Laura, thank you for chiming in and sharing your experience! I so appreciate a well thought out post from someone who has also had to make this decision and done the research. Also, I just want to say how sorry I am for your relative and his/her fusion failure. I've been avoiding the fusion surgery for many years and am so hopeful that I am a success story with ADR. Sadly, I read or hear about so many fusion failures all the time. I wonder how many are truly successful? My gut has always told me that fusion was not the way to go for me.
I'm amazed that you got your insurance to pay for your surgery! If you don't mind sharing, which insurance company did this for you? I believe you stated that your insurance would only cover fusion in the U.S. Is that correct?
I think that surgery in Europe may end up winning this battle in my head mostly because of the surgeons' experience there and secondly because of the technology available there. (I'm meeting with a top notch neurosurgeon on Monday in the U.S. so, I'll see how I feel after that experience. I'm not highly optimistic based on my past experience but, I'll see.) I'm wondering, did you pay for business class air fare to avoid the discomfort of flying? My flight would be around 16 hours to Germany and that just sounds like misery to me. I've already flown many four hour domestic flights after surgery and that was not very comfortable. People kept bumping into me and that was pretty unnerving since I was so protective of my body at the time. It's so hard to get comfortable in an airline seat. The difference is that in my case it was several days after surgery whereas with Dr. Bierstedt, it would be two weeks later. Deciding to go to Europe is a huge financial cost but, really how do you put a price on being out of pain and the chance of living life again?
Initially, I thought the M6-C was the best cervical device out there. Now, I'm trying to sort out if the Mobi-C is equally as good. The M6-C is self restraining and therefore protects the facet joints better over time. The Mobi-C may have a lower HO rate. (Perhaps I'm just reaching because of insurance reasons.) That is the question I'm trying to get sorted out in my mind. There is a slim chance I can get my insurance to cover the Mobi-C here in the U.S. so, if it is as good or better in my body, there is that to consider. Lastly, the Mobi-C does not have a keel whereas the M6-C does have a keel. If a revision surgery is necessary, it is easier if the disc does not have a keel.
Fortunately, I am getting an opinion for Dr. Zeegers who uses both devices. In the end, I think I'll have to heavily lean on the surgeon's advice because getting a good fit is very important. I believe Dr. Bierstedt uses the M6-C more often than not and it is what he has recommended for me. I'm curious to find out what the other two surgeons recommend.
Thanks again for your thoughts!
Note re abstracts on HO. The authors discuss "Grade" and they discuss "Level." I cannot figure out what the differences are between these categories so, the numbers are not an apples to apples comparison. It is also unclear if using an NSAID after the surgery will help to stop the HO process.
Data "Dema" shared from Kinetics re HO at 24 months...see his prior post dated 3/20/2015:
Beaurain,
J. et al
Intermediate clinical and radiological results of
cervical TDR
(Mobi-C) with up to 2 years follow-up.
Eur Spine J, 5/12/09
85
24 mo. 3.9% 7.9%
Quan, G. et
al
Eight-Year Clinical & Radiological Follow-up of the
Bryan Cervical Disc Arthroplasty. Spine, Vol. 36 No.
8, 2011
27 96 mo. 11% 22%
Combined
M6-C Pilot & Registry: Germany, USA & Mexico
(Independent qualitative analysis by Medical Metrics, Houston, TX, USA)
122
24 mo. 14.6% 4.1%
Information from the Abstract that Cheryl posted confuses the understanding of HO rates even further:
http://orthopedicstemcellinstitute.c...tion_Techy.pdf
Results: Class I data from older FDA IDE studies indicates the incidence of grade- 3 and 4 HO:
1. in ProDisc-C to be 7% at 24 month and Level 4 only 8% at 48-month follow-up, 4% of any HO in Kineflex-C at 24 months.
2. The Bryan trial did not report on HO. PCM had 4.4% incidence of grade-3 or 4 HO at 24 month followup.
3. Prestige had zero anterior HO at 2 and 5 year follow-up.. Newer class I studies show a much higher rate of HO after CADR.
4. The Secure-C had 19.2% of grade 3 and 4 HO at 24 months.
5.
The Mobi-C trial showed a 15.9% incidence of level 3 and 4 HO at 24 months.
6. A review of all available class II data (also newer studies) indicates ProDisc-C with 63% of either grade 3 or 4 HO at 4 years.
7.
Mobi-C disc at two year FU: grade 3 – 3%, 4 – 6%;
8.
M6 at two-year follow-up an HO incidence of 48%;
9. Bryan disc at one-year follow-up 17.8% of patients had some type of HO and 6.7 had grade-3 or 4.
10. One class III paper reported a comparison of three CADR with an HO incidence of Bryan disc 21%, Mobi-C 52.5% and ProDisc-C 71.4%