Dr Bertagnoli

[Cindylou]

I don't envy you in the decision making process Gil. I remember it well and it is very tough weighing everything out. Daunting, at times. You've been given some very good advice here tho. Toss in some prayer to the man upstairs along with everything else and I feel certain things will begin to come together for you. :thumpup:

[Gilbert P]

thank you

gil xx

[runagain]

Gil,

You have some tough decisions. From all I have read/heard/spoken to others is that the complexity of the operation goes up when you get a three-level disc replacement.
And I would say, Dr. B, Dr. Pimenta and the Stenum doc all have the most experience dealing with more complex cases. They say (in research articles and speaking to physicians themselves) a physician's experience goes up after 100 cases and these doctors are in the thousands of operations. The more operations, the more a physician's skill increases, being able to anticipate outcomes, being able to troubleshoot problems and handling complex cases, unexpected occurrences during surgery.

In the US, the doctors have not done as many cases, but there are the doctors at TBI, Dr. Delemarter, Dr. Regan and Dr. Yu?? @ Yale ( I have probably butchered his name but the exact name does not come to mind right now) that have done the most here.

I also believe that it doesn't hurt that you get other opinions, so that you can judge what looks like is best for you. But I can also tell you don't think you will get identical answers. I found that the opinions I got varied so much that I was a bit confused and then I had to research the ideas, figure out what made the most sense medically and use my gut instinct.

What I heard about ADR from my first doctors was: You are risking dying when the plastic comes out of the disc and hits and slices your aorta. Woah...that does not sound good then I asked them, what is your experience with ADR? "Oh, I assisted with Charite implantations in medical residency."

A doctor I worked with and knew pretty well as an excellent doc, spent at least an hour with me, explaining fusion (his experience), his experience with ADR ( which was Charite and a training class, but he had vast medical/surgical experience).
I won't say what he said about fusion here (PM me if anyone is interested) but his advice helped formulate my plan of attack to find out what was best for me.
So although the opinions varied significantly, I learned from that and it helped me better understand ADR and ultimately know that was the best op for me.

My doc didn't have 100 lumbar ADRs under his belt at that time, however, he is extremely talented and had experience with cervical ADRs and some lumbar ADRs, fusions of all kinds, etc... He laid out the facts and said I had a good chance of recovery. He didn't push ADR over fusion to the point of dismissing fusion. Just told me the chance of preserving my discs above and below l4/5 were better with ADR because of the motion preserving aspect of the discs. I was also told by others that his fusion success rate was very high.
So before surgery when he told me if he got in there and couldn't do an ADR, he would do fusion, I though that is alright (and I prayed for ADR). I know there are limitations to what surgeons can do. It was fine.

So some people getting fusion or ADR, they are both okay as long as they are indicated for that particular person. I can tell you before my op, I was at peace with my decision.

We cannot tell you who to go to or what surgery is best, that is between you and your surgeon.

I can tell you nearly six months post-op when I felt so good after ADR surgery and I was at PT and I felt a pain I was familiar with, what I call a "take your breath away" pain, I felt like the bottom dropped out of my world.

I knew it was another disc because I had a positive discogram at L5/S1 but it was dismissed as "referred pain" from L4/5 by another doc. That doc didn't transfer my records completely to my surgeon or I would have had two levels operated on. To be somewhat fair, the CT after my first disco did not show an abnormal disc morphology. However, I had pain at L5/S1 (which you shouldn't have pain with a normal disc), it was dismissed as not-significant, but i told him it was 5-6/10 because compared to L4/5, it was not as bad, and he had to inject the disc twice with Lidocaine to "calm it down".
I think I have a high pain tolerance and I do not show how painful something is and that gets me in trouble because then some doctors do not take me seriously when I say something hurts pretty good.

My point is if Dr. B or some other doc that has that kind of experience says, we should do three levels instead of two because so and so level could go, I would consider that very deeply.
From my experience, it is no fun going through this twice. After ADR surgery, the doctors do not even consider (unless there is an emergency) that they should do something surgically about an unusual pain/symptoms because it takes up to a year or more to heal and things crop up here and there. I had to push to get some intervention/ treatment.

I do like that Dr. B, and I think Dr Ritter Lang, do a discogram before your surgery.

I can talk a little about discogram, considering, I just had my third one Thursday (Something I would not recommend highly).
They do vary. One thing has remained constant about my L5/S1 disc, it has been painful each time. With the second-disco, it was painful but not "childbirth" painful and I can take a lot. My result was partially concordant because "I didn't jump off the table", the disc morphology was "normal", the disc "showed" pain at a high pressure rather than lower and no major problems showed up on the CT. No problem with my surgeon as I told him I also had 10/10 pain in a leg that occurred a day after the disco and lasted for at least a couple weeks. After that, he went off to view my test results (the films) and then came back. Finally, it was determined that L5/S1 was my "pain generator" after I had ruled out other potential culprits.

Well, Thursday, a little more than a year since my second disco dance, I had 10/10 pain in L5/S1 (I was blinded to which disc was being tested). OMG. What a difference in a year and three months makes. Surprised me even though my pain has been increasing.

Your spine changes and I don't care if you don't show stuff on an MRI or CT, I have learned you shouldn't have pain in a 'normal" disc during a disco. So I definitely believe in discos.

Another thing to consider is that when you speak to a doctor for a second-opinion, or third, etc..you might ask them what they consider a successful outcome is? It might not be what you consider successful.

Gil, I know it is hard. You are going into a major surgery and there are frankly, a lot of unknowns. Just know we are here to support you wherever you go, whoever you go to.
I am long-winded, so excuse me, but just like everyone on here, if you ever need to pick my brain, do so. PM me or someone else on here.

Best wishes and God Bless,

R

[dagmountain]

Hi Gill-

I am sitting in a recovery room at Stenum hospital with my roommate Troy from Montana. Let me tell you the stories I've heard from others and my own personal experiences, many doctors in the U.S. are cowards that would rather bill the insurance companies for surgeries that they know have low success rates for nothing but the profit motive, either, or the medical device lobby is so powerful and probably have people that sit on the FDA board itself.

Dr. Ritter-Lang was so fast and accurate that I lost less than a tea cup of blood (140ml) on a triple adr! Check out my films here.the glennen bunch .If you have the money come over here and give it a try you have nothing to lose. We are receiving first class treatment in our recovery and I and everybody are overjoyed by the experience. Good luck Gill.

-David

[Gilbert P]

Hi All

Thanks for your post R I sent you a P.M.

David we need to talk Rest and get strong I send you a P.M. with my contact information.

All The Best

Gil