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.

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!

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

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

Nice posts from everyone -- thanks Gene, Kelly, Jeff. :angel:

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/

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.

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.

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!!!

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?

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.