L4-5 Activ-L ADR
L5-S1 STALIF Fusion
Dr. Zeegers, Alphaklinik
Munich, Germany - December 2006

January 1, 2007 - What a way to start a New Year!

Each day that I wake up, Iím surprised and relieved to not have lower back pain. That was the most discouraging, to wake up in pain. For almost a year, I was in constant pain, with weakness in one leg, and unable to do more than essential activities.

Hi, Iím Alan Kucharski and I'm from Scottsdale, Arizona. Iím 45 years old and a month ago I had a two level hybrid spine surgery. A week after the surgery, I did a walking tour, albeit stiffly and in some post-surgery pain, through the beautiful Nymphenburg Palace in Munich.

I donít think I would be here now, pain-free and confident that it will stay that way, without Mark Mintzer. Having Mark with me in Munich proved to be critical to the diagnoses of my L5-S1 condition, and the procedure shifted from being an ADR to fusion. Mark guided me through the entire process, attended all doctor meetings, and provided valuable input every step of the way. In two days you do what would take two weeks here in the States. By the end, your head is reeling, and you have one of the most critical decisions of your life to make.

Before my surgery, Mark and I went into Munich for the evening. We happened to be
outside the Stadtoper as people were entering, and on a whim we got tickets and saw
a wonderful performance of Orphee at Eurydice, by Gluck.

The interior of the Munich Stadtoper house, not quite as impressive as those in
Vienna and Paris, but worth seeing.

Ten years ago, I badly herniated, ruptured, the disk at L4-5. The well-respected neurosurgeon Dr. Sonntag from Barrow Neurological Institute in Phoenix performed a microdiscectomy and limited laminectomy. Two weeks later, it was like I had never injured that disk, but little did I know, that the disk dies and degenerates after an injury like that.

When I saw Dr. Sonntag this time, and he started talking fusion, I knew I had to find an alternative. I have extremely tight hamstrings (and I rely even more on the flexibility of my back to bend forward), always have and my brother is the same, so perhaps itís genetic. If I had fusion at L4-5, it would destroy the rest of my back.

I searched the web, spoke with other medical professionals in Phoenix, and found Markís website, which contained some very good information. In spite of all my research, after I spoke with Mark, I realized how little I knew compared to him, and I subscribed to creating a profile and having him help me present to and select a surgeon.

This is my first meeting with Dr. Zeegers, and I'm a little apprehensive, but he is so
nice that soon I was very comfortable and expressing all my thoughts and opinions.

It was clear that I had to have ADR at L4-5, but the diagnoses of L5-S1 could be tricky. The MRI showed some bulging of the disk, injury compounded by the degenerating disk above it, but I had no nerve pain at that level, and when Dr. Zeegers initially called me, he was 95% sure that L5-S1 would need ADR. I wanted to ensure that afterwards the pain was gone, and that I wouldnít be back here in a couple of years operating on L5-S1 if we left it alone. I decided on Dr. Zeegers, and I contracted with Mark to be in Munich with me so that we would make the best decision regarding the procedure. Mark has so much experience with patients with ADR and other spine surgeries, I considered it vital to have him there in person -- and it was.

At our first meeting with Dr. Zeegers, Mark pointed out the difference between right and left side of my spine at the L5-S1 level, and suggested that it be investigated further. Dr. Zeegers concurred, and ordered x-rays and an MRI focusing on that area. The difference was that one facet joint had been fused naturally at birth, and I was not a candidate for ADR at that level. Since the L5-S1 disk was bulged, ďblackĒ meaning losing hydration and would degenerate, and could be contributing to my lower back pain, it was recommended to replace it now with a STALIF cage and fuse it, and implant an Activ-L disk at the L4-5 level. The fused level, in this case, is isolated from the rest of my natural spine by an ADR, and cannot cause injury.

There were a few gloomy days, including one day when it snowed, sleeted, and rained, but for the most part, the weather was wonderful for December!

Iím now convinced that with Markís help I picked the best surgeon and the right procedure was done. My lower back, barring another serious injury, is now set for the rest of my life Ė- full function restored, no further degradation, and no additional surgeries required.

In addition to thanking Mark Mintzer, my thanks and gratitude to Dr. Zeegers and the Alpha Clinic, he was not only as I expected him to be, very meticulous and precise, and also extremely personable and caring. All the other doctors and staff at the Alpha Clinic were very thorough in the pre-surgery work-up and the work was of the highest quality. I believe that it helped that it was all done in house as this provided a level of accountability not otherwise possible.

My friend Karen came to join me in Munich. I'm a week post-op and we're
warming ourselves after sightseeing in one of the cafes close to our
hotel by Arrabella Park.

Sylvia is one of the Gyrotonics therapists at the Alphaklinik. She lived in the
San Francisco Bay area for several years before moving back to Germany.

She sings with a band, and has recorded a couple CDs. 8 days after my surgery,
Mark, Karen and I went for an evening out to watch her perform in a local club.

January 17, 2007 - Update

Iím now 6 weeks post-op, and Iíve had my first pain-free day. It was a Friday, and the evening before, I jogged for the first time in a year, the weakness in my right leg is gone. That Friday, not once did I feel any lower back or hip related pain, it was to me a miracle.

Not only that, but I appear to be better than before. I have always had a weakness in my lower back, limiting how long I could stand, and doing things like push-ups, I would have trouble keeping my body straight, my back would give out before my arms. Now, perhaps with the fusion of my L5-S1, I have a stability I didnít have before, and I can stand longer, and my arms give out first, as they should, with certain exercises and stretches.

The results of my surgery has exceeded my wildest dreams, and I am truly happy. I will forever be grateful that I found Mark and made the financial investment in my health to have this surgery in Germany.

Xray from the front shows the screws from the STALIF cage at L5-S1
below the artificial disk at L4-5.