multi level ADR in US?

[tisury]

I am a bit confused. I thought for a long time that the US doctors could only ever do one level, unless it was a special circumstance. Yet, I know I have seen quite a few posts of people who have had multi levels done here in the United States. Which doctors (qualified) are doing multi levels in the US?

I have been in contact with both Dr. Zeegers and Dr. Bertagnoli in Germany. Dr. Bertagnoli is recommending a 2 level ADR above my already existing one level. I am waiting to hear what Dr. Zeegers opinion is. I have so far been quite impressed by both of these doctors and their staff. I am not sure I could afford a 2 level here in the US anyhow and so many have praised the German doctors- but I need to explore all my options.

So, does anyone know which qualified US doctors are doing multi level ADR's? If I recall correctly, I believe I remember seeing Drs. Bitan and Yue mentioned on the east coast and Dr. Delmarter on the west coast. Is this correct? Anyone else?

And this may sound like a dumb question, but how are some doing multi levels when others say you can't do more than one level in the US? Or does that just mean it's not approved, so insurances won't pay for it? Insurance coverage is probably not a deciding factor for me. My first ADR was covered, but he is the only ADR doctor within my insurance network that I know of and he isn't doing multi levels. And my insurance has denied requests again and again any referrals to go out of network for ANYTHING. But right now I am at the point, I think I would mortgage or sell everything I own for the chance to be near whole again and have a life again.

[Harrison]

Tis, did you see Carl's recent post -- 3 level? He had his done locally and is very happy, and seems more than willing to help too!

PS Thanks Carl

[Dale S]

I was scheduled for a 3 level with Dr. Regan in Los Angeles until my insurance company pulled the plug. I ended up with Dr. B in Germany and despite my reluctance to leave this country for surgery, I'm glad I did. Aside from the airplane ride, none of my fears were realized.

Good luck to you,
Dale

[Juli]

Basically, it is up to the doctor as long as the device has been FDA approved for one level, they can use it anyway they deem fit.

However, as Dale said, most insurance companies are still not approving even one level, so there are many issues to look at.

I would look at some of the other posts that have addressed this subject and look at the post surgical outcomes to see what and where people have had their surgery and
you should be able to glean quite a bit of information. There have been a lot of recent posts about finding good docs in the U.S. though.
But there are quite a few doing multi-level ADR in the states.

Good luck,

I'm curious about these multi-level implants, as well, especially given the Dupuy Spine information stating that only one level is appropriate. Is there a mulit-level study going on in the US? If the manufacturer only recommends one level, why are some doing multi-level, against the manufacturer's patient selection criteria?

[Juli]

It is pretty weird to those of us outside the medical field. From my understanding, limited though it is, once a device or a drug is approved for a specific use, a doctor can apply this device or drug in any "off label" way they choose. I think this is a way to get around waiting for FDA tests for every possible use other than what the device or drug was specifically approved for.

Apparenlty there are a lot of drugs that are used this way, one example was neurocontin, I believe, was originally approved for epilepsy but doctors are now using for nerve pain. I may have the specfics on that wrong, but that is the idea, as my tiny brain has grasped it.

[Mariaa]

GMW,
This is the same process that cages and other fusion devices went through. I remember back in 1998 when I was advised I'd need a 3 level global fusion and then reading at these websites like Depuy (tho it was another at the time) that the cage was recommended only for one level...

Once FDA approved, the surgeon may use his/her perogative how many levels he or she wants to do,however it doesn't necessarily mean the insurance co. will authorize esp. seeing if the device is recommended just at one level.. tho multi level studies are done, and with time, the use of devices expands in clinical practice.

And yes, there are quite a few multi level studies going on in the US~ there's a page somewhere here on the forum that lists the study centers in the US.. check them out, give them a call..

Thanks, Maria. I'm all set with my situation, but I did meticulous research prior to my operation, and was quite surprised to hear of these multi-level procedures being performed. This was especially intriguing given the proximity of L4 and the vena cava and aorta. My surgeon will only perform the installation of Charite at L5-S1, just for this reason. Thank you for the post.

[sam]

Hey Guys,

Dr. Robert Dzioba does two level ADR at the University of Arizona Health Center. I was considering getting 2 ADR by Dr. B, but I am not so sure now (given that it's available in sunny tucson, az.

Part of my law practice consists of helping people get medical procedure approved. I would love to try to help people get adr approved by their ins. co.

if there is any interest, let me know.

sam@samlevine.com

[chasswen]

sam your r going to be very busy does that mean free?
best wishes chuck