[Spinal Fusion / Cervical] Two-level Cervical Fusion (C5/C6 and C6/C7), multilevel DDD & cervical cord compression

[scotto74]

Hello everyone,

I have been battling a slowly deteriorating neck for the past 6 years (mostly inherited, but have had some minor auto accidents and ran a marathon), and have finally reached the point where my doctors feel I must have surgery to relieve the compression on my spinal cord at C5-6 and C6-7. The cord compression has started to affect my legs (difficulty walking uphill, up stairs, stiff, achey and increasing amounts of nerve pain) -- which is the scariest thing for me.

I have consulted with a number of surgeons (UCSF, Hopkins, NY Presbyterian, Dr. Bertagnoli, Stenum, TBI, Dr. Bitan) -- and while the recommendations have varied in terms of ADR vs. fusion, most have agreed that I need to have this surgery relatively soon to decompress my spinal cord. They have also mostly agreed on a two-level approach (5-6 and 6-7) although the levels above are also problematic and may need additional surgical intervention in the future (my older brother has had three neck surgeries already). I am leaning towards Dr. Bitan, who is recommending a hybrid approach -- fusion at 6-7 and ADR at 5-6. Just trying to work through some insurance challenges right now and get this thing scheduled. I'm a little concerned about the long-term viability of the ProDisc C, however, I'm not really sure that I want to go overseas for another device (like the M6) given the multitude of issues in my neck and the likely need for additional surgeries in the future.

I tried to attach a snapshot from my most recent MRI (May 2010) as well as the radiological report -- but am having some trouble doing so. Will try to post them again later...

I look forward to getting to know some of you, and thanks in advance for taking the time to read my post -- or any thoughts or insight you might be able to offer.

Best regards,
Scott
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[Katie]

Hi Scott, and welcome

I had similar problems, but in my C4/5 and 5/6. I saw Dr. Bitan a year ago April, and liked him immensely. He gave me similar recommendations. Unfortunately my insurance wouldn't cover it, and the cost with him was way beyond my means.

I ended up going to Dr. Luiz Pimenta in Brazil this past March, who opted to do only one level in my cervical, the worst at C5/6 and used the Nuvasive NeoDisc, which is much less invasive as far as ADRs go. It is a silicone block covered in mesh that is screwed into the side of the vertebrae, and the mesh eventually bonds with the bone.

So far the results have been terrific. All the symptoms that even Dr. Bitan thought were permanent have disappeared; the bladder & bowel issues, the inability to walk steadily, the numbness in the hands & arms, etc. All the consulting surgeons thought that the surgery would just stop any progression of the damage, but thankfully it has been reversed. I'd been fighting with this for over four years, and also had enormous pain in my lowest lumbar at L4/5 & L5/S1 which was also successfully treated, but with a PEEK fusion (a plastic disc for lack of a better term) because I am severely allergic to metals, and there are no lumbar ADR devices on the market yet that aree metal free.

I thought it was interesting that although everyone but Dr Pimenta thought that I needed two levels done in my cervical (an it does show compression in both levels in the MRIs), his approach of only doing the worst one has worked. There's no guarantee that things won't go south as I age of course, but so far so good.

I am glad to see that you have done so much research. Our mantra here is to get as many opinions as possible...you are well on your way to success

[scotto74]

Hey Katie,

Thanks for responding. Your story is pretty amazing and definitely inspires some hope for me that some of the neurological stuff that's going on may get better with time. I'm so glad to hear that you are doing really well, and I hope things continue to move in a positive direction for you!

I guess what I'm struggling with the most are both the choice of device and the number of levels in my neck to address. Most surgeons -- including Dr. Bitan, Bertagnoli, and Stenum -- noted that I have surgical problems at almost every level in my neck. However, they mostly all agreed that it makes the most sense to start with the two worst levels (5-6 and 6-7). I guess I'm just nervous about the prospect of needing to be opened back up in 2 or 3 years to address additional levels. I'm also worried about the choice of device. Seems like there are some differing opinions and experiences with the ProDisc C -- but I guess there are question marks with alot of these devices. The M6 and the NeoDisc seem like really cool devices, and much more "state of the art" at least in terms of my limited knowledge! However, I just have some concerns about going overseas -- and what would happen if I need additional work after the surgery. Decisions, decisions...

Thanks again Katie, it's always nice to hear from you

Scott

[jss]

Scott,

Condolences on the condition, and good luck on identifying and obtaining the best treatment. It's anything but easy.

The NeoDisc that Katie received should be ending clinical trials here in the US this month. The last surgical implantation occurred in October 2008, and the trial required a two year follow up. I don't know how long it takes to grind through all of the data after the two year follow ups are complete such that the device is available to the public in the US. I you contact Nuvasive, they might be able to tell you when the device will be available?

As you like the M6 ... I don't know if it is true, but I read a report that the M6 has received approval for human trials in the US and that they are currently recruiting. I could not find a press release on Spinal Kinetic's web site, or a listing on clinicaltrials.gov to substantiate that. You should be able to call them this week to validate that that is or is not true, and to find a list of facilities that are participating. Those trials always have exclusion criteria. With the mess that is your cervical spine, there is a very good chance that you would be excluded (IF the trial actually has been approved); but it may be worth a phone call. BTW: I have two M6's and can't tell the difference between them and my original discs.

Like you, I have reservations about the ProDisc. I am currently finishing up research for my second appeal to my insurance company for reimbursement; who claims that multilevel ADR is "investigational". During the course of that research I discovered a followup study on a group of 58 ProDisc-L patients. The study was performed in 2001 and disclosed the progress of 58 patients that received the ProDisc-L in 1990 through 1993; which meant that all recipients had had the implants for 7 through 11 years. At that time there were no device related failures. So at least the ProDisc-L does seem to last a long time; the ProDisc-C hasn't been around that long though. Here is a link to that study.

Good luck, Jeff

[Katie]

Scott, I had the same concerns about long term problems. But one theme keeps coming up here....that the technology is expanding at a rapid rate and that in three or four years, there may be something even better for our problems. I was happy to go with just fixing the worst for now. There are no guarantees on any of this after all. Plus it was what the best surgeon I could find thought was the best plan.

The problem with the surgeries in the US is that they are limited to doing just one level of ADR, and have to go with a hybrid if there are several levels involved. That wasn't the case in Brazil.

I have had such a positive experience in going there as opposed to the hospitals here, both with the professionalism of the staff and the cleanliness of the facilities, that I wouldn't think twice about going there again if need be.

[Justin]

Hi Scott,

Welcome to the Spine Patient Society.

You've had some great replies from Spine Patients with cervical issues. You are right with cord compression, it is wise to move forward sooner than later. Spine Patients with artificial disc replacement in the cervical spine have done "well" as per peer reviewed publications and by personal accounts as posted on the SPS Forum. The surgical approach for a cervical procedure lends itself to less complications and also quicker recovery times.

I do hope you are able to move forward soon, while getting your insurance company to cooperate.

[Gilbert P]

Scott you will be moving forward soon

All The Best

Gil

[KBear]

Welcome to the site! It sounds like you are doing the right things, getting opinions, researching and trying to pick the best plan. I wish there was an easy answer to what to do. I think it is pretty common for the surgeons to recommend just fixing the worst levels. I have small herniations above and below my ADR, but they are not pain generators at this point. I realize that there is a good chance that I will need more spine surgery before I die (I'm 30, so hopefully gonna be around another 50 years or so.) That was a chance I was willing to take. For me, I wanted relief now, and not to wait for better technology, because there will always be bigger and better on the horizon. I decided if this lasts me for only 10 years, that's 10 years of pain free living I didn't have before and I'll take it. Some decide to wait for different reasons. Only you can decide what is best for you. Good Luck with your decision,
Kathy

[Katie]

Kathy, you added what I left out, as usual

[scotto74]

Hey everyone,

It's been awhile since I've posted, so I just thought I would check in and say hello! I'm still deliberating and trying to figure out what to do, but I'm leaning towards either staying close to home and having the hybrid surgery (fusion at 6/7 and ProDisc ADR at 5/6) with Dr. Bitan in NYC or possibly heading to the UK for a two-level ADR (Spinal Kinetics M6) with Mr. Nick Boeree. I had a phone consult with him last week and found him to be extremely knowledgeable and he instilled a lot of confidence that I would be in very good hands if I were to have him perform my surgery. I do have some concerns, however, about going out of the country to have surgery (follow-ups, etc) -- and the out-of-pocket cost is also something I need to think about.

Another lingering issue that I'm trying to sort through is whether or not I can wait until the very beginning of next year to have the surgery, as I'll be able to switch from my current insurance carrier (CIGNA) over to Aetna, who I have heard is much more favorable toward disc replacement surgery. Some days I think I can wait that long, and some days my body tells me otherwise. Mr. Boeree said he does not see any significant damage to my spinal cord at this point (based on what he could see in the MRI) but he also strongly encouraged me to have the surgery "sooner than later".

I've also attached a quick snapshot from my last MRI in May. I tried attaching a PDF of the radiology report but keep having trouble with the "manage attachments" thing. Oh well!

Hoping to make some decisions this week -- thank you all for the continued support!!

Scott