Why do a lot of people go over seas for ADR

[Icanraceit]

I was wondering why a lot of the people go over seas for the ADR operation. Is it insurance related. Is it better doctors. What is the reason. I understand it has been going on over there for decades, but we have been doing it here for since 04 under the FDA and experimentally since 00. Any info would be great as I am making the decision currently to have the operation or not to have the operation. Thanks for the responses in advance and God bless!

[jss]

Matt,

There are a couple of reasons.

Until recently it was unusual for an insurance company to pay for ADR, so you had to pay out of pocket. It costs much less out of pocket over seas than here in the US.

The other reason; overseas surgeons tend to have much more experience than their American counterparts, and overseas you can get much newer technology than here in the US.

Be aware that there are plenty of risks in going overseas; such as the one you mentioned; that is, getting home if the surgery goes bad.

Good luck, Jeff

[JeffR]

Matt,

There are a couple of reasons.

Until recently it was unusual for an insurance company to pay for ADR, so you had to pay out of pocket. It costs much less out of pocket over seas than here in the US.

The other reason; overseas surgeons tend to have much more experience than their American counterparts, and overseas you can get much newer technology than here in the US.

Be aware that there are plenty of risks in going overseas; such as the one you mentioned; that is, getting home if the surgery goes bad.

Good luck, Jeff
Not to dissuade you, it's obvious you want to know all the facts, and to build of what Jeff said here are some other reasons why (at least for me):

-Better technology, the m6 is far superior to a prodisc in my opinion, especially for multi-level adrs.

-Multi-level adrs, the FDA hasn't really approved any discs for multi-level adrs - there is some recent news in this: I think one cervical just approval last week or something. On top of this insurance companies won't cover multi-level for the most part.

-Results, don't discount this one as it was a huge factor for me. Look on this board or others and see which doctors are producing consistently happy/satisfied patients. That tells you a lot. :)

[Harrison]

The Charite trials started then, so it's been almost 13 years in the states. And most of those docs are still performing spinal arthroplasty, and many more have been trained since them.

[pelada]

I really only hear about clavel on here. No mention of dare. Guess hes pretty new. But there has to be many more. Who has the best results. Can we do a poll or something and get real data on this

[Lillyth]

Pretty much what everyone else said. Better care, cheaper for out of pocket, and better discs, not to mention insurance won't pay for more than one level.

My understanding about Dr. Dare is that he is the protegee of the late Dr. Boree, who was also a prolific surgeon. My interaction with his was great, I liked what I was able to glean about him via email, he cares genuinely about his patients as people, and a really cool bonus, he reads these forums, so hopefully if I got anything wrong about him he will correct me. I believe he is newish to the field, but got the impression he knew his stuff.

IMO, I would NEVER put a Prodisc in my body, but then, I am a freak of nature and not your typical case. Also if you are allergic to nickel, you do not want it. Go with the Bryan if you do a stateside ADR. The Bryan has shock absorption, while the Prodisc does not. All the docs in Europe are using the M6, with a few exceptions.

And a poll would be great! Can we get that going Harrison?

[Icanraceit]

Thanks for all of your help.

I thankfully have insurance that will cover all of the surgery. BCBS of Illinois has been wonderful in the explanation of benefits in and out of network. I believe I can go anywhere to in the country but I am leaning to stay in North Carolina. There are two doctors I am considering Dr. Musante of Triangle ortho and Dr. Dahari Brooks of greensboro orthopedic and sports medicine.

As for Dr. Musante. He was actually the first doctor who spoke of ADR and fusion with me. He did a fellowship with doctor Scott Blumenthal at the Texas spine clinic. This is a big bonus as I understand Dr Blumenthal is a pioneer in this surgery stateside. The problem I have with him is the fact that he suggested a fusion. He said since I am round and have tons of life left and I own a construction company that I run it would be
Long term more inteligent to do the fusion. I guess this is not a bad idea in the case of adjacent disc failing at the l4l5 level we can install a artificial disc at that time. Also he didn't take the time to help me understand what he would use any of the concerns or recovery times and expectation. He kinda seemed in a hurry.

Dr.Dahari Brooks suggested that I only do an ADR because if my age and the reduced chances of adjacent disc problems. He informed me that he had done 65 ADR's lumbar and cervical and had great success with both regions. He also went into all the details if the surgery answered every question and spent over an hour with my wife and I on two separate occasions. He is also 20 minutes from my house and to be honest. I liked him better as a person, he seemed human. He joked and even through in a swear word as I being a contractor swear a bit and he acted like a friend which was a pleasant change.

As for the prodisc. I have read a lot of threads on this site and of what I read the people who have had single level ADR's done the prodisc seems to have the most success and least problems. This is just what I've read there me be tons of bad stuff too. I agree the M6 L is much more advanced but being that I am a guy that believes in most cases simple is good I kinda like the idea of less stuff to fail. That's just me. I am so thankful for all of your posts and Lillyth I hope you surgery goes absolutely perfect and you are back to pain free within the year just as I plan to be. Thanks again and God Bless!!

[JEVE19]

You have to remember that surgery is where the doctor's make their money.
It's their business. Most are great sales people and can make you believe in them but...does that make them the best doctor for you? Is the disc they are using the best disc for you?
Is the procedure they recommend the best one for you? Are they recommending what's best that's FDA approved or just what's best?
Why would a US doctor tell you that the M6 is the best disc when it's not FDA approved?
They want your money to stay in their office and not fly overseas, where most of the doctor's we talk about on this site have "hundreds" of these surgeries under their belt.
My first visit to my US doctor who wanted to give me a Charite in 2005, I would have been his 13th ADR surgery. Gulp!! Plus, that was the first year that ADR's were approved here but...I couldn't get insurance to cover it. I lived with chronic pain for ten years and finally had Dr. Boeree do my L5-S1 with an M6-L.
Dr. Boeree was such a great loss because one conversation with him put you at such ease.
Experience and confidence is what sold me on him.
It's been 15 months since my surgery and I haven't had one set back. Haven't taken a pain pill since day 4 of surgery. Now, when I look back on it, I'm grateful to be fixed and kinda annoyed at loosing ten years of my life to chronic pain. At least I'm better now.
If I had to have another ADR done, I would have Dr. Dare do it.
I've spoken with him and I'm very confident that I'd be fine in his hands.
Those ten years of dealing with US doctor's really opened my eyes up to how the system here works and how far behind the times the US is when it comes to back care.
My doctor just had way more experience than any US doctor had and he showed me more care and concern in one phone call than I had in many years of seeing US doctor's.
I would never have another ADR done in the US.
That's just my personal feelings. I had such success, I'd have a hard time not going back overseas. If it's not broke, don't fix it.
I have my life back and I just don't trust the doctor's here now.
Thank God for the forum, finding this place lead me to Dr. Boeree and to getting my life back. I know now to not just listen to the doctor because he's a doctor. I read about any medicine or procedure they want to give me to educate myself FIRST. I want it to be my decision too.
Your smart for going on the internet to educate yourself. Keep doing that and best of luck to you. I hope God leads you to the right decision ;)

[JeffR]

I agree with Vicki - similar story up here in Canada except there is less of a money incentive but definitely a bias against going overseas for the m6 for the orthos and neuros I spoke with. Some of it is ignorance as well and you need to take all this (the money incentive, the ego of the doctor not being able to solve your problem etc.) into account as much as this is against your natural inclination to trust them.;)

[Lillyth]

The last two US based doctors I spoke to had never even HEARD of the M6!

[Icanraceit]

After reading all the replays saying I should consider the M6L overseas you have finally gotten me to start looking In that direction. I am having trouble remembering who said it but they said "if you take money out of the equation where would you go". I have to admit that this single comment really put things into perspective. I'm by no means rich but I would be able to make it happen without being a huge burden in my family. Although the surgery is in the $30000 range with Dr. Calvel it is a small price to pay for a better chance at success. I am just quoting a price I saw on his site for a single level ADR. Hopefully I can get some help on the doc decision and make some forward progress soon. Hope everyone is pain free today and God Bless!!

[Harrison]

Lillyth, that's because the M6 has only been approved for outside the US....

[JeffR]

Lillyth, that's because the M6 has only been approved for outside the US....
Harrison, surely a good U.S. ADR surgeon who is attending conferences and is keeping up with things will have at least HEARD of the M6. For instance Zigler at TBI knew it and said it was one of the only discs not approved in the US that "intrigues" him.

[2Confused]

I had surgery in Spain & My neurosurgeon agreed to treat me post op - that was huge! however, he admittedly has no knowlwdge of the M6 disc. I'm sure his ego was bruised because I chose to go elsewhere, but he also admitted that
1.) he had never done a two level ADR
2.) did not know anything about the M6
3.) he felt like a 2 level would be my best option & provide me with the best results
4.) insurance would not cover the procedure, the out of pocket expenses would have exceeded $150,000
Had my insurance been willing to pay, I most likely would have ended up at TBI...
That being said, I based my decision on what I believed was best for me & my body.... The cost of paying cash for surgery in Spain will set us back financially, however, the inability to work due to neck pain had already set us back! So, it was a risk I was willing to make after due diligence, research and much soul searching.... only time will tell if it was the absolute right decision. Based upon my condition almost 13 weeks after surgery I say the risk was worth it and the money well spent.
For what it is worth, based upon the fact my local neurosurgeon has no knowledge about the M6, he has told me that he feels like the disc placement is less than optimal;in his opinion they are not centered properly but he also admits that the curve in my cervical spine due to the double whiplash may play a factor in the way the discs were/are placed. He feels that the worst case scenario would be a revision years from now, so he says I may have bought myself some time and avoided the fusion which I was so opposed to, again remember he has NO experience with the M6 and that is purely speculation. I am anxious to hear what Dr. C's response will be when he receives my 3 month post op films and the dictated report from my Neuro.

Many people here on the forum and through PM provided support and encouragement as I struggled with the decision, again, I cannot thank you enough (you know who you are). Here I am three months post op, no neck pain, no cervical headaches and I feel 100% better. Yes, there is still some nerve pain radiating down my right arm, over my right shoulder & under the scapula - those nerves had been compressed for 3 plus years, all I can do is hope that it will eventually decrease and hope that it will go away completely with time. I also have some achy muscles in the center of my back that comes & goes depending on what my activity is & some muscle spasms in the trapezius & another muscle (can't remember the name) on both shoulders. My left tricep shows considerable loss of strength which both my NeuroSurgeon & PT say is due to nerve damage. Prior to surgery I had the nasty EMG nerve test and there are nerves in my left arm that are non-responsive and there were indications that there was damage in the right arm as well. So considering I waited 3 plus years for surgery and may have compounded the damage by doing so, I have to say that I am 100% happy with the outcome at this point.
Do your research, talk to others, listen to their stories and then --follow your gut instincts! We have to be our own advocates in todays medical world.

Hope this helps in some small way to lead in to a decision you are comfortable with.

[Icanraceit]

So when you all go overseas do you still go back to the same doctor you basically just dumped or do you find someone else to help post op. I guess my main concern is the post op. If it all doesn't go well. This is really the only concern I have with leaving the country. Let me know of of the post op duties I will have of I do decide to head to Europe. Thanks and god bless

[2Confused]

I think I got lucky, we discussed the possibility of Spain & the reasons why we were considering surgery overseas with my Neurosurgeon before going to Spain. We point blanked asked himif he would do follow up treatment post op. I think he understood that without insurance paying we could not afford the approx. $150,000 it would cost to have surgery here. Plus he had never done a 2 level replacement..... So when you all go overseas do you still go back to the same doctor you basically just dumped or do you find someone else to help post op. I guess my main concern is the post op. If it all doesn't go well. This is really the only concern I have with leaving the country. Let me know of of the post op duties I will have of I do decide to head to Europe. Thanks and god bless

[Icanraceit]

2con,
I know that one doctor probably won't help. He is a very good spine doctor by the us standard and is probably great with the prodisc but he is one of those docs that know he is great and acts that way. He worked under dr Blumenthal and probably has in the 150-250 ADR surgery under his belt and he isn't even 45. I was pretty much sold until the m6l was brought to my attentions and now I'm thinking the right decision for the rest of my life is the m6. Still working hard to make the right decision. I know that surgery is the only real chance I have of a pain free life. I was wondering if anyone here knows of anyone that is having trouble with the m6. I have read that facet problems have been reported but I'm not sure that its the ADR's fault or maybe he was predisposed. I guess you may never know. Thanks for you fees back and god bless!!

[Jstuckey]

Ican: as far as your follow up concerns go, this is how mine went:

I was there (England) for 3 weeks post-op. I started therapy there, saw the surgeon and pain doctor regularly for follow-up for the 5 days hospitalized, and the 2.5 weeks afterward as an outpatient. The therapists told me exactly what to do when I got home for the first 12 weeks, and I took that information home to my local therapists (who knew nothing about artificial discs - but didn't need to since the therapy protocol was handed to them, and I knew about my disc). Once home, I continued to refill pain prescriptions as needed from my family physician, and started therapy following the instructions and restrictions given to me. I emailed or called my surgeon with questions (he gave me his personal cell phone number) whenever I felt confused or concerned about something. I had xrays at 6 months and 1 year that were sent overseas to be reviewed by my surgeon - the one who knows the hardware and what it should be doing! (I sent my xrays on CD in the mail, but there are more techy ways to do it). He emailed me back with his review of my studies, what the placement looked like, anything special I should know/be doing. (Really no different than sitting in your local ortho's office and reviewing your studies on a board in front of you). All of this interaction was part of the cost of the surgery and is no additional fee (except the therapy/pain meds here at home, of course).
I've never had any problems that needed treatment, but this surgery is pretty much a one-time shot at getting it right. It isn't something they can really go back in and tweak with a follow-up appointment, so if something did go terribly wrong, it would be a brand new set of full-blown surgery circumstances to deal with rather than a follow-up. Everything less than "terribly wrong" is addressed with therapy, posture, lifestyle, etc. Does that make sense?
This has all worked well for me, but there are other scenarios too.

[Icanraceit]

Thanks for your responses pertaining to post op situations. I am going to be talking to ritterlangs office and clavels office today as well. I am hoping that I will have my doctor soon. I have to get a purple X-rays done to complete their packages and will know soon after I send them. Thanks for all you help and I will keep all posted. I am sure I will have more questions. Thanks and god bless!

[M.Frost]

Sent you a pm yesterday, just to give you some info on my UK surgeon Mr Chris Dare, perhaps it didn't get to you I'll try again.

[Icanraceit]

Mfro,
I did get it and I am thankful for the message and info. It has been very tough here lately as all of this is really wearing on my lovely wife. She is of corse worried about me but I believe it is really worrying her to think of an overseas surgery gone bad. I know she is trying to e positive but there is a possibility of failure. I did respond to your post on the world wide doc search thread and I do understand not wanting to go through with it for fear it would get worse. I couldn't even begin to imagine WORSE ahhhhhh!!!!!! Any how thanks so much for taking the time to share your info with me. Real quick how are you feeling now. Also did you have leg pain pre-op or any other conditions besides low back pain. Just so you know I have no leg pain, no facet problem/pain, and no other underlying pain or problem. I have had facet blocks and a discogram and the facet blocks didn't work and the discogram showed the pain was in L5S1. I am getting tired of all of this and am sitting here typing to you with pain that has overstayed its welcome;-/. Have a very blessed week and thanks again

Matt

[JEVE19]

You mentioned that your wife is worried about your overseas surgery going bad.
After finding this forum and doing alot of reading, I actually felt more fear of going to a doctor here with less experience than the overseas doctor's have.
Our doctor's can still only do a one level ADR. The overseas docs have been doing multi level ADR's for years now. We just can't close that gap here in the US.
Most of us were all in your shoes at some point. The thought of going overseas for surgery seems crazy but then when you read most of our outcomes, we are all so glad we did it.
The M6 seems to have really good results at this point. I feel I dodged a bullet not getting a Prodisc put in. Only time will tell, but there are too many bad Prodisc posts to read about on Google, etc. The disc is as important as the doctor.
You'll keep seeing me say this but make sure you ask why a doctor recommends the disc/fusion/etc. Is it because it's the best for your case, or is it the best they have to offer.
Those could be two very different answers.
Once the disc is put in, it's not like a doctor can go in there an tweak it if something's wrong.
Once it's in, it's pretty much a done deal. This is where more experience comes into play.
The overseas docs we discuss on here usually have way more than the US docs do.
It is a big financial burden though and some just won't be able to have a choice in the matter. If you do have a choice, then consider ALL options.
Best thing I ever did was speak to the overseas docs on the phone.
Just think of that...when have you spoke to your back doctor here on the phone?
What about email? Geez, I had my docs home phone, cell phone, office phone, and email.
I would have never got that here in the US.
Honestly, once my surgery was over...the only thing I needed my US family doctor to do was order my x-rays for me. Dr. Boeree emailed me what he was looking for in my x-rays and I printed that and gave it to my family doctor who ordered what he had asked for.
Other than that, everything else was pretty much covered by phone and emails.
Dr. Boeree told me that I didn't really need to go to a physical therapist.
I was trying to do that but it was costing me $125 a visit.
When I told my doc that, he told me to find a gym or a trainer who had good experience with someone needing to start off slowly. Told me to try swimming, try a cross trainer, very basic pilates. Just told me to not bend backwards, don't lift heavy weights and not to do twisting motion (like sweeping a broom type of movement) for at least 6 months.
I found a gym here that had a pool. They also had trainers who worked with me and set me up with a basic plan. Been moving forward ever since.

I'm just trying to take away a little of that overseas fear I think we all felt before went.
Talk to these doctor's on the phone, it's such a different conversation than most of the conversation's you've had with the US docs.

[Icanraceit]

Vicki,

Your story is very helpful and I believe that I am ok with the trip but I'm not so sure about my wife. I do know that if I said that this is what I was doing my wife would be on board. I don't want to just say this is it and like it so I am trying to let her do some research on her own and with some gentle nudging so that she feels like she was part of the decision because she is part of the decision! I couldn't do it without her. That's a FACT!! Again thanks for taking the time to write on my post and god bless!

[JEVE19]

I pray you get the same divine intervention that I had!

[Icanraceit]

I believe it's on the way Vicki:-) god bless my dear and thanks for all the help!!

[Lillyth]

Lillyth, that's because the M6 has only been approved for outside the US....

Oh, I know. But if I were a spinal surgeon, I would be keeping my eye on what Europe was doing just on general principal. The idea that a doc here would NOT know about the M6 is just terrifying!

[Lillyth]

Prior to surgery I had the nasty EMG nerve test and there are nerves in my left arm that are non-responsive and there were indications that there was damage in the right arm as well.

My EMG was TERRIBLE. I have instructed all medical professionals that in the future, they need to tell patient that they are being sent to be TORTURED. That was the second worst painful thing I have ever experienced. I would prefer natural childbirth to an EMG. I was sore and bruised and had additional nerve pain for almost a week!

[Lillyth]

Thanks for your responses pertaining to post op situations. I am going to be talking to ritterlangs office and clavels office today as well. I am hoping that I will have my doctor soon. I have to get a purple X-rays done to complete their packages and will know soon after I send them. Thanks for all you help and I will keep all posted. I am sure I will have more questions. Thanks and god bless!

What are purple X-Rays?

[Lillyth]

Vicki,

Your story is very helpful and I believe that I am ok with the trip but I'm not so sure about my wife. I do know that if I said that this is what I was doing my wife would be on board. I don't want to just say this is it and like it so I am trying to let her do some research on her own and with some gentle nudging so that she feels like she was part of the decision because she is part of the decision! I couldn't do it without her. That's a FACT!! Again thanks for taking the time to write on my post and god bless!

Just tell her what you are learning. If she is doing all you say she is doing, she doesn't have the time for research on top of all that! I just distill everything down at the end of the day for my husband. In fact, he is the one who finally said "Honey, you loved Dr. Clavel, everyone raves about him, why are you even considering another doctor?" Just share everything you are learning with her. I'm sure getting back the man she married (not to mention no longer having to do EVERYTHING - I know, my husband is doing this right now) will be worth it. Why is she not okay with the trip?

[Icanraceit]

Just tell her what you are learning. If she is doing all you say she is doing, she doesn't have the time for research on top of all that! I just distill everything down at the end of the day for my husband. In fact, he is the one who finally said "Honey, you loved Dr. Clavel, everyone raves about him, why are you even considering another doctor?" Just share everything you are learning with her. I'm sure getting back the man she married (not to mention no longer having to do EVERYTHING - I know, my husband is doing this right now) will be worth it. Why is she not okay with the trip?

Lil,

She is concerned that if something goes wrong the doctors here that we all think are crazy wont be able to do anything to help or we would have to pay to go back on our dollar for a repair. We can afford it once now but two trips in short succession would be impossible for us. I understand her fears but my fear of pain forever overtakes that fear for me.

[JeffR]

Lil,

She is concerned that if something goes wrong the doctors here that we all think are crazy wont be able to do anything to help or we would have to pay to go back on our dollar for a repair. We can afford it once now but two trips in short succession would be impossible for us. I understand her fears but my fear of pain forever overtakes that fear for me.
Clavel has revision insurance that you can buy to help with those fears.

[TPatti]

Icanraceit,
I am also in the process of deciding what and how to take care of my back. I am for the most part a fairly fearless person and have to admit that some of the scenarios you can come with are pretty scary. Much like you, my wife has a lot more fear of going to Europe than I do, but after she came to one of the local consults with me and started reading thru the forum she told me that she is beginning to see that the possibility of a far superior outcome may override the fear of going overseas. Don't let comfort level of our perceived norm become a fear. The clincher for us both feeling comfortable was the great lunch we had with JeffR last Sunday - He is a normal guy, doing well, and ran into many of the same obstacles in decision making that we are:)

[Jmbeam]

Jeff,

What is this revision insurance you spoke about and what is the cost. I never was informed about this?

[JeffR]

Jeff,

What is this revision insurance you spoke about and what is the cost. I never was informed about this?
There seems to be some confusion about this. I signed for it when I was checked in and was told it was for 2 years to cover revisions, there was no special quote for it. The situation has changed recently however as patients now are being told that the insurance is only for 1 year and it a couple thousand dollars I think. If you got it in November you should have the same deal as me, you can contact Yolanda to get clarification.

[Lillyth]

I can totally understand that. But be assured that from what I've read Dr. Clavel is who fixes the ones that go wrong! But I totally get the fear. I keep thinking "What the hell am I about to do?!" But 20 years of low back pain and 10 or cervical pain? I'm just done. I know recovery is going to be hell, but it will be worth living the rest of my life without back pain. I'm 35. The rest of my life is a long damn time.

[Icanraceit]

Does anyone know what Dr. Clavel's advertised success rate or at least what he tells his patients prior to surgery? Thanks and God Bless!!

[JeffR]

Does anyone know what Dr. Clavel's advertised success rate or at least what he tells his patients prior to surgery? Thanks and God Bless!!
He told me he's never done a revision.

[Icanraceit]

I have a phone conversation with Yolanda in a few minutes.. I am hoping to get some of my questions answered. I will let you guys know the outcome. Thanks again for all of your help and god bless!

[JeffR]

Good luck! Tell her Jeff from Canada says hello. :)