Ruptured Disc While Running *MRI Images*
 

Hello everyone. Found the site while researching alternatives to a L5-S1 disc fusion.


Short Story:
o I am a 31 year old male who is in good physical shape. Currently live in Chattanooga, TN.
o Injured back while doing sprints in August 2017 at the age of 30, while at an Army school. No fall or anything. Something just "happened" in my lower back during a session of sprinting.
o Doctor referred me to physical therapy, which had little long term effects. Recovery mainly came from resting.
o Physical therapy and chiropractic haven't had any real results. Feels good immediately after each session, back is not as tight, which only lasts for a couple hours. But no long term results.
o Had my first appointment with the nurse practitioner at the orthopedic Surgeon's office. She ordered an MRI. MRI was completed 12/20, and my follow up with the nurse practitioner is scheduled for 1/2.
o Just started researching ADRs. I don't believe this orthopedic surgeon that I'm seeing offers that procedure. If they start talking about me needing an L5-S1 fusion, I will plan to find another ortho (probably in Atlanta) who is familiar with the ActivL ADR. I'll have to find an ortho that is in-network with Tricare if it gets to that point.


Long Story:
I'm an active 31 year old male, who has to stay in shape since I'm also in the National Guard.


I originally injured my back in August of 2017. I was running, doing high intensity interval training where I would sprint a certain distance, then slowly jog a certain distance. Well, during one of the sprints I felt something just "happen" in my lower back. I didn't know what it was at the time, but my lower back just hurt and had tightened up. I now know that I had ruptured my L5-S1 disc. This happened while I was at an Army school, and coincidently also happened to be my 30th birthday. Welcome to not being in my 20's anymore.


I went to sick call, and the doctor prescribed rest and a muscle relaxer. A few days after the injury, I started getting sciatica down my right leg. Doctor referred me to physical therapy. Did that for about a month or so. My progress seemed to plateau. The physical therapy seemed to help in the short term, as in my back would feel a little less painful right after the PT, but I don't think it did much long term. Graduated the Army school in late September 2017 and went back home to my civilian job in Chattanooga, TN.


Back home I just took ibuprofen to relieve the sciatica. My civilian job is sitting at a desk all day. I rested during the winter months, trying to give my back time to heal. Spring came around and I tried running outside again. I would run 2 or 3 times a week, but after about 2 weeks my back would hurt and be so sore I'd have to take a couple weeks off to let it rest. I went through this cycle several times, until in August of this year (about a year after the injury first occurred), my back was so sore and locked up that I stopped running altogether and started seeing a chiropractor. Looking back, I think every 1 or 2 week session of running was just hammering that L5-S1 disc and making things progressively worse.


This chiropractor supposedly specialized in "physical medicine". He would put me in a harness, and then I'd lay on my back on a table where the bottom half back and forth, but the top half of the table kept my upper body stationary. The harness was attached to a cable that pulled on my pelvis and supposedly decompressed my lower spine. Traction therapy I guess it's called. After about 15 minutes on the table, he would then adjust my back. Did this for about 2 months and never saw any real improvement. At $40 a pop, and me paying this out-of-pocket, it was getting expensive.


So I quit seeing the physical medicine chiropractor and bought an inversion table, since it did the same thing for decompressing my lower back, and was a lot cheaper than seeing the chiro. I later did some research and learned that studies show that the traction therapy pulling on the lower back is pretty much useless. My inversion table used to feel good, but now whenever I use it, my back hurts the next day and is extremely sore. I have stopped using it now.


I then made an appointment with a local orthopedic surgeon in October, but they were so booked they couldn't see me until mid-December.


From the time I made the appointment in October, to actually going to the appointment in December, I have noticed that my sciatica has mostly subsided. I feel the sciatica if I stand for an extended period of time, and sometimes when walking, but now my pain is mostly concentrated in my lower back.


I finally had my initial appointment with the nurse practitioner, who scheduled me for an MRI. Had my MRI on 12/20 (pictures below), and the radiologist's report concluded that said "L5-S1: A loss in disc space height, 1.4 cm central disc extrusion, and mild bilateral facet arthropathy result in mild central canal and bilateral stenosis".


My follow up with the nurse practitioner at the orthopedic surgeon's office is next Wednesday, the day after New Years.


In the mean time, I shared my MRI and report with my primary care doctor. He admitted that he's not an orthopedic surgeon, but seemed to think that a L5-S1 fusion was in my future. He said that because the disc was herniated straight backwards, he wasn't sure if the surgeon could get to the herniated portion to do a discectomy. I guess I'll find out what my options are at my follow up on January 2nd.


In the meantime, I've been researching alternatives disc fusions. My thought was "with technology was good as it is today, why the hell can't they simply replace the disc instead of fusing it together?" Well, I've since learned that they have been replacing discs in Europe since the 1980's, and for some reason that technology has been lagging behind here in the US.


The good news is that being military, my health insurance is through Tricare. Tricare just started recognizing ADR as a proven surgery, and has started covering it. So if my current surgeon starts talking about me needing a fusion, I'll find another one who is in-network with Tricare that does the ActivL ADR. I've found a couple surgeons in Atlanta through the ActivL manufacturer's website, and some are in-network. No clue if those surgeons are any good or not though.


I've attached images from my MRI. I have redacted my personal information from the image.

Adr
 

Good news is all the other discs look perfect

Bertagnoli
 

Get His free opinion also he is recognised as best in world n is cheapest cost due to socialized medicine

I'd like to have it covered by my insurance instead of paying out of pocket, if at all possible.

Rob, in 2004, I had a one-level ADR at L5-S1. I also appealed to BCBS and got the entire procedure covered.

You should be able to get covered OK. And there are many surgeons throughout the US that have been performing ADR for 18 years, so all this bodes well for your future surgery!

texas back institute
 

I am currently seeing Dr. Guyer at TBI. He suggested a possible two level lumber ADR . I am still debating whether i want to have the surgery yet. However, I have heard good reviews about Dr. Guyer and other fellow doctors such as Dr. Blumenthal and Dr. Zigler. The last time when I saw Dr. Guyer, I was told their current revision rate is about 1%.

You might want to check to see whether your insurance would cover them.

Unfortunately, Texas Back Institute is not in-network with Tricare (Humana Military) :(

I've been checking different providers to see if they are in-network here: https://hmd.humana-military.com/ProviderSelection/

I've heard of a few surgeons in the U.S. from this site (Blumenthal, Garcia, Zigler, etc.)


But none of those that I listed are in-network with Tricare.

I have found, however, that Doctors Regis Haid and Roger Frankel with Atlanta Brain & Spine Center are in-network. But I have no idea of their experience, and whether or not they are any good?

When I go to the ActivL website and use their surgeon locator (https://www.soactivesofast.com/low-b...urgeon-locator), it comes up with Dr. Erik Bendiks with Georgia Spine & Orthopaedics, and Dr. Tuan Bui with OrthoAtlanta are the two in Georgia that also in-network. But I have no idea if they're any good?

So the MRI images I posted were from 12/20, and yesterday (1/2) I had my follow up with the local orthopedic surgeon. She basically told me what I already could see for myself on the MRI and the report. That I had a large central extrusion of the L5-S1 disc. She said there was such little disc material left between the vertebrae that I will likely need a fusion. They are going to call me in the next couple days to schedule an injection.

In the mean time, I've reached out to Dr. Roger Frankel's office at Atlanta Brain & Spine center. They are in-network with Tricare. I'm trying to setup an appointment with them.

I've also reached out to Texas Back Institute in Plano, TX. They are out-of-network with Tricare, but I want to see what the cost would be to me to have them do the surgery. I would be responsible for 20% of the cost, while Tricare would pickup the other 80%. I have sent them my MRI and radiology report, and am waiting to hear back from them.

Just an update, I am also reaching out to Texas Back Institute. I've sent them my paperwork and my MRI, and I'm waiting on Dr. Blumenthal to review the information and get back to me. In the mean time, I did have a consult with Dr. Scott Hodges here in Chattanooga (local). He is the surgeon that does the BalancedBack, where he flies you to the Cayman Islands and replaces both the disc and the facets from the posterior. BalancedBack isn't approved by the FDA, and obviously insurance doesn't cover it. Dr. Hodges also told me he does perform ADRs with the ActivL. When I asked him how many surgeries he had performed with the ActivL, he told me "a handful", which to me means probably not that many. I'm sure he's a very skilled surgeon considering his success with the BalancedBack, but I think I'd rather have someone who has done more than "a handful" of ActivL disk replacements.


Hoping that Dr. Blumenthal contacts me soon.

I figure I also should have posted an MRI image from this view as well.

Heard back from TBI yesterday. Dr. Blumenthal reviewed my MRI, and wanted flex/extension x-rays, as well as a CT scan. Luckily my local orthopedic surgeon had wanted those as well, so I already had them done. Immediately emailed them over to TBI. They said to give their insurance team 3-4 days to run my insurance benefits, and they'd get back to me. Hopefully they have no issues with Tricare.

Tbi
 

I saw Dr. Guyer yesterday and asked a bunch of questions. My insurance Aetna won't cover at all. It is nice that your insurance can cover part of it.

you said in another thread he charges based on your job title? you said he charged you $60k, definitely not the cheapest, make your mind up man or at least keep your stories consistent.

I had a steroid injection (two actually) in my lower back on Monday 1/21. Didn't seem to do much for me.


I'm scheduled to meet with Dr. Blumenthal next Thursday 1/31. So I'm flying out there and flying back same day. Hopefully we get a surgery date set and I can get this over with.

yeah I dont know I would want the best possible chance at a full recovery with no complications

That's definitely the goal.

Met with Dr. Blumenthal today. Cool guy. Told me I'm a candidate for ActivL ADR at L5-S1. So I'm scheduled for surgery March 5th. Hopefully it's a smooth operation.

On another note, I asked his opinion on the Axiomed lumbar Freedom disc, since I've heard it's supposed to be getting FDA approval soon. He said it will never get FDA approval because the company ran out of money. And even if it did get approved, he said he'd still use the ActivL over the Freedom disc. He also said that with the company running out of money, all the research data is lost? Not real sure how all that works, but regardless, he wasn't a fan.

Adr
 

Congrats on booking your surgery! It’s a shame these companies go belly up because they can’t afford the conduct these ridiculously expensive trials.

12 days out from having surgery, and I'd be lying if I said I wasn't a little nervous.

But my flight to and from Atlanta to Dallas is booked (flying Southwest). Hotel room is booked for that week (for family to stay, and for me to stay in night before surgery, and day after planned discharge).

On another note. I'm still exercising. Not doing any running, that irritates my back. I alternate between cardio on the stationary bike, and resistance training. Resistance training includes dumbbell presses, bicep curls, triceps extensions, incline dumbbell presses, and situps/crunches. You would think that the ab work would irritate my back, and I guess it does a little bit, but not enough to stop me. Trying to strengthen my abs as much as I can before they cut me open. Hopefully it helps with recovery process.

Forgot to mention that I got my pre-approval from Tricare (Humana Military) for the procedure. No denials, no appeals, no fuss so far. Hopefully the insurance side of things stays that way.

Being frugal with your spine is gonna cost you bro

What are you talking about? Is the surgeon going to perform better if I had fought with the insurance company beforehand, or paid out of pocket?

Bertagnoli doesnt take insurance bro you have to pay out of pocket then submit it to insurance. As insurance companies delay payment n arbitrate prices its not what the BEST Surgeons in the world want. I had bcbs federal. Usually if your in usa n the procedure is not fda approved it makes it hard to get an advance payment. Insurance is like medicade now. I believe to get the best care you need cash. Cash is king. And bei g oainfree is better than cash to me. Its all a game in the usa. Doctors go to a 2 hour class n then r certified to install new discs

Dude, wtf are you talking about. Why do I have to go to Bertagnoli? And why do I need to pay my surgeon upfront with cash? Is he suddenly going to perform better? And guess what, if I had surgery and had complications back in the US, most surgeons here won't want to take me on as a patient. Instead of having ADR surgery in my hometown (which was an option), I chose to fly out to Texas and go to what is generally considered to be the best place in the US to have this done. It's all about weighing the options and deciding what's best for yourself.

GKTM300, what you said about surgical training for US doctors is false. Docs here have been performing ADRs since 1999. I received mine in 2004.

Frugality has little to do with Robb's issue; your comment is not helpful. Please refrain from posting on this topic. Thanks for your cooperation.

Well, I made it to Plano, Texas. Did all my pre-op stuff today. The meeting with the psychologist was interesting. You take a test which is 433 questions long. Some of the questions are pretty obvious in what they're trying to figure out Have you ever made a plan to kill yourself?. Some of the questions weren't so obvious (at least, not to me) Does the top of your head feel tender?.

Surgery is tomorrow morning.

Adr
 

Good luck tomorrow!

Maybe I didn't follow the whole thread. Why the psych testing? Everyone thought I was crazy for going to Spain by myself, with a doc I met on the internet, to get 3 non FDA approved devices! Somehow it made perfect sense to me then. Looking back, it now seems a bit crazy. But in my case, so far, crazy wins thanks to this forum and Dr Clavel's team. You will be a winner also. Stay positive and frame your recovery expectations appropriately. (TBI never did approve me for ADR due to low bone density)

Good luck with your procedure and recovery!

I've started a new thread here documenting my surgery and recovery:

https://www.adrsupport.org/forums/sh...012#post118012