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ALSO CONFUSED, Clavel v. Bierstedt Clashing Diagnosis
Or perhaps I should say clashing prognosis since the bad discs are agreed upon(mostly). Clavel thinks he may need to go up one higher level than Bierstedt.
So, here's my latest round of email exchange: From Yolanda(Clavel): Quote:
Quote:
From Bierstedt: Quote:
Both great neurosurgeons, but two vastly different approaches. Its like Rodan clashing with Godzilla. You don't know which one wins in the end. Clavel's approach. Fixation of the L5/S1 with a Sovereign PEEK cage filled with bone graft and Activ L over the adjacent level(perhaps two). Or, wait, build up calcium stock and in a few months go for M6 instead. Bierstedt's approach. Go for a bottom two level M6 now. Doesn't agree about either subsidence risk or the need to fuse the bottom segment. That's tough. I want the pain to go away, but I want the right long term solution. Stability in my case is also something that may be what Clavel is going for since I'm a multilevel DDD and he wants to ensure that the upper levels aren't thrown off like the leaning Tower of Pisa later on down the road. Lost a slight bit of mobility, but then allow the muscles to rest on a solid foundation. Throw in ADRs above and retain enough motion. Make sense? Comments welcome. Please, fill in the space below. Your thoughts are why I'm here and most of you have great research of your own.
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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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To provide further clarity on the information exchange, here is an email from Clavel a week before this.
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So, there is disagreement about the chiseling as well as sacral slope(pelvic incidence). It seems the sacral slope is becoming more of an issue now on the radar of ADR neuros. I wonder why. I was told it was stress on the implant over the lifetime of the implant. Sheer forces present at L5/S1 that are not present at discs above that.
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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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Logic under duress
Drew,
The experiance of or the lack thereof of an incidence does not make the argument true or false. Logic should prevail. Many have had contradictory diagnosis by surgeons. For me fusion3 level or lamidisco 3 level. I took the second most conservative approach and 2 level L3-5 ADR. L5 S1 was gone and almost fused anyway. Sacral slope too steep for ADR. Pain free baby! Now is when you need calmness of mind. You have done the conservative approach so I would think the only question in your mind would be do I RISK!! Regardless of one or the other surgeons unprovable response about subsistence or lack thereof do I risk the rest of my life with problems, if you can hold on for 6 months. In either case your bone density would be better for either surgery from or by any surgeon. Same goes for the slope thing. Im 6 moths out and I can see with how htings have adjusted and why the shear angle could be a problem. Remember you are the one that has to live with the outcome. You actually answered your own question as well above. Foundational. No leaning tower. Use logic albeit very difficult right now to do so. There is a difference between wanting the pain to go away and needing to stop or eliminate any more nerve damage if that applies. Maybe ask yourself that question and you might come up with the answer. Heck worst case, if you wait, you can use the time to get in the best shape possible so you bounce back quicker. Lastly, none of the options presented are ever going to be optimal but rather the best estimate in fixing you. Logic dictates you add NO more to that unknown equation. F
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Lumbar issues 18 yrs herniations lumbar L3-5 multiple Epis etc etc Annular tears L3-5 cauda equina Cervical herniation symptoms 2011 C5-7 M6C by Dr Clavel on June 5 2013 L3-5 M6L by Dr. Clavel on 12.18.13 Living life instead of living the condition |
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dexa
Not to confuse you further,but you asked for comment, don't count on increasing your bone density in only a few months, unless you have seen a specialist . And consider that you have to keep it strong if you get adr , meaning that you better determine the cause of low bmd now. I can tell you that after hitting the obvious culprits,and finding no cause,these endocrinologists just throw pills and forteo injections at you,all of which I have declined. I have been at the density game for 5 yrs, the only saving grace is that I wasn't able to get prodisc because of low bmd, and thus might someday see m6 implants come my way
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Yeah, Frank, for me I wouldn't say its about nerve damage at this point. I have full bladder & bowel as well as sexual function. My legs are strong. I just have pain and stiffness. Sometimes cold feet.
There's pro and con with each approach. Just trying to weigh them and see. I can't predict the future but wish I could. Philly, there is a polymer disc like the M6 that doesn't have keels. The lp-esp. I'm researching it. Not too many doctors use it and I don't know why, but it looks like it would address the issues about spinal stability better than even the M6.
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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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