Going to Spain for 3 levell cervical ADR, (Dr. Pablo Clavel)

[Jarrod]

Mark,

Thank you for the info on c7/t1 and the complications that can arise with someone of my build. I am a big boy just naturally, 6'3 250 lbs, and am feeling better than I did when that disc herniated.

As far as pricing goes: Dr. Rajakumar (India) quoted me $30,000 for a 3 level, using the prestige lp.
Dr. Pablo Clavel (Spain) quoted me $39,000 for a 3 level, using the m6-c.

I am sure that c7/t1 will have to be removed no matter what as it was told to me to be a major factor of my symptoms in my left arm by both stateside neurosurgeons and abroad surgeons.

As far as choosing Dr. Clavel I have read great things about him and his skill as a surgeon, from the info I have gathered he has done over 300 cervical adrs using the m6. I will now contact him and ask him about his experience with c7/t1 adr surgiers and also reinterate my size and build to make sure he is confident in doing that level. Here is what my mri report says word for word.

c5/6: Broad, moderate, undulating postier disc protrusion producing severe canal stenosis and apperant slight cord compression. There appear to be some intrinsic signal changes in the cord at this level which may reflect contusion or myelomalicia. There is moderate to bilateral foraminial narrowing present.

c6/7: Large, broad left paracentral disc protrusion is present severly effacing left lateral recess with a moderate degree of associated canal stenosis. There is moderate asymmetrically left sided forminal stenosis.

There is a large left paracentral to left lateral disc herniation which obliterates the left lateral recess and exit foramen. The thecal sac is deformed and turned related to the disc herniation but overall degree of canal stenosis relatively mild.

So I guess I've done a number on myself. Never had any back or neck pain before Sept. and no atropy of the arm. Also no dexterity problems either.

Sometimes I wonder if I should have surgery because i am not in severe pain like I was when I herniated c7/t1. But all 4 surgeons who have seen my MRI scans agree that I am in danger if I do nothing. Fusion is not an option for me if I am an ADR candaite, which I am. My next move is of course to talk to Dr. Clavel about my c7/t1 disc replacement and to arrive in Spain on Dec 5th. Not scheduled for surgery till the 9th. I will personally talk extensively with Clavel when I arrive in Spain about all my concerns.

Mark thanks for the reply and if you have time will you please post other questions I might want to ask Dr. Clavel. Again thank you to everyone that has replied and to all that have posted their stories and questions on this board, I wish the best for all of you GOD BLESS.

[mmglobal]

Is the paragraph below C6-7 for C7-T1?

I'm not sure you care much if they were to have to fuse that level. The mobile segments in your neck will already be insulated from a fusion by the 2 ADR's above. I don't know how much easier it would be to do an ACDF @ C7-T1 than an ADR? Perhaps the requirement for a 'straight in' approach would be a bit more relaxed. Whatever it is... it is.

If I had it to do over again, I doubt I'd put the ADR in T1-2. It was possible in me because I have the long neck that goes with being a tall, skinny guy. (Ok... formerly skinny.) I wonder if my thoracic pain is related to the difficulty of getting the ADR in there?

Words like obliterate and myelomalacia give pause. It is my understanding that once you get there, there is a 1/3 chance that symptoms will not be resolved when the cord is decompressed. I know it's tough to consider surgery without being in a lot of pain, but if the symptoms were to be locked in... it's nice that they are not yet severe. With the c-spine, things can go to hell in a handbasket in a hurry... then the 1/3 chance of not resolving symptoms is very daunting. The atrophy is another 'hurry up' indicator. (All this comes along with the appropriate "I'm not a doctor" qualifiers... remember, I'm a computer guy... don't listen to me about this stuff!)

300 discs is a very good amount of experience. It really seems like you've done a great job with your research. I look forward to learning more about Clavel. I spent a week in Barcelona last May... it's a shame that I didn't connect with him. Talk to you later,

Mark

[Jarrod]

Mark,

Nope, c6/7 is right. I forgot to label c7/t1. The Impression is as follows:

Multilevel disc herniations with broad undulating protrusion at c5/6 contributing to severe canal stenosis and appear to be some signal changes in the cord at this level. At c6/7, a large left paracentral protrusion produces a moderate canal stenosis, and c7/t1 level a very large protrusion obliterates the laft lateral recess and exit foramen.

I enjoy your posts because a know how informed you are and the procedures that you have seen and experienced is by far the most comprhensive on the internet. I must ask you, do you recommend a fusion over ADR at c7/t1 because there is less movement at the thoracic spine (flexion,extrension) than in the c spine. Should I worry about adjacent disc disease after a possible fusion at c7/t1. It is my understanding that when you start to get into bad discs in the thoracic area it can be difficult and even more dangerous. From what my US surgeons told me c5/6 and c6/7 have more than likely been herniated and diseased for a couple of years and their weakness and instability put the adjacent c7/t1 disc under more stress until my activities combined with added pressure made it herniate. This is what I'm trying to avoid, so whatever is the best route for me I will take. I am setting up an extensive phone conversation with Dr. Clavel so I can ask his opinion on all the questions that have come up.

Also do not worry, I will keep you and the forum up to date with what is going on. It will be important for me to post my story and outcome for other relatively young adults who are in a serious situation such as mine. I agree that something has to be done about my issues in the c spine area, as I have read also that things can get really bad really fast. Scared to death, but posting seems to reassure me that I am making an informed decision based on mountains of research and with talking to people like you who have been through it.

[mmglobal]

Jarrod, I wouldn't presume to recommend any surgery. In my opinion, all things being equal, I will choose motion preservation over fusion if I have the choice in treating a mobile segment. Not all our decisions are black and white. In some cases, you are highly motivated to use motion preservation devices because you fear adjacent segment disease more than you fear the risk of ADR. If you were talking about fusing 2 segments in the middle of your neck, you would be highly motivated to use ADR instead of fusion.

Because of all the structure around the thoracic discs, they move much less than the highly mobile cervical discs. Think of your c-spine as a highly mobile system on top of an (almost) immobile t-spine. The highest risk of adjacent segment disease will occur at the mobile segments adjacent to a fusion. The longer the fusion the more the risk. When you are talking about a 3-level construct from C5 to T1, the segment that you will be most concerned about will be C4-5. T1-2 is already in the mostly immobile system and a single level fusion above it would not put it at risk.

When I'm talking about the options at C7-T1 I'm thinking about C4-5. Will there be a significant difference in the potential excess load placed on C4-5 if you have 2 ADR's and a fusion below, compared to 3 ADR's below? I think not. The 2 mobile segments at C5-6 and C6-7 will insulate C4-5 from whatever additional load is generated because of a fusion at C7-T1. I would never say that I recommend a fusion there. I'm just pointing out that there is less motivation to maintain (preserve, restore) motion at C7-T1 because of the 2 ADR's above. All things being equal... I'll choose motion preservation, but if there is some motivation to fuse (possibly because of some borderline contraindication, or the difficulty of ADR at that level), that motivation will trump the desire to preserve motion. That desire is reduced by the 2 ADR's above.

It sounds like I'm talking in circles... I hope I'm clear.

Remember... I'm not a doctor and these are just my impressions based on my experience. Take it for what it's worth... the ramblings of a computer nerd.

Good luck!

Mark

PS... say "Hi" to Messi for me! Make sure you take in a game.

[Jarrod]

Mark, I got it. Thank you for clarifying the c7/ t1 situation, I was unclear about the t1/2 disc being mostly immobile and there for not being at risk for adjacent disease. I thought axial compression on a disc might also contribute to it becoming diseased also, but if most of my concern is with the motion of the disc ( flexion, extension) then I see the reasoning behind a fusion at c7/t1. Also thanks for clarifying that if an ADR is not feasible or to difficult at that level then a fusion is not the end of the world. It's like I've read on this forum so many times before, fusion does and can have a valid place in spinal situations such as with us on this board. Again thank you and everyone who posts for their knowledge and insights.
Jarrod

[cfbugsbunny]

I am glad that I found this forum. I have frequented ADRsupport.org prior to my two-level ADR at Stenum Hospital in Bremen, Germany. I did learn at this forum that Dr. Clavel is very well respected and a professional by all means. I would encourage using all information that is available to you prior to making a decision and both forums seem to provide quite a bit.
Mark

[Jarrod]

CF,

I have been on both forums since Sept. I've read all the cervical stories and have looked at my options carefully. Also researched Dr. Clavel and have talked to other forum members who have had their ADR's done by him. I read your Stenum postson ADR Support also. I have made all my arrangements and feel like 8 have justified for myself that ADR surgery is a better option than fusion or waiting for myeopthy to kick into full gear in my cervical region. I would like to thank all the hundreds of posters who have shared their stories such as yourself for their courage and willingness to try and explain their outcomes (good or bad) to us newbies. Your experience is invaluable to people like myself, I hope and pray that I am ready to tacklethe otherside like so many before me. Thanks again CF.
Jarrod

[fortitudine]

Jarrod - your departure is coming up. All the best for a successful surgery and a speedy and pain-free recovery! We'll look forward to hearing how it all went.

[Jarrod]

Thanks guys,

Maria, Fortitude and all those who post and share their stories for all of us, You guys got it, I will be posting my outcome and experience as soon as I can. Taking my computer so I can update. Also very nervous, flying out Sunday at 2 p.m.. Thanks for the kind words and luck. Be talking to everyone soon. Take care,

Jarrod

[cherylstewart67]

i have had stand alone peek cage at c 3/4 bone graft with plate and screws at c 4/5 5/6 and trust me when i say it will lead to more ddd. if i could go to europe, brazil, or india i would not hesitate. i just don't have 43,000 usd to do it. where am i going to get that king of money? bur fusion has failed me. the only reason doctors here still do it it is one insurance will not pay for multi level adr because the fda has not yet approved it and two the doctors would have to retrain. time out is money lost. i may be totally wrong, but after what i have been through and researched, that is merely how i feel. i can't even type well anymore, thus the reason for lower case

[Maria]

Cheryl,
there are many a doctor/surgeon here in the US that is trained to do ADR lumbar and cervical and did take the time out for this. Still as you stated FDA regulations/restrictions re levels that can be done is a limiting factor in terms of getting multi levels paid for and sometimes even a single level even if recommended by the surgeon.

I believe I'm correct in stating there are surgeons in the US as well that will do multiple levels for cash altho I believe this is even more costly than in Europe let alone other places such as India, Thailand, etc.

I had both fusion and ADR recommended for me re my lumbar area after 2 disectomies but didn't really like any of the recommendations fully enough at the time because I felt I should have vertebroplasty as well and it wasn't offered here. I couldn't afford Europe or anywhere else either tho WC would have picked up the tab at one point.

Now I'm no longer a candidate for ADR in my lumbar spine at the levels that were needing it. My L5S1 autofused and saved me the hassle of having to go for more surgery at least at that level so that was nice.

My cervical spine is somewhat problematic and so far up until at least 2 years ago I wasn't a surgical candidate or surgery wasn't recommended so I guess I'll just see what happens.

And guess what?? I have DDD in my cervical spine as well as throughout my spine. Probably well hastened in those lumbar levels (L3-L5S1) because of discectomies altho I've been told many times that my spine has DDD throughout and it's probably largely hereditary/genetic.

Whoohoo. As long as it doesn't hurt I'm Ok if it's there.

[mmglobal]

Jarrod... looking for an update... looking for GOOD NEWS!

[cherylstewart67]

yesterday i saw a nuero surgeon for what i was hoping would be a referral to a pain mgt doc as i am ready now to submit to pills. in stead he is sending me back for injections or radio freq. proceedures...anyway, once i told him that i wasn't willing to consider anymore fusions, he could not get rid of me fast enough. if fusion is all they know, that is all they will tlak about. they won't tell you the sucess of patients with adr cause they can't or won't do it here for one reason or another. but trust me, most of the time fusion should be avoided.

[dshobbies]

Cheryl,

I don't know what your insurance circumstances are but it's time to find another doctor - get more opinions, etc. No one should be dismissed because they want more information or don't want a certain procedure that a doctor recommends.

I once had a doctor tell me 'when the patient's circumstances become difficult, I simply have to work harder.' To many simply won't do that.

Regardless, I wish you and yours happy holidays - and start afresh in 2011.

Dale