Good Morning Everybody!
Tomorrow, my girlfriend (TexasT as some of you may know her as on this board) and I are going to see Dr. B in NYC. For those that have seen surgeons for the ADR surgery, what advice could you give to us regarding our visit tomorrow? Specifically, what questions should we ask, what information can we expect to be given, etc.?

Any advice would be greatly appreciated!

Oh boy Jeff--so many possible answers to that, and so little time!!! http://adrsupport.org/groupee_common...icon_smile.gif

You've also given us no info on your girlfriend's case, so hard to advise. I'd say go through the FAQ here and see what applies to her case/symptoms; you'll probably come up with some good questions there.

If Dr B in New York is Dr Bertagnoli, he's reputed as one of the world's best, so bring pen and paper and take notes if you need to (you can always look up related info/ terminology later on).

It's hard to whittle down a concise response to your questions, given the enormity of ADR issues and lack of specifics in your case, sorry.

But I've found that it's really necessary to research both ADR and one's particular pathology (ies) before, after, and in between medical consultations...

In short, I've found that with ADR issues: the more you know, the less you know--but the more you're then able to ask (if that makes any sense):

Good luck and keep us posted--

Trace

Hi Jeff,

Harrison asked if I would share my list of questions. Here is a list that I have shared behind the screen many times because it is a bit taylored to me and my situation but there are questions that may be good for you and others. Good luck on your appointment.

1.If you agree that a disc replacement is the preferred approach to fix my problem. Am I a candidate for a Prodisc @ L5-S1?

2.In your opinion looking at my films do you think that I would have a good result? Are there any anatomical issues with my body that you think could pose a problem with an ADR?

3.Do you see any stenosis or other abnormalities on my films?

4.Can you explain the facet joint issues that show up on my MRI? What grad would you give my facet degeneration at this time?

5.Do you believe the prodisc will fit in my body? If the smallest Charite core size is 7.5 and adding the end plate you get a prosthetic apx 10 mm how small is the smallest prodisc?

6.Dr Bertingoli says that my case would be better for a Prodisc due to the less distraction needed to put it in vs the Charite. Do you agree or disagree with this.

7.As a professional athlete do you feel I will be able to get back to the ski profession after ADR. Is the Prodisc or the Charite better for an athlete please explain.

8.How many Prodisc have you implanted at this time?

9.Do you use nerve monitoring during the surgery?

10.How long would the hospital stay be? What kind of post surgical experience will I have there? What kind of pain medication will be available to me immediately after ADR? I don�t want to be in a position where I don�t have enough pain medication after the surgery.

11.Approximately what % of your patients have had good results or in other words are significantly improved in Oswestry and VAS scores 6 months after the artificial disc replacement?

12.What % of your patients have had complications (what type of complaints?) or required surgical revisions to either a fusion or a new disc replacement?

13.Is a revision possible with a Prodisc, have you done it and what what was the outcome?

14.What do you make of the differences between the Prodisc and the Charite?

15.Regan says that the Charite is a superior product due to its un-constrained design. He says that the Prodisc may split the vertebra in a catastrophic fall. Do you agree or disagree with this?

16.How do you determine the correct size during surgery? I have heard about problems with someone getting a disc too large for their body and having distraction pains�

17.Do you remove the annulus during ADR surgery? Why or why not.

18.Who is your vascular surgeon? Can I choose from your vascular surgeon choices? Dr. Wagner has come highly recommended?

19.What is your opinion of the Charite?

20.What are you indicators post ADR of when its ok for them to go back to work? I have a very physical job if reasonable accommodation are needed for me to get back to work will you work with my employer to develop these accommodation so I can get back to work?

21.My health insurance is Health Comp/Universal Health Net. They have approved me for ADR surgery with my local doctor and now the Dr Regan. What is the chance they will consider approval of ADR the prodisc.

22.What is the FDA status of the prodisc? Why do they continue canceling meetings? When did you believe approval would come?

23.Do you feel if my insurance will not cover the prodisc until FDA approval would waiting be an option for me or would it cause more damage to my body causing contraindications towards ADR in the future?

Since you are a non-network provider to them, they will pay for 60% of customary and reasonable charges. Will you accept their customary and reasonable payment; this would make me responsible for the remaining 40%?

Thanks to everyone who responded. We are both nervous about tomorrow and have done a ton of "homework" to be prepared.

Here's my info: I have a tear at L5/S1 and may also have another tear at L3/L4. I've been hurting since I was 9 (trampoline injury caused trama; DDD and later herination) and have had significant problems since a MVA (caused tear) last year. The pain generator is L5/S1. I cannot walk very far anymore because my leg's buckle and must use a cane. My EMG is normal. Discogram shows tear at L5/S1, adnormal (DDD) L5/L4 but no pain only pressure and a possible tear at L3/L4 with no pain only pressure. I had a failed IDET at L5/S1 in 2003. I am now 25 and want to move on with my life.

My doctor here in VA is a big fusion guy and is very negative on ADR. From what I've read and from my tests etc. I am a very good candiate for ADR at L5/S1.

Thanks again to everyone,

Thanks for helping y'all, good luck Tricia. Let us know how it goes... http://adrsupport.org/groupee_common...icon_smile.gif

you should find doctor bitan a fine doctor http://adrsupport.org/groupee_common...icon_smile.gif
good luck tomorrow
chuck

Tricia,

Good luck tomorrow. Remember, you are interviewing the doctor as much as he is interviewing you. Don't leave until he has answered your questions in a way that you can actually understand what he is saying. Don't be shy!! By the way, I sent you an email through the forum with the surgeon that I used here in houston. His name is Dr. R. Eric Santos. I have had three surgeries by him and think the world of him. I sent more details in the email. Let us know if we can help with any other questions.

Gene (in Houston)

Wow Pauletteski--now THAT's a list of good questions!

I'd be interested especially in seeing what kind of response you'd get on these two:

I asked related question twice to DR Fenk-Mayer via email, only about the ProDisc Vs Mobi-C (why does he prefer the Pro, and how does it compare to the Mobi-C?) and got the same 'pre-fab' response twice, to the order of (not verbatim, but close):

'Dr Bertagnoli generally prefers the semi-constrained concept of the Prodisc, although he has implanted all types. Indeed, he has modified the Prodisc to suit his needs..but can implant all types according to need...however, we do not think this will be the case for you".

I think he just prefers Prodisc,especially after using it so much and modifying it, period. The Mobi-C people gave me much the same response on their product as well, also stopping short of comparing it outright to another disc on the market.

I forget who first said it (Maybe Alastair, but don't quote me? Confirm/deny Alastair?), but it was something to the order of 'pretty much all the discs out there today are based on a few basic designs and principles; you're much better focusing on the surgeon's capacity more than the prothesis itself' ????????

Probably in a few year's time, we'll know more about the pros and cons of each design variation, but right now I tend to believe ADR is too young to know much in that line.

Trace

Yes Trace, I firmly believe that all the prosthesis are very similar and no prosthesis makes a terrific difference to the patient.

I believe the doctor and his experience and skill is 99.9% of the whole deal. In the UK the use of the different protheses is a franchise -- -- -- a little bit like Kentucky fried chicken -- -- -- it's the individual preferences of the surgeon and what suits him as well as you.

There are a few isolated cases for the Maverick and we have one specific doctor in the UK using that for specific conditions -- -- -- but beyond that I reckon there's no difference in performance, between all of them, the Charitee, Pro Disc and Maverick.

The Charitee really has the longest history, but I think that the engineering progress since the 1980s has been huge and they've caught up with it because the Charitee was inspirational at the time

T & A,

As I stated above the questions were tailored to my case and the information I had received from my many doctor�s appointments. BLW I did not include everything here.

Re: Question these were the answers I got from the doctor to the best of my recall.

14. The ProDisc is the next generation artificial disc and has improved features over the Charite and they learned from the Charite. It also has the coating unlike the Charite disc that you can get currently at the time in the US. The snap in core will protect the facet unlike the un-constrained design of the charite.

15. He disagreed with this statement.

I am not interested in having a prodisc vs charite debate (been there done that use the search tool) just trying to help out with doctor�s questions, by request. http://adrsupport.org/groupee_common...icon_smile.gif

It'd be hard to have a debate on the relatively little comparative literature I've managed to find on the different disks to begin with, but in my experience doctors even seem loath to really compare the discs themselves, even in one-on-one patient consultations.

Hmmm, maybe because there's either so little difference between them and commercial investments/decisions must be protected, or so much we don't know yet? That might be a good question to ask in itself, but I doubt there'd be many straignt answers to that one http://adrsupport.org/groupee_common...s/icon_eek.gif

Trace

I asked my doctor's office today which disk they are planning on using for my surgery...she answered me with a bit of a tude and said "the charite is the only FDA approved disk in the US right now".
Not sure why the question made her answer me with an attitude though?

I've read lots on here and on my next appt, I will be ready with a whole list of questions.

Vicki,

One can only surmise, but there are still docs out there who don't like getting questions which they consider as belonging to the realm of the MD and not the patient. Finding a doc who don't mind our trailing our question lists behind us into his/her office feels like the pot at the end of the rainbow http://adrsupport.org/groupee_common...icon_smile.gif

Trace

Thanks for questions and help! I had a great visit yesterday with Dr. Bitan, they checked my facet joints to ensure they weren't a pain generator and we're moving ahead to get insurance approval and schedule a Charite ADR at L5/S1. Bitan couldn't have been more helpful; because I was coming from VA he squeezed me in for the facet joint blocks in the afternoon and waited until 7 pm to meet with me afterwards to discuss our options. I've never had a back doctor treat me with such caring and respect, I probably talked to him for 2 hours.

I asked my pro fusion doc in VA where I could get more info. about fusion vs. ADR and he said "I've told you everything you need to know" this was after short talk where I was practially holding him back from the door the entire time and he commented twice on the number of questions I had. Gotta love those doc's with the god complex

I asked Bitan about Charite vs Pro disc and he said he perfered the Charite b/c it had been around longer and he is simply most familer with it.

I feel really good about this now and am confidant moving forward with the surgery ASAP. I'm real sore today from all the poking and proding but am SO happy and relieved.

Maybe you can ask Dr. Bitan why he doesn't do his own discograms too. Is he just too busy?

You're lucky to see him. He is one of the best Charite Dr.'s around...

Texas,

Glad you got the answers you needed and the treatment you deserved! A doctor with a great bedside manner makes all the difference in the world coming out of the consultation. Still too many 'doctators' out there... http://adrsupport.org/groupee_common...s/icon_mad.gif

Any idea of when your surgery will be?

Trace

Thank you everyone to responding to my initial post. Tricia pretty much gave the better answer, but I felt like throwing in my two cents on how well the visit went with Dr. Bitan and his staff. Not only was Dr. Bitan's demeanor very reassuring, but the fact that he has operated with a "team" during his 380 Charite surgeries is also very reassuring. He provided us with statistics of the percentage of people that have had little to no pain after the surgery, people who still continue to have a little pain, and only one case where a he performed the ADR surgery failed, and he had to then do a fusion which cured the pain.

He mentioned to us that he has done several ADR replacements (removed the Charite and did a fusion) and the results have always been successful, but still recommended that he feels Charite is the best way to go.

I mentioned his staff above, so I wanted to discuss them as well. The vascular surgeon that has performed these surgeries with Bitan also met with us and he's a GREAT doctor... very trusting, very reassuring. Annie, who seems to be almost his office manager (for lack of a better term) was very friendly and worked with us throughout the day to make sure we'd be able to speak with them after returning from Tricia's facet block test.

If anyone is still searching for a doctor to speak with, the day trip to NYC to visit with Dr. Bitan is well worth it in my opinion. Tricia and I are both very happy that we were able to make the trip and were given the answers we were so hoping to hear. Thanks again to everyone for all your help! Please let Tricia or me know if there is anything we can do to help return the favor!

~ Jeff

Jeff,

It's really nice to read your positive return on Dr Bitan and his staff, and even nicer to read that you're reassured by your contacts with them!

I'd be interested in the pain statistics he gave you, and I'm sure a lot of others would too.

Trace

I'm under the impression that the only way to rule out facet joints as pain generators is to have facet injections. In short, I believe that looking at an MRI re: facets isn't good enough.

ans

ANS - That is correct. The only real way to test a facet joint is to numb it with an injection and see if that decreases your overall pain level. When I had this test I had an increase in my overall pain level that has lasted for 3 days now so they aren't worried about the joints. Sometimes I think the Dr's can also "test" the joints by moving your legs etc. and seeing what/where the pain is coming from but it's not as clear as the injections. There is someone on the board who has a lot of facet joint problems who could probably tell us more.