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TEMAT: 2x M6 lędźwiowy + 2x M6 szyjny

2x M6 lędźwiowy + 2x M6 szyjny 1 rok 3 miesiąc temu #13876

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Zap3- a orientujesz się może czy dr Clavel w czasie zabiegu sprawdza śród-operacyjnie stabilność segmentu i w razie niestabilności jest w stanie usztywnić ów segment? Zastanawiam sie też cały czas czy w przypadku operacji od przodu jest dostęp do korzeni l5-S1 i można w razie potrzeby ( gdyby nie wystarczyło podniesienie samej przestrzeni m-k) dodatkowo uwolnic korzeń od nacisku ( np od zrostów, blizn po poprzednich operacjach) dodam, że polscy specjaliści właśnie twierdzą, że się od przodu nie da.
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2x M6 lędźwiowy + 2x M6 szyjny 1 rok 3 miesiąc temu #13878

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Wilku

wg mojej wiedzy stabilnosc segmentu ocenia sie przed operacja za pomocą rtg czynnosciowego, nie w trakcie operacji
jeśli by jednak z jakiegos powodu okazalo by sie w trakcie operacji ze jednak trzeba usztywnic to zadecyduje w trakcie
z rozmow z nim jak i z Glowackim wiem ze czasami pojawiala sie niestabilnosc przy robieniu 3 poziomow ruchomych (czasami nie zawsze)

co do dostepu od przodu moze tak byc jak piszesz - ze sie nie da czegosc usunac - wszystko zalezy od typu i miejsca zrostu- na pewno zrosty kostne jestes w stanie wylapac na tomografii komputerowej, blizny - nie wiem
co do metod ich usuniecia (jesli sie nie da od przodu) to wiem o dwóch:
1. io-flex@system (w necie znajdziesz o tej metodzie dekompresji)
2. druga robiona od tylu - microdekompresja

z lektury mojej roznych trudnych casow (jeden wkleje ponizej)- wiekszosc konczyla u Clavela na rewizji albo ze wzgledu na to ze jako jedyny byl w stanie postawic trafna diagnoze i podjac sie z sukcesem rewizji)


zamieszczam dluga historie jednego goscia ze stanow opisana na jednym z forów
skonczyl z 4 ruchomymi w szyi
fuzja l5s1 i l45 z ruchomym + 2 dekompresje

mam nadzieje ze to Ci pomoze

1992: Pars defects; Grade 1 Spondylolisthesis: Bilateral bony fusion @ L5-S1 with Dr. Michael Neuwirth, NYC.
10/2013: M6 @ C5-6, C6-7 & L4-5 with Dr. Thomas Bierstedt. Germany.
8/2014: Anterior Foraminotomy @ C3-4 & Posterior Lumbar Decompression (iO-flex), with Dr. Carl Lauryssen, L.A.
1/2015: M6 @ C3-4 with Dr. Bierstedt.
1/2017: Revision @ C3-4 (M6 replaced with new M6); M6 @ C4-5, with Dr. Pablo Clavel.
4/2017: Posterior Lumbar Micro-decompression @ L4-5 & L5-S1, with Dr. Clavel.

It's been a while since I've posted in the forum. Most of my time has been consumed with desperately finding a way to get better after a series of mistakes. For me, it's literally been about survival. I live alone, so I have no one to depend on. No family nearby and my friends can't be my nursemaids. I must be physically capable of doing everything for myself or it doesn't get done. Due to my spine condition (and other factors to a lesser degree), my life has been on hold since 2013 - no job, no relationship, very few recreational activities. It's been a kind of purgatory - a lot of solitude and struggle.

I believe I am finally on the right track after much trial, error and cost. The key to any success in life is dedication and intestinal fortitude, so never give up on yourself. Keep striving to find a way, no matter what.

The main reason I'm making this post is to outline my experiences with four surgeons who have been mentioned on this forum. My hope is that my experiences with them will help you to make good decisions. This will likely be my last major contribution to this forum barring a brand new spine issue.

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In 2013, I consulted many surgeons in NYC and abroad. The general consensus was that the herniation at L4-5 was the cause of my bilateral radiculopathy (more on that later). Also, C5-6 and C6-7 were shot and compressing nerves. After researching the available options, I concluded the M6 was the right choice for both lumbar and cervical. The surgeons who were most popular on this forum at the time were: Dr. Thomas Bierstedt (Germany), Dr. Pablo Clavel (Spain), Dr. Willem Zeegers (Netherlands) and Dr. Carl Lauryssen (then, Los Angeles; now, Texas).

My choice for the M6 surgeries were among Bierstedt, Clavel and Zeegers. Zeegers doesn't particularly champion the M6, so he was out (more on him later). I was originally going to choose Clavel based on patient testimonials, but ultimately went with Bierstedt (who also got favorable reviews), because of the Medicos rehab facility. I was traveling alone for cervical and lumbar surgery at the same time, and I thought Medicos would offer more post-op support for someone in my situation.

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Dr. Bierstedt (October 2013)

The only times I was able to talk to Bierstedt was the initial phone consultation and in-person. Outside of that, I always had to go through his assistant Malte. Malte is kind of like the ONZ gatekeeper.

Bierstedt put an M6 at C5-6, C6-7 and L4-5. The cervical portion was quite successful - alleviated a number of nerve symptoms and helped with neck pain. The lumbar, not so much - ultimately, did nothing for the bilateral radiculopathy down the legs, but thankfully did not make my lumbar pain any worse.

He did a provocative discography at L4-5 immediately before the surgery. I was drugged, but I remember it. It caused localized pain in my lower back, but did not recreate the concordant nerve symptoms down the legs. I do not recall him asking if the pain was concordant. After my painful, "ow!" it was lights out.

Intraoperatively, Bierstedt attempted to put a needle into the L5-S1 disc (which is in a fused segment) and concluded it was "significantly solidified" and would not require replacement with an anterior fusion cage (ALIF).

Medicos was great. The man who runs the place, Dr. Vieregge, is awesome. Really like that guy. The hotel is literally connected to the rehab facility. Very convenient. It's like a well-oiled machine. They keep you on a schedule that fills your days with various rehab treatments. That kind of set-up does indeed help someone who is travelling alone and going through both cervical and lumbar surgery at the same time. Only downside is it's closed on weekends.

The first few months post-op were very hard. I developed a DVT blood clot in my left calf. I think it started before I left Germany (despite the preventive Lovenox injections I was given), and the plane trip home made it worse. Thankfully, my intuition was working well, and I was able to discern after several days that the symptoms in my left leg were not normal post-op. I got myself to the ER in time, before the clot had a chance to break loose and migrate to my lungs or brain. They admitted me for about four days. Had to take Warfarin for 3 months. Clot eventually went away.

I can say with 100% certainty that the L4-5 disc was NOT the direct cause of my radiculopathy; it was not mechanically compressing any nerve roots (more on that later). The distraction pains caused by the M6 being implanted were pretty bad, because the posterior nerve roots were still compressed and more tension was just put on them (I didn’t know that at the time). Eventually, things settled back down to pre-op symptom levels.

Because of the continuing leg symptoms and residual left scapula pain, I decided to have numerous surgeons with M6 expertise review the xrays (this was long before I knew the extent of the nerve root compression still active in my lumbar spine). They all concluded that Bierstedt's placement of the M6 discs were excellent.

Not knowing what to do, I decided to consult Dr. Lauryssen (I had already had a good phone consultation with him).

---

Dr. Lauryssen (August 2014)

Lauryseen is a charmer. Has a way of making you feel like you're his only patient. Actually hugged me when I met him for the first time.

I explained to him that I had residual left scapula pain and the unchanged bi-lateral nerve pain in my legs. He said something was wrong, that things should have improved by that time.

Long story short, I had a left-sided osteophyte complex at C3-4, which MRI showed was impinging the left C4 nerve root. The theory was removing that complex may help the scapula pain. Lauryssen proposed an anterior approach to squeeze passed the disc (leaving it largely unchanged) and decompress the C4 nerve root by removing as much of the osteophyte complex as he could.

It just so happened that I consulted Dr. Clavel about my situation before going forward with Lauryssen. Clavel told me that kind of anterior approach foraminotomy/decompression surgery is antiquated in Europe, because data showed it often damaged the disc. They flat out didn't do that anymore. That scared me, so I asked Lauryssen about it. Told him what Clavel said. I asked him, "are you sure you can do this surgery without making my C3-4 disc worse?" He assured me that he could do it. He said, "I will not damage your disc any more than it already is." I bought it (despite Clavel's warning). He has a way of making you trust him.

As for the lumbar, Lauryssen thought that minimally invasive iO-Flex posterior decompression was the way to go.

Results:

1) Lauryssen removed most of the osteophyte complex freeing the C4 nerve root, but he left behind a jagged posterior osteophyte at the top of the C4 vertebra (just below the C3-4 disc space), which was indenting the thecal sac dangeously close to the spinal cord. Presumably, he simply couldn't reach it to remove it with the disc in the way. Numerous spine surgeons since then have told me they couldn't say if the osteophyte is causing neurological symptoms - maybe, maybe not - too close to tell for sure.

2) The osteophyte complex must have been providing support for the disc in some way, because removing it, along with some minimal disc material, caused the C3-4 disc to collapse to half of its original height. The pain was much worse than before. Cervical lordosis (curvature) was compromised. Clavel was right.

3) Left scapula pain: unchanged.

4) Lumbar radiculopathy after iO-Flex: unchanged.

Shortly thereafter, Lauryssen closed up shop in Los Angeles for reasons unknown. Moved to Texas. Was very difficult to reach. Eventually, got a hold of him. He recommended no further surgery, and that was that.

---

Dr. Bierstedt (January 2015)

There was no way I could live with the neck pain I had after the Lauryssen surgery. I had no choice but to see if I could get another M6 at C3-4, so I went back to Bierstedt. I was relieved that Bierstedt concluded I was still a candidate for M6 at C3-4. He did a good job at C5-6 and C6-7, so I thought it was a no-brainer.

Results:

Initially I felt better, but for months thereafter the neck pain got incrementally worse until it became pretty bad again. I couldn't understand it. Between the worsening neck pain and the continuing lumbar radiculopathy I was at my wit's end. I decided to get a CT/Myelogram of my entire spine in August 2015 (not a fun test). Titanium (M6) causes artifacts on MRI, so I thought this was my best chance to see what the hell was going on.

---

The CT/Myelogram showed that Bierstedt did not remove the jagged osteophyte at C3-4, which was indenting the thecal sac, before he put in the M6. It also revealed Heterotopic Ossification (HO) occurred at the bottom of the C3 vertebra (anteriorly), which grew down and wrapped around the upper endplate of the M6.

CT/Myelogram also showed minor osteophytes at C5-6 and C6-7, but the canal was "patent" - nothing encroaching on the spinal cord or exiting nerve roots.

CT/Myelogram was otherwise unremarkable - could not tell what was causing the continuing lumbar radiculopathy from this test.

From August 2015 to January 2017, I was in no man's land. Just going to Pain Management and Massage religiously. Doing diagnostic facet blocks. Doing Stem Cell injections. Accupuncture. Physical Theraphy. Basically, everything I could find to discover the cause of the pain and to manage it. There was nothing else I could do. By the way, the best thing I've ever found for pain in the soft tissues is a dry needling technique called "Gunn IMS."

Anyway, I reached out to Malte repeatedly during this time to let him know about the CT/Myelogram findings and that something was wrong. Could not speak with Bierstedt, only Malte. Malte basically said the HO was normal osseointegration (it was not). He also downplayed the jagged osteophyte as nothing to worry about. I was basically at a dead end here.

---

I decided to see if I could get a digital motion xray of my cervical spine. It's basically an xray movie of your spine moving in real time. I thought maybe that would reveal something the static tests were missing - some kind of instability or weird movement at C3-4 or whereever. I had to travel to Florida for it.

The test showed that C3-4 was not moving normally in extension. To my surprise it also showed a "hypermobility" at the left C4-5 facet joint. It wasn't technically unstable (3+mm of movement), but it was moving more than normal.

The doctor who did the xray recommended that I get a flexion/extension MRI of my cervical spine, which is what I did upon my return to NY. That test showed the C4-5 disc abutting my spinal cord in flexion and both exiting nerve roots in extension.

So, you have a disc abutting the cord and roots plus "hypermobility" at C4-5. Remember, C4-5 is sandwiched between the M6 at C5-6 (which is close to normal disc movement, but not quite) and a quasi-fusion at C3-4 due to HO. I guess it was just too much for the C4-5 disc and left facet to deal with. The disc was already somewhat degenerated, and these surgeries just accelerated the damage.

---

So, I reached out to Malte again. I explained all of these findings and my symptoms and asked if I could send him the motion xray and flexion/extension MRI for Bierstedt to review. He agreed. So, I used a service called WeTransfer.com. The cool thing about WeTransfer.com (other than it being free) is they send you alert messages when files you upload to them have been downloaded by the intended recipient(s).

I had to hound Malte for an answer. He has never been too good at responding to my emails or returning my calls (except for a short while immediately after the 2013 surgery). Eventually, he gets back to me and says Bierstedt reviewed all of the studies I sent with the reports and concluded that there was no indication for surgery at C3-4 or C4-5. There was nothing they could do for me.

I was shocked. There was clear pathology on these diagnostic imaging tests. Bierstedt literally operated on me for equally or less severe pathology already.

You remember the alert messages from WeTransfer.com? Well, never got them for the motion xray or flexion/extension MRI, so either there is a glitch in their system or Malte never downloaded them. I did get one alert for static flexion/extension xrays I sent to Malte, so the alert worked in that case. Highly suspicious.

I sent Malte a reply email virtually begging them to reconsider, not to leave me like this. Malte never replied.

---

Dr. Clavel (January 2017)

I felt like Dr. Clavel might be my last and best hope. I reached out to his assistant Yolanda with the whole story and all the diagnostic studies/reports. WeTransfer.com indeed showed she downloaded every one of them.

I had a Skype consultation with Clavel (I had already spoken to him several times since 2013). He listened patiently to everything I had to say (it was a lot).

Clavel said the HO occurred at C3-4, because Bierstedt used an M6, which was too small (ML instead of LL), and left room for HO to grow down and around the upper-anterior endplate of the M6. He said that a quasi-fusion resulted from the HO at C3-4, causing a hypomobility, which was transferring stress above and below and causing or contributing to the hypermobility at C4-5. He said he saw on MRI how the L4-5 disc herniation was abutting the cord and exiting nerve roots.

I would add that during the 2 years that I had the M6 Bierstedt put in at C3-4, my C2-3 disc has progressively degenerated, showing some loss of height and signal on MRI as well as an increased left-sided postero-lateral bulge possibly abutting the C3 nerve root. Clavel didn't seem too concerned about the C2-3 disc at this point, however. He has never had to do an ADR at C2-3 in his career; he believes the robust musculature at the upper neck helps to protect the disc.

He said both levels (C3-4, C4-5) have to be worked on. He said the M6 at C3-4 had to be removed and the jagged osteophyte taken out. To be clear: the M6 was NOT malfunctioning; it was just the wrong size (and therefore placement), and there was no way to reach the osteophyte without removing the M6 anyway.

Because Lauryssen removed the left uncovertebral joint along with the osteophyte complex, Clavel wasn't 100% sure what to replace the M6 with - we might have to fuse instead. He was leaning toward replacing the old M6 with a new one, because on motion xray the segment appeared stable with the M6. Clavel contacted the head bio-engineer at Spinal Kinetics (the makers of M6) and described my situation to them to make sure it was safe. They gave us the green light.

Clavel removed the jagged osteophyte at C3-4 (hard to reach) and revised to a new, larger M6 (you can see on xray that it covers the vertebral endplates completely, making it much less likely for HO to occur again). He also replaced C4-5 with an M6 (he told me it was obvious during surgery the disc was degenerating).

So, I have four M6 discs in a row... Initially, I expressed my concern about 4 in a row to Clavel. I asked him if it would be better to do a hybrid (fusion at C4-5, M6 at C3-4) to make sure the spine would be stable. He said absolutely not, it would be more than stable enough after osseointegration is complete and normal scar tissue develops (1 year), and it's always better to preserve mobility unless there is clear and actual instability, which I did not have (digital motion xray; flexion/extension xrays; and, flexion/extension MRI all confirmed that).

He and his colleagues were very pleased with the result. I can see why - on xray the normal lordosis is restored, and the positioning and alignment of the M6s look very good.

I could tell immediately after the surgery that it was a success. Sadly, I've been through enough of this to know. Old, deep neck pain - gone. Cervicogenic headaches - gone. Equilibrium issues - gone. Left scapula pain - gone. Burning left arm pain - gone. I was able to walk all over Barcelona after a few days without needing to take much pain medication.

Unfortunately, the 5 year old pain down my legs (especially to the right foot), the pain that started this nightmare journey to begin with, remained unchanged. I was hoping all of this was coming from the cervical spine. Clavel said we have to give it some time to see if my legs improve, but he thought it was very likely a lumbar issue, because I could trigger the symptoms with flexion/extension of the lumbar spine as well as certain leg movements; also, because there was literally nothing left in my cervical spine that could cause the type of mechanically induced L5 pain I had in my right foot.

So, I decided to return to Barcleona three months later for Clavel to do a posterior micro-decompression surgery at L4-5 and L5-S1. He said Lauryssen's iO-flex was insufficient to really access the areas I need, and the microscope/naked eye would be able to see exactly what's going on (things MRI and CT can miss).

Dr. Clavel (April 2017)

I was worried that the L5-S1 disc (which was left in place 20+ years ago during my bony fusions at L5-S1) might have been causing nerve problems. Turns out the disc was not the issue (thankfully) and did not have to be replaced with a fusion cage.

Dr. Clavel found that both L5 nerve roots were still compressed at L4-5 by scar tissue and (calcified) ligamentous and facet hypertrophy, despite Lauryssen doing iO-Flex (iO-Flex might be a good technique for some select patients, but it sure wasn't for me). He said on a scale of 1-10, the compression was a 6/7. That's no joke, and explains why nothing I've had done for the past 3.5 years worked! I honestly don't know why no other surgeon I consulted or hired suggested this type of operation. I remember even suggesting it to them, but everyone was hell-bent on only replacing the L4-5 disc with M6.

Dr. Clavel followed the L5 roots down to the L5-S1 level and made sure any remaining irritants were removed. There was some excess bone growth at L5-S1 affecting the L5 roots, but no where near as bad as L4-5. There were also some problems with the S1 nerve root on the left, which Clavel fixed. He said it was a very thorough decompression (finally) and expected a full or near-full recovery of the nerves in 6 - 12 months. I certainly hope his prediction comes true, but you can never tell for sure with nerves. Plan to start nerve flossing exercises in a couple of weeks and will take Acetyl L-Carnitine and R-Lipoic Acid for at least the next 12 months to help with nerve healing.

As for the neck pain, I'm at about 4 months post-op, and I'm still dealing with sub-occipital, SCM and scalene pain. It's not too bad, but can flair to migraine type pain once in a while. Dr. Clavel agreed that it's probably due to muscle splinting (protective muscle spasms), because my facets are in pretty good shape. Obviously, I've had a lot of cervical work done. Lots of trauma. After Bierstedt put the M6 at C3-4 it took a minimum of 8 months for the same type of symptoms to calm down and loosen up (with the help of Gunn IMS and Massage). So, I hope and expect it will be roughly the same this time around.

3-Month post-op cervical xrays (AP, Lateral, Flexion, Extension) show good placement of the M6s, good mobility and no signs of HO. Clavel wants new xrays at 12 months post-op. It's interesting to note on xrays how thoroughly Clavel cleans out the posterior osteophytes, compared to Bierstedt's work at C5-6 and C6-7. In my case, whatever Bierstedt left behind at those levels is minor enough not to cause symptoms currently, but he shouldn't have left them there at all.

Even after all these surgeries and M6 discs, once healing is complete (1 year), Clavel has said there are no physical restrictions on me. He strongly recommends that I play it smart and not subject my body to any extreme activities, but that's advice he'd give anybody my age. He said I have new discs but my facets are still 44 years old. For example, skydiving may not be the best idea; that's fine, since I've done it already. Clavel is a big running advocate, so he said I could try to run after healing (I used to run years ago), but to take it slow. A few miles here and there, but no marathons. Not sure I'll do that. Might just stick with core strengthening, walking, biking, eliptical and swimming, but we'll see. One day at a time.

Now, just got to give it to time and rehab and hope the M6s keep doing their thing.
02/2015 M6 C45 i C67
06/2016 M6 L45 i L5S1
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2x M6 lędźwiowy + 2x M6 szyjny 1 rok 2 miesiąc temu #14042

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Zap3 mam pytanie.
W jaki sposób dobrnąłeś tak daleko? Czy język do komunikacji jest angielski? Ja znam bdb niemiecki z angielskim miałbym problem w komunikacji tak istotnych technicznych pojęć. Rozumiem że do komunikacji używaliście angielskiego? Ja zrobiłem sobie na trzech poziomach ls l45 l43 Pldd. To była najgorsza decyzja w moim życiu. Po trzech tygodniach czuję się fatalnie.
Jak dokonałeś płatnosci? Po prostu 35 tys euro do ręki czy przelewem. Rozumiem że przed zabiegiem?
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2x M6 lędźwiowy + 2x M6 szyjny 1 rok 2 miesiąc temu #14044

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jasioq


czytalem, szukalem w necie, wpisywalem w google rozne hasla jak np adr, fusion, facet degenration, ddd , surgery itd. uzywalem translatora, moj angielksi jest srednio zaawansowany

analizowalem, mysle ze tak rok mi zajelo, moja stuacja sprzyjala , po godzinie, dwoch musialem usiasc lub sie polozyc wiec czytalem
co do niemieckiego to zalowalem ze nie znam. wiem ze sa niemieckie fora gdzie mozna poczytac, w niemczech m6 jest robiona na ich nfz

platnosc na fakture przelewem, przed zbiegiem, gdyby wyszlo dzien przed operacja ze jednak nie jestes kandydatem to by zwrocili
02/2015 M6 C45 i C67
06/2016 M6 L45 i L5S1
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2x M6 lędźwiowy + 2x M6 szyjny 1 rok 2 miesiąc temu #14045

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A jak powrót samolotem? Na siedząco? Po lędźwiowym?
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2x M6 lędźwiowy + 2x M6 szyjny 1 rok 2 miesiąc temu #14046

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w moim przypadku powrot bez problemowo, nie pamietam czy bralem leki przeciwbolowe, moze paracetamol na okres lotu
natomiast wiem ze moje dochodzenie po operacji ledzwiowego w stosunku do historii innych bylo duzo szybsze i latwiejsze
powrot na siedzaco,

ale wielu amerykanow wracalo z europy do US i trwalo to 20 nawet godzin i dawali rade, czesto po prostu wstawali, chodzili po samolocie, nie ktorzy brali business klase
na lotnisku mozesz mozesz tez poprosic o wozek inwalidzki
najwieksze ryzyko gdybys byl sam i musialbys np podniesc bagaz
w cenie operacji masz tez oplacona miejscówke osoby towarzyszacej przez okres pobytu w szpitalu i hotelu
02/2015 M6 C45 i C67
06/2016 M6 L45 i L5S1
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