New to ADR- Seeking Information
 

Good Morning Everyone,

I am new here and looking for information. I have been dealing with constant back pain for over 8 years. I am trying to find information regarding ADR and fusion combined. My L4-S1 are degenerating, the disc space between L5-S1 is basically gone at this point. I have had Dr's in my area offer either a multi-level fusion or to do a One level fusion with the possibility of having to undergo another surgery within 5 years.

I have been doing research, and searching for other Dr's who offer ADR- Which seems to be VERY hard to find in the Florida area. If anyone is around this area, or knows an amazing Surgeon who performs ADR combined with fusion PLEASE help!

I greatly appreciate responses, Thank you!

Tiffany

Dear Tiffany,

For this type of surgery, you may have to travel. One of the best I've heard of in the United States is Jack Zigler of the Texas Back Institute in Plano, TX. I'm also not sure how much insurance will cover if any. Although the FDA has approved certain ADR's at one level, I don't believe they've approved them if they're adjacent to a fusion. You might be able to get the fusion covered, which is more expensive, and pay for the ADR off label. There are a number of surgeons in Europe who can help you if you're willing to pay and have no expectation of insurance reimbursement. The best ones I've heard of on here are Dr. Pablo Clavel in Barcelona, Mr. Dare in the U.K. and Dr Bierstedt in Germany. To go overseas, you are looking at $40k and that's without the flights. Most packages include hotel, hospital, surgery, etc. If you're willing to get a fusion, the hybrid approach may be most cost effective. Even if insurance doesn't pay for ADR, you are covered for most of surgeon costs (certainly for the fusion), anesthesia, hospital, etc if all done in one surgery.

I hope this helps.

Gene

Tiffany,

I ditto everything Gene posted and add something.

Most major insurance carriers will cover the off label ADR procedure known as a "hybrid"; which in your case would be a fusion at L5/S1 and a ProDisc-L at L4/5. That is possibly your only hope for insurance coverage with ADR in the US. If that's what I'd do, Dr Zigler at TBI in Plano, TX is the only one I'd let do it.

Before going with your surgeon's recommendation, I would encourage you to spend a few dozen hours (no I'm not exaggerating) researching your various options, the outcomes others have had with each of those options; the procedure involved, the implant(s) involved, the surgeon, etc... Not just on this site, but every site that you can find. There are no mulligans in lumbar spine surgery and bad outcomes tend to be tragically bad. You have to get it right the first time.

While we've seen glowing reports of numerous US surgeons on this site, I don't recall that any of them were in Florida. Anyone?

BTW: In my non-medical opinion, Jack Zigler does meet your description of "amazing" for ADR surgery.

Good luck, Jeff

Hi there. I'm in the same boat as you. Where in FL are u? As far as ADR goes I'd only trust Dr Rolando Garcia Jr he works out of Aventura Hospital in Miami. He started doing ADR surgeries since 2000. First in FL and I believe the Southeastern US to do it. He also helped on the design of the Active-L disc. From my research his bedside manner isn't the best but he came highly recomended by a Dr who I have the upmost respect for. He flat out told me he'd trust his spine to Dr Garcia. With that said if traveling is an option I second what the others have stated.

Jacksonville, FL
 

Hi,

If you are near Jacksonville, FL. Dr. Gregory Keller at JOI-Jacksonville Orthopedic Institute has probably done the most in the city. He has been involved in the FDA trials for the ProDisc since the beginning. When I saw him about a year and a half ago, he wanted me to wait a while as he was planning on participating in the 2 level lumbar trials.

I obviously did not wait, but it may be an option for you. He is an Orthopedic surgeon and has a good reputation in the area.

Dr. Garcia-Benchochea-spelling? Is a neurosurgeon that has done some ADR's, not that many. He is a very skilled neurosurgeon and developed some the techniques and tools for minimally invasive fusions.

St. Vincents Brain-Neuro Institute has some experience, more with cervicals.

That's about it that I know of for northern Fl.

Laurie

Thanks
 

Thanks everyone for the advice! I have been doing hours upon hours of research, the Dr's in other countries have come up numerous times. I am not too worried about insurance covering the ADR- I will find means if I am eligible for the procedure. I have seen two Dr's here in FL and both of them do not do ADR.

I am meeting with Dr. D' Ariano in May, and fingers crossed for good news. Nothing but great reviews on him.

I finally got my second MRI report back, For a 23 year old it looks like my back belongs in an 80 y/o's persons body.

I am located North of Orlando. I've been to Miami and heard of Dr's down there as well. The Dr I am meeting with in May works in Tampa, Orlando and Lake Worth area.

Best of luck Tiffany. Do the doctors have any idea why you're in such bad condition?

Please keep us posted.

Dr. Rolando Garcia, Aventura Florida, was part of the FDA clinical trial process for ADR / TDR from my limited recall. Dr. Garcia possibly did work in the Aesculap active-L TDR FDA Clinical Trial. He may have written some articles with Dr. Yue of Yale about ADR / TDR.

You asked about a hybrid surgery: adr L4-L5, fusion L5-S1. You need to ask the surgeon about that question.

Insurance coverage for a hybrid lumbar surgery may require some work, ie. paperwork and an appeal, work by the surgeon also.


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slackwater_sf

Tiffany, were you in a car accident, or any trauma to the spine?

Tiffany,

I am glad you found this board. There are a lot of people here who can offer some excellent advice. I am not familiar with any surgeons in FL who do hybrids. Would going overseas be a possibility for you. I know of several posters who have traveled to Europe and had successful surgeries, myself included.

Also, check out Dr. Scott Spann in Austin, TX. He is an incredible surgeon!! He had an accident that basically turned him into a quadripelegic and he came back from it!! If that isn't amazing, I don't know what is!! He is using stem cells as well as other techniques and different procedures. He is affiliated with AIMIS spine. It is the company that my surgeon, Dr. Pimenta, Dr. Cappuccino, and many other top of the line surgeons are a part of.

Hmm..
 

Well, as far as the questions regarding what happened, I am not too sure. I have always been a very active person from Horseback riding to volleyball.
The only instance I can think of when I could have severely injured my back was when I was about 11 and had a horseback riding accident.
The horse spooked, causing the saddle to flip under the belly, and I ended up falling right on my tail bone.
I have been rear ended, which I believe is what caused this 'flare' up I have for over the past year. Cortisone shots only worked for about a month.

I had looked into going oversea's, my main concern with that is, If I go, and come back to the states. What happens if something fails? Or the ADR is defective? My insurance will not cover any injuries after a "Foreign" surgery.

I have found a Dr in my area who performs a "hybrid" procedure. I am nervous, yet excited.

I am very thankful for everyone advice, and support! I am beyond happy I found these forums. :)

Regarding going overseas
 

Tiffany, the majority of people who go overseas are willing to do so because they are suffering and want their life back. Most who go there do so without any expectation of insurance coverage from home. Since most of the European doctors mentioned on this board have close to a 95% success rate, future insurance coverage at home is the least of their concerns. Furthermore, most of these doctors offer insurance of their own in case something goes wrong.

I was all prepared to go overseas myself. However, the spine surgeon who performed my previous fusion offered me a minimally-invasive procedure that could be done by him in NYC and be fully covered by insurance. He also assured me that ADR was still possible in the future on the small chance that I had future issues.

Gene

Tiffany,

First let me ditto everything that Gene has posted.

Second... Getting state-side care if, God forbid, something goes wrong overseas is not just limited by insurance, but is also limited by the fact that many, if not most, US surgeons will not touch you with a 10 foot pole if you need care after a problem with your overseas surgery. There are a number of risks of going overseas, and the problem that you've cited is but one of those risks.

As Gene has noted, the probability of needing state-side care after an overseas surgery is very small, but as a few posters on this site have demonstrated, it is not zero. Are the risks worth it??? That is a question that only you can answer. Here are some further risks:

• It may be very difficult in getting care in the US if something goes wrong overseas
• No protection from the US legal system in the event of medical negligence by your foreign medical team
• If complications occur, you will be required to remit payment at the time of treatment with your overseas provider (some offer insurance for protection in this unfortunate event)
• If you come out of surgery worse than you went in (though rare, it does happen), getting home could be very difficult

I went overseas because my active lifestyle would have ended with further US care, and I believed (right or wrong) that I would have become an invalide or suffered an early death with US treatment (I had a very unusual case). I don't envy the decision that you're being required to make, because you can't know that it was correct for possibly many years. Overstating the importance of researching options and the outcomes of those options would be difficult.

Good luck, Jeff

Tiffany,

I ditto what people on here said about Dr. Garcia. I know someone who was in trials for Active-L and that person is doing great.
I don't know how many surgeons do hybrids besides TBI, the surgeons in Colorado, Dr. Bitan in NY, and the top ones in California. My surgeon does hybrids but he is not in Florida.

Yes, insurance issues can be problematic, but if that is not a major concern, go to one of the best surgeons. There are also several qualified surgeons on the East Coast (Dr. Yue was mentioned).

There are advantages to staying in the U.S. Complications do happen, and you have to take that into account when deciding where to have surgery. Get a surgeon with experience, whether they are a big name or what. IMHO, I would not do one surgery and follow it with another anterior surgery. It is best to get your surgery done all at once.

Best of luck,

Kimmers

Tiffany,

One other thing I would mention is another reason people go overseas is because you get access to more advanced discs than are available state side (or in my case in Canada). Since you mentioned you are pretty active you may want to investigate in depth the restrictions you will have if you get a disc in the US (which will be a prodisc). In Europe and elsewhere you have access to the M6-L which designed much more like a normal human disc and allows you to do activities that the prodisc does not - like running.

Just something to consider.

-Jeff

Thanks Everyone
 

Wow, this is quite a bit of information to take in!

I really appreciate everyone's advice! This is the most information I have been able to find since I started my search over a year ago!

I hope everyone with Spine issues finds this page. It is full of great and caring people :)!

I haven't made any decision yet, Luckily the cortisone shot I got has kind of kept my pain manageable. Still hurts, but nothing like it did before the shot.
Deff a decision I need to take my time, and do LOTS of research.

I have found a Dr in FL who performs Hybrid's his name is Dr. D'Ariano. He has great reviews from here, so fingers crossed he can provide me with some great news!
If it turns out he can not help me, I will be looking into California. Everything I have read is that the most experienced surgeons, and ADR's are available there.

I am open to any suggestions, or advice. Thanks everyone :)!