Hello musketeers ! (Severe Disc Degeneration from C3 to C7)

[cragar59]

I just signed on and hope a new thread will reach Tyler and others with cervical situations, as they better relate to my C3-C7 mess. I must say that I am amazed at the amount of damage to most of you. It grieves me further to see that a lot of it was not your fault. Anyway, I suppose I have no one to blame but myself for my condition.

According to the radiology report from a recent CT scan I have severe disc degeneration from level C3 to C7, with nerve impingement from bone spurs and canal restriction. I have been searching for as many opinions and estimates I can find to make a decision (like all of you) and unfortunately they vary too much to be confident.

Recommendations vary from: 4 level ADR, 3 level ADR/1 level fusion, or 1 level ADR/3 level fusion. Isn't fusion old school? I have received estimates from various locations in India & Germany and am awaiting others from Spain, England, Mexico, and Thailand. It looks like Bergtnoli (sic) is best, then Ritter-Lang, but India's Fortis is the best price so far. Chavel (sic) in Spain, Germany, and UK use the M6 and India uses the other types. I would like to read good and bad from patients of all surgeons and devices.

From what I see of the device design, I am impressed by Spinal Kinetics M6 and Axio Med polymer core compositions. Dr. Hegde in India uses the ProDisc C or Prestige LP, which I do not like, but I see the new PDC Nova has two shorter upper retainers instead of one large keel. The invasive type plates with ADR and screws in fusion appear to me to compromise the vertebrae, especially in multi-level procedures.

Tyler, I was told the M6 is too flexible for multilevel, but I think it replicates the natural disc best. Please stay in touch with your post op condition. It was a month ago, correct? Looking forward to reading about selections and satisfactions from all of you. God bless!

[Justin]

Recommendations vary from: 4 level ADR, 3 level ADR/1 level fusion, or 1 level ADR/3 level fusion. Isn't fusion old school? I have received estimates from various locations in India & Germany and am awaiting others from Spain, England, Mexico, and Thailand. It looks like Bergtnoli (sic) is best, then Ritter-Lang, but India's Fortis is the best price so far. Chavel (sic) in Spain, Germany, and UK use the M6 and India uses the other types. I would like to read good and bad from patients of all surgeons and devices.

Hi cragar59,

Welcome to the Spine Patient Society.

I'm sorry you need to be here, but we are here to help. There are many SPS Members that have had cervical artificial disc replacement recently. It can be very difficult to make a decision regarding spine surgery, especially when there are many different recommendations as in your case.

Fusion is surgical procedure that has been around for many years. However, it is the best option for many Spine Patients with certain contraindications for artificial disc replacement surgery. Fusion has been greatly refined over the years.

Make yourself at home and feel free to contact members via private message or through our unique real-time chat feature. Also, if you a search for cervical procedures (or any keyword) in the upper right-hand corner of the Forum, you should pull up many pertinent threads.

I wish you the very best as you move forward.

[jss]

Cragar,

Condolences on the mess you have in your cervical spine. It sounds EXACTLY like mine, except that my four level problems didn't occur all at once, but slowly over a decade. I have two fusions from 2000 and 2002 (C4/5, C6/7) from back before they were doing ADR in Europe. I have two ADRs with the M6 at C3/4 and C6/7 courtesy of Dr Clavel at the Barcelona Spine Center in Barcelona, Spain.

To date I couldn't have hoped for a better outcome. Two days after surgery, on Nov 25, 2009, I was out walking for 6+ hours a day touring Barcelona on foot. Since time I've completed two half-marathons, one full marathon, a 100 mile bicycle race, am currently training for the 2010/2011 marathon-ing season and plan on running my first ultra-marathon in February. I would not be attempting such absurd feats with any other ADR. While I would certainly encourage any ADR device over fusion, the M6 is one of only two cervical ADRs that cushion axial compression of the spine; the other being the Nuvasive NeoDisc.

On this site you will find that there are many outstanding outcomes using different ADRs and different surgeons. As you're already seeing, finding the one combination that you believe to be the best for you is a very difficult task.

I would encourage you in your current endeavor, getting many opinions. I was fortunate in that in the five or six opinions that I got, all but one prescribed the same treatment, a double ADR. One suggested M6, one Prestige, and the remaining suggesting ProDisc-C. At the time Dr Clavel was using Prestige, which he suggested to me. I had already decided on the M6. He'd done 200+ Prestiges and 10 M6's; so I was his 11th M6. I am told by others on whom he's operated since that he now prefers the M6. Anyway... if you continue getting opinions, hopefully a clear best option will begin to emerge.

Good luck, Jeff

[cragar59]

Thanks for the post for hope JSS. Why did you go with Clavel instead of Stenum or Dr. B? It looks like M6ers charge about the same for competitive reasons. I am pretty set on the M6, but wish India did them to save quite a bit of money since I am self-pay. From what little I know at this point nobody in the USA does multilevel ADR and FDA approval for devices operates at a snail's pace; leaving me to believe that overseas is my only option.

[jss]

Cragar,

I decided on the M6 and then set about looking for a surgeon that would do it.

Dr Zeegers does only Mobi-C, so he was out; I had other issues with Dr Bertagnoli, which eliminated him; as you noted, the M6 is not approved in India. I wanted to go to Stenum because of their unparalleled experience, but their cost was 50% more than Dr Clavel (like you I was self-pay). I was willing to wait and work on my insurance in hopes that they would approve Stenum; but I was in too much pain, sleeping 2 hours a night 15 minutes at a time and confined to my couch.

My research of Dr Clavel gave me the opinion that his credentials were just as eminent as the Germans. He had less experience than the Germans, and at that time a little more than twice that of any US surgeon. He spent about a third of his life in the US and received much of his training here, so language wasn't a problem. He was involved in research for a new ADR device that solved the problem of subsidence, etc... I was happy with his credentials, education, culture, experience and cost.

On cost... I have been told that recently Dr Clavel changed his cost structure because he's added hotel accomodations and physical therapy to his 'package'. Those weren't in there when I went in November 2009. His cost was $27.5k where the Germans was over $40k. I'm told that for a two level cervical M6 that it's currently in the $34k range?

I am fully expecting to require surgery on yet a fifth cervical level in the coming years (hopefully a while). If that becomes necessary, I intend to have Clavel do it.

Since my surgery I've since learned of two other international ADR surgeons that I would encourage you to research. I've learned of both of these from people on this site that have been to them. Dr Boeree in England, and Dr Pilmeta in Brazil. I've only ever heard glowing reports about those doctors. Hopefully former patients of those doctors will chime in with their experience.

I don't know if anyone in the US does multilevel-adjacent ADRs. Perhaps someone that knows will chime in?

Good luck, Jeff

[cragar59]

Jeff,

Do you think that Clavel could do a 4 level ADR? It looks like I'm going to pay way high for this. I wonder how much the M6 implant cost compared to the others. I guess I had better try to find success stories from people with 4 ADR if they are to be found. From what I can see so far, the run time on this new replacement is only about 2 years back. Did you get the M6-C, as I see there is a different M6-L for lumbar? Maybe it has always been 2 different devices since inception.

Craig

[tyler]

Tyler, I was told the M6 is too flexible for multilevel, but I think it replicates the natural disc best. Please stay in touch with your post op condition. It was a month ago, correct?

Hi Craig,

As far as multiple implants, it would seem that the potential 'flexibility' issue could be greater for discs that allow more free movement - typically referred to as unconstrained or less constrained discs.

My understanding is that ProDisc, which has been used in multiple levels (although not FDA approved for multilevel since the trials were 1-level), is considered 'semi-constrained.' Basically it's less constrained than the native discs in some directions, e.g. turning, and more constrained in others.

As for multiple implants of M6 (also not FDA approved but used in Europe), I didn't hear any substantial concerns about it with the docs I consulted - and several of us (including Jeff, Marti and myself) have all had multiple M6s implanted.

While M6 can bend in all of the natural directions, it actually has some resistance to pull - just like the native disc - because the fibers making up the annulus start to resist further extension the more they're stretched (this is referred to as 'graded resistance'). Same with compressibility, it has some but is not soft or floating by any means.

It was pretty cool to feel these motions with the actual discs that my surgeon Nick Boeree let me play with (pics in my photo album). It's not at all like a spring, much more like compressing or turning a fixed piece of tire tread - you can do it, and it does absorb shocks/stresses, but it's also resistant to turning and compression as you push it more, which is why it works as it does. Again the discs were basically designed to match the originals.

Here's some more technical information on M6:
Spinal Kinetics M6 - A Shock-absorbing Artificial Disc with "Graded Resistance"

I would raise these issues with the docs you're talking to. It does sound like you're making progress, and hopefully you'll be well guided into what works best for you. There are also situations that some docs believe favor hybrids (i.e. discs and fusions), which many people have also had.

In your case, are the multiple discs you referred to all severely affected? And what about the arm pain and weakness - does it appear to line up with images? I can say that my situation seemed fairly clear-cut - in fact several of the docs more or less said that from my pattern of arm pain/weakness they could have basically drawn the MRIs.

By the way, Friday will mark 4 weeks since surgery - and I've been completely off pain meds since the second day post-op. Surgical info is at the following post:
Relief After Cervical ADR C5-6 & C6-7 with Spinal Kinetics M6-C Artifical Disc / Nick Boeree, Nuffield Wessex

Please let me know if I can help further in any way.
And in the meantime wishing you the best!
Tyler

[jss]

Yes, I got the cervical M6 which has been in service I believe since 2005 with over 5000 installed, per an email from Spinal Kinetic's CEO. I assume that M6-C and M6-L mean cervical and lumbar, but I don't know.

I have spoken with one other person on whom Dr Clavel did a double M6 ADR, and three others on who he did a single level M6 ADR; but I don't if he has or hasn't done a quad-level, or if he would even be willing to do a quad-level. If you decide to pursue him as a possibility for your surgeon, I would encourage you to question him thoroughly regarding a quad-level ADR. Has he ever done one? What risks are unique to such a procedure? What are the additional challenges? What will he have to do differently for a quad-level compared to a two level? Are sizing considerations different for a quad-level over a double or single? etc... Actually, I would encourage you to quiz ANY surgeon that you consider in such a manner.

I paid 2000 euro's each for the M6's; which at the time was $2967 each. I am told that this summer Spinal Kinetics upped the price by 10%. You will probably find that you will pay a different price for each device in every country. Where ever you go, you will probably find that with a surgery that is as expensive as what you're going to pay if you do have a quad-level that you can dicker with price. (that's what the insurance companies do, and I know one patient that got 10% off with Barcelona Spine by objecting to their price hike)

I have seen success AND failure stories from patients with a triple-level cervical ADR, but I've not seen anyone post on a quad-level.

Good luck, Jeff

[tyler]

I have spoken with one other person on whom Dr Clavel did a double M6 ADR, and three others on who he did a single level M6 ADR; but I don't if he has or hasn't done a quad-level, or if he would even be willing to do a quad-level. If you decide to pursue him as a possibility for your surgeon, I would encourage you to question him thoroughly regarding a quad-level ADR. Has he ever done one? What risks are unique to such a procedure? What are the additional challenges? What will he have to do differently for a quad-level compared to a two level? Are sizing considerations different for a quad-level over a double or single? etc... Actually, I would encourage you to quiz ANY surgeon that you consider in such a manner.
I have seen success AND failure stories from patients with a triple-level cervical ADR, but I've not seen anyone post on a quad-level.

I would certainly agree with Jeff on questioning docs. I believe the folks at Stenum have done triples and, if I recall correctly, they actually do significantly more 2-level implants than 1-level.

I'm not sure about Nick Boeree. I know he's done double M6s in numerous cases, and I believe has done other multilevels, but not sure what he would say about three or more.