summer to 'decompress' me on his fancy machine. Temporary relief.

But, this isn't working. I can't sit and can't drive. Can't eat at the dinner table with the family. Can't go to the movies. You all know what this is about.

I want to fast track my healing but I don't want to rush into anything either.

I am with Kaiser Northern California which I'm not happy about. My spine specialist whom I've met with 3 times now is a small, affable asian lady, but she acts like a bouncer at a nightclub not allowing me to get in to talk to the surgeons.

I have already researched about the overseas option Ritter-Lang, Germany, from all of you folks here giving me a heads up.

I meet again with my spine specialist(Kaiser) this Wednesday to push for an MRI and X Ray to get an update.

Oooops. I just found the hot thread on Stenum and RL/Clavel. Didn't know there was so much passion on the subject till now.

Am open to hearing either side.

I'm sure people are getting tired of me harping on this, but you don't need a doctor's permission to get an MRI or xrays. You can pay cash and there are imagine centers who are happy to negotiate a low cash price. I paid $300 for an MRI and xrays and $200 for a CT scan after calling several different imaging centers and playing let's make a deal until I got the lowest price.

There's something wrong when we have to 'push' our doctors to get films. If you can spring for the few hundred to get an MRI, just eliminate the middle man and go around the doctor. You should never have to push a doctor to do what's in your best interest.

Also, several doctors overseas will look at your films and offer a free opinion.

Good luck, and I hope your docs start putting your health first.

Thanks. I appreciate that. Last time I had an MRI, my portion of the cost was $1,800, and another likewise amount was billed to my insurer, supposedly.

Which is a ridiculous amount.

I will look at alternatives.

I went with Dr. Bierstedt, I could have easily gone with Clavel. From my understanding both worked with R-L. As did Malte Petersen, if you want to Google.

Adr
 

Did Bierstedt work with RL???

It is my understanding that Dr. Bierstedt worked with Ritter-Lang in Stenum. Malte worked there as well in a business context.

Adr
 

I recall malte working there but have never seen an affiliation to Bierstedt? Nothing mentioned about stenum in bierstedts resume either

Thanks for the heads up Ian.

My portion for MRI, Kaiser: $925
With dye: $1257

I called around other places to pay with cash:

My portion from Mercy: $1,800
With dye: $2000

My portion from a guy down the street:

My portion for MRI: $500!!!
With dye: $925

Laison with Bierstedt today told me dye was not necessary, so Ian saved me $425!

Sweet! :beer:

Way to go Ian! :clap:

Waiting on second MRI/X ray report. Hopefully will come later today, but I already know. It 'feels' like my L5/S1 has totally collapsed in there. I'm feeling micro-movements, bone on bone. And I'm not looking forward to Kaiser's approach to my problem. I can already here the cliches.

So.... I know this is subjective, but would like to have like a field poll or something for the folks here, and I know I'm going to get a ton of different answers, but I am sending all my paperwork and MRI stuff out to 1) Clavel 2) Bierstadt 3) Zeegers and 4) TBI.

Would anyone like to rank those in terms of which they feel is the best to worst?(with explanations if possible, but not necessary) It would really help me.

I've only spoken with Drs Clavel and Bierstedt. Based on my conversations with them and several of their patients I don't think you can go wrong with either doctor. With that said, I'm having Dr. Bierstedt perform my ADR in a couple weeks. I based my decision on the aftercare/rehab program that Dr. Bierstedt's team has set up. It just seems a little more comprehensive. As far as the surgery goes, I think both doctors would be an excellent choice.

I'm sending off my MRIs today to both as well as Zigler. Am very interested in you and will be following your progress with Bierstedt.

My MRIs kind of frightened me. Lumbar area, discs look thin and black, no light in any of them. What in the hell is wrong with me?

Kaiser's spine specialist called me finally today and gave me a bunch of cliches. She said there is mild bilateral nerve root compression at L5/S1 but it doesn't feel mild. My feet get numb throughout the day and my butt starts to hurt in the afternoon. Can't sit either.

Her advice? Kind of live with it.

I'll definitely update my progress as I go through my surgery and recovery.

Sounds like you've got some desiccated discs going on. The 'light' represents fluid. Black means their devoid of fluid. What many doctors don't realize is that a persons films alone aren't a good indicator of why they're in so much pain. I'm becoming less and less patient with doctors in the US.

Ha! "Live with it." Classic. Makes me want to poke a doctor in the forehead repeatedly with a toothpick and each time they complain tell them to live with it.

IAN,
Kudos to you for suggesting self referral/cash for imaging...while I have amazing insurance (just paid $62 out of pocket for my MRI, the total billed to my insurance was $1800) it's often times overlooked that we have choices.

And don't get too jealous of "amazing insurance", as I am looking at a two level cervical ADR which I'm anticipating a denial for...

Hardest part is how nobody relates to what you're going through. The wife, while supportive, just has no clue. And Kaiser is absolutely disappointing, from their spine 'specialist' to the PTs to my GP. They just don't even seem very educated at all.

Looked at my friend's MRIs yesterday who is my age(45) and was disappointed to see all his other discs look really bright and tall. I thought perhaps they would be deflated like mine and that mine were more the norm. Not so.

Will be nice to get the Euros to look at my MRIs/X ray and get feedback from them.

The thing about chronic pain is, that unless a person has experienced the same thing, that have no way of relating. I love it when people tell me about the time they broke their arm, or cracked a rib and how it was the most painful thing they've ever experienced. I just roll my eyes. Unless you know what it's like to wake up with pain and go to sleep with pain, day in and day out, you have no idea what it feels like.

My girlfriend, who is a national caliber professional mountain biker, has had 4 knee surgeries and her ankle is basically fused. She eats pain like candy. Seriously, I don't know anyone who can absorb more pain. But she also deals with constant pain off the bike and wakes up every morning limping. She understands what I deal with, and it helps to have someone who doesn't dismiss what I'm going through as being all in my head

I've been racing mountain bikes for a while, and cyclist like to talk about suffering on the bike during a hard ride or race like it's a badge of honor. I just walk away from these discussions because it'll just piss me off if I have to explain to them that I'm in pain before I get on the bike and 30 minutes into a ride I can't feel my left foot. They think enduring pain is fun because as soon as they get off the bike the pain stops. When in my case the pain really begins after the ride is over.

But enough of my whining. Keep searching, Drewad, you'll find relief at some point. Just don't give up.

Waiting for Zeegers 'perfect diagnosis'. In the meantime, he gave me a little taste of it which shows multi-segmental lower lumbar DDD, the bottom two showing the most damage.

Malte got back to me yesterday. He is recommending a two level M6 at the L4/L5 which is basically gone as well as the L5/S1 ditto.

Here's his own words:

Dr. Bierstedt reviewed and commented your medical data.

Findings/diagnosis
Severe Degenerative disc disease L4/5, L5/S1
Moderate DDD at L2/3 and L3/4

Here's their recommendation.

Surgical decompression of the spinal canal by total discectomy, removal of osteophytes and artificial disc replacement L4/5 and L5/S1

Pre-operative discussion on disc replacement L2/3 and L3/4.
Assumption: these levels are clinically irrelevant. If symptoms develop in the future, additional disc replacements can be offered by lateral or posterior surgical approach.
For now these findings could be ignored.

I responded back to Malte and asked this.

I was curious about this....

" If symptoms develop in the future, additional disc replacements can be offered by lateral or posterior surgical approach.For now these findings could be ignored."

If I needed these two levels later on, do you mean you couldn't approach from the anterior like you would be this time? And if so, why? I never knew you could do an ADR from the posterior.

He responded back thusly.

The surgery will be performed by Dr. Bierstedt.
Ref disc replacement in high lumbar levels:
The anterior access to L2/3 is complicated due to the vessels. or higher leels Dr. Bierstedt uses a posterior approach

referencing this, the Triumph. Was wondering if anyone heard of it?

TRIUMPH® Lumbar Disc, posterolateral approach - Spine

However, what I want input on is that some here have received a 3 level ADR and vessels weren't an issue with you I assume so it is possible. Did Biersdadt or any other doctor mention higher lumber levels being a contraindication from an anterior approach?

I've only heard of three level ADR from L3/L4 to L5/S1, but I'm unfamiliar with complications concerning vessels at L2/L3. I've read that Dr. B is one of the few doctors who performs ADR higher up, especially in thoracic vertebrae.

Ask to speak with Dr. B over the phone. I was able to clear up all my questions in one conversation that would have taken countless back and forth emails.

While he primarily uses the M6, he also uses the disc that he feels works best on a particular patient, or in a particular area of the spine. With that said, I've never heard of the Triumph disc.

Ian,

Could you link a reference or case where an ADR has been placed in the thoracic area of the spine. I seriously have never heard of this being done. I've always thought L2/L3 was the highest level they could go for an ADR. Higher than that i believe your getting into the rib cage.

I misspoke. I blame it on lack of sleep. :sleeping:. He replaces discs from L1 down.
You can read more here: Dr. Thomas Bierstedt

Ian, I thought you'd be up in a plane today heading across the ocean. No?

I depart LAX at 7:25 tonight. Didn't sleep a wink all night!

So... a couple interesting things I learned today and wanted to bounce off you guys.

First, I asked Zeegers about why he preferred the Activ L over the M 6. He told me the M 6 is a good disc, especially the decompression aspect inherent within it.

But, the M 6 can only go in one way, from the front. The Activ L can go in front or posterolateral as well if need be. Also, the real key to his preference was due to removing the ADR if it ever had to be taken out in the future. The M 6, while it can be removed, is much more difficult to take out. You have to have a skilled surgeon to do it and its tricky.

The Activ L is very easy to take out and has tools just for that purpose if necessary, making it very adaptable.

Anyways, he has more on that for me and is going to email me more stuff in the way of specs. Hope its helpful because I can't get Spinal Kinetics to call me back at all.

I've read this about the Activ L also.
I believe after surgery for an ADR scar tissue causes the veins to adhere and makes it extremely difficult to move in case of any kind of revision.
dreward if you go to the Braun website you can see all the info on the activ L

Dr. Clavel did mention that he thought the Activ-L was a good disc and has used it a few times. He said that revisions get kind of a bad rap...He said the ones he did with the M6 weren't terribly difficult. Food for thought. If you have an L5/S1 disc issue with no other contraindications....the Activ-L has specific designs to better fit various sacral slopes at that level. Being Zeegers is well versed with that disc...i'm sure he'd have no issues with finding the correct configuration. With 2-levels of work in the lumbar and wanting to have an active work and lifestyle again....it was a no brainer to M6 my lumbar for the shock absorption alone....especially since i had to have the level below the M6 fused.

A good question to ask would be the ability for scar tissue to form....i've heard posterior approaches are prone to scar tissue formation and anterior approaches are far less. But, I don't know about this posterolateral approach. I wonder if they still have to cut the anterior ligament to get the disc in...If not, that would be a plus for the Activ-L, avoiding potential instability issues.

Dr. Clavel said if asked about the potential for instability after cutting that ligament with SpinalKinetics. They told him the inherent design of the M6 makes up for the potential instability that MIGHT be caused by cutting that ligament. WE ARE ALL GUINEA PIGS!! :Dead:

Following your experience
 

I am following this thread to see how Kaiser is responding to you. I work at Kaiser in Northern California and am very curious where they stand regarding ADRs.

So Kaiser yesterday told me, flat out, they don't put ADRs into people anymore. My Kaiser surgeon, Dr. Veoglei, said that they stopped about 6(I'm guessing now) years ago.

Here's my take on that. Kaiser is the most bureaucratic of all HMOs and thus, cost containment issues. Ergo, they have the most robotic statements to patients regarding their issues on what they can and cannot say(legal). Cost containment is paramount to the organization. Its how they stay in business. And with the FDA only allowing a one level... well, that only makes a guy like me more S out of luck. I am a multi-segmental. Thus, at 44, it appears I am in no man's land from an HMO perspective. A shame.

Kaiser is not a dr/patient organization. You need a PPO to get that. Kaiser, in a lot of ways, is like a cult. Those strange pink buildings almost have a Scientology feel, don't they? Anyway, I pushed and pushed my surgeon and he could only say what he was allowed to say. A guy like me, they're going to do steroid injections, they're going to prescribe any drug I want(I don't want any).

By the time Kaiser is completey finished with me, I will be an opiate addict and my back much more worse off with possible early fusion and a chain reaction of future fusions.

My only hope, for now, is learning as much as I can here and getting all the doctors(both overseas and here) opinions as to ALL my options. My goals are simple. I want to drive a car again without having to be the strange Driving Miss Daisy dude in the back. I want to sit at a restaurant with my wife. I want to be able to go to a movie theater and sit in a chair. I don't want to do triathalons. I just want to be a part of the human race again, and not be excluded from it. This isn't too much to ask, is it?

Even at Kaiser yesterday, there I am in the waiting room, a very healthy guy who can't sit down. Everyone is sitting down, all the sick people are sitting down quite fine it appears. I can't sit down. And there are no beds, so I'm standing or taking a knee. And since my doc was backed up an hour, I finally gave in and laid on the floor and had people walk around me!

This leg pain has been a journey and its one I will get to the end of eventually, but I don't think its going to be inside the giant pink buildings that gets me to where I need to go.

Dreward, im going to say something you might want to hear.
This is not personal nor meant to insult anyone here or backpain sufferers in general.
You have a herniated disc that is causing you legpain.
You have an option as far as removing your legpain.
You can have a discectomy.
I've had 2 for legpain over the years.
Both times legpain was gone.
If I would've stopped playing football and basketball after my first surgery I might be in better shape now.
If I had quit smoking when I was younger, stretched more, built up my core etc. I might be better off.
I know many people who've had discectomies and are still doing OK today.
When we are unlucky enough to injure our spines we have to really work a lot harder then others and also keep it up.
I think we look for that magic surgery that will make us 100% and it probably will never happen because of the complexities in the human spine.
While ADR seems to be great, I think we think its one of those magic surgeries.
I'm speaking from experience and I know if I really worked hard I could manage better than I do. It's just hard to keep it up every day, every month, every year.
That's just my 2 cents bud.

M6
 

I just received a response from my US Representative. There is NOTHING in the pipeline about this M6. IOW, J&J have this company locked out of the US market, for quite some time. Guessing, another 7-10 years.

Roger that.

I guess for me, I think that if they're going to go in, I'd rather they did me in the front and get around all that back muscle destruction along with the potential for future adhesion(scar tissue) build up which can sometimes get to being worse than the disc herniation.

Zeegers told me yesterday that my two bottom discs are both 80% gone, so I figure go for the real fix now and have a potentially better outcome than if I just get bits and pieces taken out here and there.

Zeegers is top notch IMO.
Thank you for not blowing up on me about my response.
I so badly want to pull the trigger and go overseas.
For me it's not about the travelling to a foreign country or the $$$$$.
I'm just scared that i'm not at the point were i'm in debilitating pain.
If my legpain were to come back though, i'd probably be on the next flight to Germany.
That legpain is extremely evil.

Adr
 

I've spoken to Zeegers as well. He seems very sharp but his eval cost is insane and I've heard of him demanding more money to complete the diagnosis. I was turned off by that immediately

It is, but I consider it the foundation for building upon a successful outcome. I'm also paying Laurryson a nice little mint as well as Clavel(smaller). I want all the best minds on this. I deserve it. I'm also obsessive.

Here's some useful information from Zeegers today.

Dr. _______________

For more information on Activ-L and M6-L, have also a look at my website www.zeegersadr.com and in my Facebook page.
The commercial information about these implants on the web is incomplete, there is much more difference between the implants than is published.
It could be necessary to make a combination of Activ-L and M6-L on the different levels because of the implant design and instrumentation.

Now to your questions:

For sure we will need more pre-surgical tests.
If we need a CT-Myelo and/or a discography, that is estimated as Beta Klinik costs, but not yet included in the Beta Kliniks estimated gross surgery costs.
We will send those cost estimates later.
Discography estimate: Euro 600
CT Myelo estimate: Euro 538

To clear why I would like have the freedom to implant an Activ-L Artificial Disc, a STALIF cage or a M6-Lumbar Artificial Disc depends on many biomechanical and surgical issues,
for example: because of the vertical instability, the possibility of instrumental oblique approach and the correction of the lumbar curvature, which is almost impossible with M6-L,
I would prefer Activ-L, depending on the anatomy during the surgery and only if everything is concordant with the new pre-OP tests.
The image below is showing the solution for the oblique pararectus approach, to safe the soft tissues and vessels during the approach.



https://col128.afx.ms/att/GetInline....e9b&oneredir=1

The images below should give an impression how much freedom the surgeon has in posting the Activ-L Artificial Disc.
This is impossible with the M6-L. The instrumentation of the Activ-L allows also to remove the implant when it is posted
in a wrong or almost wrong position. This is not possible with the M6-L. Therefore revision surgery with M6-L is much riskier
than with Activ-L. The gossip about 'damping effect' never impressed me. In my opinion there is no difference in the effect they have
on facet joints respectively over time. If the risk of facet disfunctioning seems high, a STALIF hybrid construction is preferred.




https://col128.afx.ms/att/GetInline....15c&oneredir=1

The combination of the Activ-L with a hybrid STALIF has perfect results on the long term.

https://col128.afx.ms/att/GetInline....134&oneredir=1
Don't worry, a discography will not weaken other structures or 'puncture'(potentially weaken) discs above such as the L2/L3 and L3/L4.
I did this a thousand times and never had this experience. My method of discography is very sophisticated and safe.
To do too little or too much is completely depending of the new pre-OP tests and we will discuss this during consultation with me in Germany.
If the pre-OP tests shows only ONE pathologic cause of your leg pain, decompression could be appropriate to release nerve impingement,
but it is unlikely.

truly,
drs.Willem Zeegers MD

Adr
 

Interesting stuff. Bierstedt claims discos can cause DDD. The m6 can restore lumbar curvature to almost any degree you wish, it depends and what angle the doc uses. Have you spoken to clavel or Bierstedt?

I am 7 months post-op from 3 level with Dr. Bierstedt and doing well. I plan on posting my 6 month follow up soon(been very busy with work). To the comment about a disectomy being sufficient, that may not be so depending on how much height loss you have and/or you have a large annular tear. If you have any questions for me feel free to ask.

Appointments with both in early March. I do like the M6.

Cause? Maybe. Accelerate the degenerative process by suppressing the immune system?

YUP. :(

What's causing the degeneration?

1. Poor diet.
2. Bacteria and microbes of many kinds.
3. Trauma.
4. Compression: sitting, etc.
5. Lack of blood flow and oxygen.

Drew, I am glad AND sad that you posted this from Zeegers as it pegged the needle on my BS detector:

"...Don't worry, a discography will not weaken other structures or 'puncture'(potentially weaken) discs above such as the L2/L3 and L3/L4.
I did this a thousand times and never had this experience..."

Dr. Zeegers is surely a hero and great teacher to many, but his ego is well ahead of him here in my opinion (see previous comments). He's writing in the first person and has provided NO evidence that his particular upper or lower discos are NOT injurious.

Maybe he's using antimicrobials or cart. regen therapeutics, but if he is, he aint sayin...

Good grief. These German docs have been outsized in their egos for so many years. I am OK with big heads, but not big heads without evidence. Or with failures. Which all of them have.

Stop the spin.