TBI initial meeting

[randy leach]

I go to the Texas Back Institute 1/24 for my initial consultation. I am currentlyfeeling that Germany is a better option, but I want to check out the 'locals' and chekc out the insurance situation. can anyone help me with a list of questions that I should have answered (technical, not insurance)??
thanks,
randy leach

[Harrison]

Randy, this is a seemingly simple question, but is not to easy to answer. As much as we have patients have in common with our spinal anatomy -- we differ!

Generally, you want to be prepared with an understanding of your spinal health. Do have imaging of your spine yet? A diagnosis of any kind? Your doctor should help you understand what your diagnosis is and what treatment options exist for you -- this may or may not be ADR!

In the meantime, have you read Dr. Regan's paper yet? It is technical, but will give you a better understanding of questions you may want ask relative to ADR. One of the many issues that arise for patients is the doctor(s) experience -- and how this relates to patient outcomes. You may want to read the paper's conclusion first, then delve into page 1.

Lastly, the docs at TBI are highly experienced and have treated thousands of patients; but I'll defer to some of the patients on this board to comment. Next week, I'll be posting a "Q and A" from 3 top docs from TBI -- drawn from questions from this board.

More later, hope this helps...

[Alastair]

Hi Randy,
I know where you're coming from, in that the Europeans have much more ADR experience than any of the USA surgeons.

I know they have done thousands of surgeries at TBI but they have not done 1000`s of ADR spine surgeries.

If you can afford to go to Europe then that certainly in my humble opinion would be better than having spine ADR surgery in USA at this time. The spine surgeons in USA in my humble opinion, need more experience with this operation.

We have seen some good results from the trials in the USA but if you are going for something that needs to be as near hundred percent as possible then Europe is the way to go -- -- -- it all depends if you can afford it.

As Harrison says you should have at this juncture in time MRI scans and further spinal x-rays as evidence that you need this surgery proving it is the one for you,so you can justify the surgeons time and expenses. Also in USA your insurance companies costs. This surgery is done on evidence of need as all are, it is not a surgery to be taken lightly.

You need to be asking about success ratios, infection rates, number of surgeries done. In fact you need to be talking about recovery rates also, plus follow-up following surgery, plus how long will you be off work etc etc. Its VERY "Early days" for the USA ADR surgeons.

I hope that is helpful
Best wishes,
Alastair

[TXTony]

Randy,
I concur strongly with Alastair. As you can see, I had ADR at TBI. In fact, I'm one of their "complicated" cases, so might be able to give you some insight. Please PM me at my email address. (Click on my name in the left column and then click on the link to send me an email.)
Tony

[bobb0]

Randy, here are my 'questions':

How mnay adr surgeries have you done?

What is your patients success ratio and please define 'success'?

Why should I have an adr over a fusion?

What will my options be if adr does not relieve my pain and what will the process be to determine a course of action. (This may shed some light on how interested your doctor is about following less than successful outcomes).

How many revision procedures have you been involved with and what are their outcomes?

What are my odds of being worse than before surgery?

Have you had any 'failures' in placement or outcome?

bob

[Alastair]

I think one thing which is common to all of us, is that although we are aware that the USA doctors are extremely skilful, ADR is something that they don't have the experience in yet. Nobody really wants to be in the first batch of people who have ADR because of the likelihood of an error in these early days.

I know they have got to get experience from somewhere but we none of us want it on us -- -- -- we need them to come with a big dose of experience injected into them from the beginning.

The experience of Dr Zeegers was one of the reasons that I went to the Alphaklinik
Best wishes,
Alastair

[Harrison]

Randy,

Where ever you will go in the world for surgery (ADR, sex changes or lobotomies!) you will find "good" and "bad" doctors. The number of years a doctor has been doing ADR is just part of the many criteria I employed to make a decision. And for what it's worth, my doc in Boston has been doing ADR for 5 years, and anterior lumbar procedures for many more.

What else matters? How about if you like and trust your doctor? The fact they he/she is consultative and educates you on your options? That puts you in the right frame of mind before your go under the knife - and peace of mind is a BIG deal before your take on a highly invasive procedure.

Bob, your reply is great and is what Randy really needed. Nice!

There are related threads on this...I'll see if I can dig them up.

[Alastair]

Gosh Harrison! I didn't realise that anyone had been doing ADR in the USA for five years. I thought it was prohibited until the FDA approved it?

If you can get a surgeon like that in the USA it sounds jolly good to me
Best wishes,
Alastair

[Harrison]

There are a handful (I am guessingn appr 100) that have been doing the Charite' trials (as well as the ProDisc) for app. 5 years. Some of the Charite' spine surgeons are the ones that are training the hundreds of doctors new to ADR...you may recall reading about this in the articles I've been posting in the article library.

[mmglobal]

I believe that several Charite' and ProDisc surgeons are now over 150 procedures. December 2003 was when ALL patients in the Charite' study population were 2 years post-op. Procedures started in March of 2000.... yes, it's been 5 years!

Mark