Rick Froehlich MD (Lumbar)

Rick Froehlich M.D.

I’ve had chronic neck pain since 1995. I was an invasive cardiologist for twenty years. I did angiograms and stents, which necessitated wearing a heavy lead apron to shield against the radiation exposure during the procedures.

In 1995 I read an article in a cardiology publication about an epidemiological study showing a 6-8 % incidence of severe neck and lower back problems in invasive cardiologists wearing the lead apron for long hours. The article stated that the lead apron, which itself only weighs 30-40 pounds, lies at the base of the neck and exerts 300 psi on the spinal cord. Now there is also convincing scientific evidence for a genetic link to DDD (Degenerative Disc Disease). I saw an orthopedic surgeon in consultation who ordered standard x-rays ands a CT scan of my neck. These studies revealed severe cervical spondylosis (bone spurs) at C6-7 causing severe spinal stenosis (narrowed to 9mm). I was referred to Dr. Robert Watson in Los Angeles, California.

Dr. Watson reviewed my CT scan, performed an exam and advised me that there was only a 50-50 chance of pain relief after cervical fusion because he’d have to open the epidural space, due to the bone spurs pressing on the spinal cord. He referred me to a physical therapist for a trial of conservative therapy. After a year of progressive neck pain and muscle wasting in both my arms and legs, I decided to have cervical fusion, but I opted for an orthopedic surgeon closer to my home in Orange County, a surgeon who also specialized in spinal surgery.

The doctor performed my cervical fusion in September of 1996. I had very little pain relief after the operation and developed a pseudoarthrosis of the bone graft (a failure of the bone graft to take), which was not recognized by the surgeon.

A year later my pain increased and an MRI revealed the pseudoarthrosis and a new disc herniation at C5-6. This time the surgeon talked me into a titanium plate, for fusion of both levels, i.e. C5-6 and C6-7. Since November of 1997 my pain has diminished somewhat, but it is still at least 50% and made worse by poor positions, neck strain, cold weather, etc.

Because I suffer from chronic neck pain, when I developed low back pain in the spring of 2005, I knew that I probably had DDD (Degenerative Disc Disease) in my lower back. Severe DDD was confirmed by an MRI at L3-4 and L4-5. I decided to try conservative treatment with epidural injections of my lumbar spine, and I did get some relief with the first few epidurals, spaced a few months apart. The pain however was progressive and became so severe that I gave up all outside activities. I could only get partial pain relief with ice packs to my lower back.

I knew that I didn’t want another fusion, which simply splints the involved spinal segment, and predisposes to more disease at adjacent segments later. Think of the normal spine as movable—when you splint a segment it exposes the vertebral discs above and below the fusion to additional forces—analogous to a lever and fulcrum. I’d heard about artificial disc replacement. I researched it extensively on the internet and found Dr. Bertagnoli and the Pro-spine Clinic. As a physician, I was extremely impressed by Dr. Bertagnoli’s training, extensive bibliography and his experience with artificial disc replacement.

The ProDisc-L device has a 10 year experience in Europe with over 15,000 devices implanted with excellent device longevity. In August of 2006 the F.D.A. here in the U.S. gave its approval to the ProDisc-L for lumbar implementation in carefully circumscribed cases, specifically one-level disease when the remaining spinal segments are normal. I knew, however, that Dr. Bertagnoli had implanted the ProDisc at multiple levels in both lumbar and cervical spine cases, with excellent long-term results.

There is no other surgeon in the world more qualified than Dr. Bertagnoli to perform ADR of the cervical or lumbar spine, particularly when multiple segments are involved. His surgical experience is unrivalled anywhere. I felt extremely fortunate when he responded positively to my medical information (MRI’s, spinal x-rays and clinical history) and offered me ADR at two and possibly three levels. He suggested a discogram of L5-S1 on the day of surgery to decide if a third level was indicated. Dr. Bertagnoli insisted on a bone-density study to exclude osteopenic or weak bones, and a posterior facet injection pre-op to exclude a significant component of pain coming from the small posterior joints of the vertebrae and not the discs.

I was admitted to Bogen Hospital on Sunday, August 5th, and Monday, August 6th after a discogram, Dr. Bertagnoli performed a two-level ADR at L3-4 and L4-5 using the ProDisc-L. I was discharged August 9th, and returned to the U.S. on Saturday, August 18th.

I can recommend Dr. Bertagnoli, his staff and hospital without reservation. Dr. Bertagnoli’s demeanor and surgical competency promotes an immediate sense of trust. I am currently pain free in my lower back and I have resumed my prior activities, including yoga and golf. This surgery was “life-changing” and I’d recommend an evaluation by Dr. Bertagnoli if your back or neck pain is felt to be caused by DDD.

I'm doing great after the two-level lumbar ADR on August 6th and am pain free in my lower back. I've seen Dr. Jon White (who knows Dr. Bertagnoli) on two occasions and had lumbar xrays once. I just have a couple questions. Should I do any physical therapy (vs. Hatha yoga) and what type and how often? Can I play golf? Dr. White advised me to not lift anything over 50 lbs. (about 22 kg.) for another 3 months. Thank you for your wonderful care. The lumbar surgery was indeed "life-changing."

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