7/11
Saw Dr Heller yesterday at the Emory Spine Clinic here in Atlanta and was impressed. He wants another MRI as mine is a year old and an epidural CT scan. He said my case is not clear cut right now because while I clearly have DDD, it's not clear that the nerves at C5/6 are being compressed.

He wants me to keep fusion on the table as an option but I got the impression he was leaning towards ADR. To his credit, he wants as much information as possible before recommending a path. I got the impression that he wants a successful surgery, not just another notch in his disc replacement belt.

My follow-up appointment is August 14. I have the MRI, then the CT scan, then meet with him. He did suggest I contact the insurance company today to find out what their policy on artificial cervical discs now.

Now for the truly great news. I called the insurance company and they said ADR is apporved based on medical necessity! So at least if he recommends ADR, there shouldn't be much, if any, kind of fight.

Side note: Dr Heller indicated that the Bryan cervical disc should get FDA approval in the next 1-3 months.

Regards,
Jason


Hello all. How lucky am I to have found this resource!

After 10 years of believing that I was suffering from tension headaches coupled with carpal tunnel, I was diagnosed last summer as having advanced DDD at C5/6. PT only made the pain worse so the Dr recommended surgery as the last resort.

I've learned which activities I can and can't do based on how I'll feel afterwards. No roller coasters, water skiing, doing house work that requires me to lift my arms above my head and many forms of exercise.

If I avoid the activities then for the most part ibuprofen keeps the pain manageable. 800-1600mg is my normal daily dosage.

I'm torn about getting the surgery. On one hand I'm managing the pain better than I ever have before. On the other, my activities are severely limited and will only get more limited as the kids get older.

I'm making an appointment for a 2nd opinion with a Dr at the Emory Spine Center here in Atlanta. A firend who's a Dr in their pain management group recommended him so hopefully I can get in to see him.

This is a great site and excellent resource though and I'm definitely glad I found it. Thanks to everyone who has shared their experiences!

Forgot to mention, I'm 34 with no other significant health concerns.

Regards,
Jason

Jason,

Welcome!
You have a major decision to make regarding your health. This "is" the place for you to do your homework. Tons of friendly people here. Good luck and ask a lot of questions.

Peace,

I'm curious if anyone has had surgery done when the primary symptom was headaches? I get pain in my arms and hands too but the headaches are what really get to me.

I've read that fusion was not as successfull at resolving headaches as it was the radiating arm pain. Is ADR the same or has it had better success at reducing the headaches.

Thanks,

Jason

Jason,

Welcome to the site and good luck. You should get some great advice here.

Have the doctors said if they feel that inflammation from the bad disc is what causes the headaches? I think it would be good to talk to several surgeons that have a lot of spinal surgery experience and see if any of them have any experiences that can help determine if surgery could help relieve the headaches.

Your concern is the same as all of ours. Will surgery help with my condition and relieve the symptoms or will it make things worse or permanently the same? If there were only a way to know in advance. Good luck with getting in for the second opinion.

Don

Be very careful of how long you take larger doses of Ibuprofen every day! Has any dr frowned upon this? There is a reason.

Before I really knew what was wrong I was taking a lot of it and PT and PCP's told me not to do it but I felt like I had to and they weren't giving me any options.

Well as a result, I started poping Tums like candy and it turned out that I had damaged my esophagus (chronic GERD with a hiatal hernia) and now require one of the Protien Pump Inhibitor medicines every day. My med is called AciPhex. It's not cheap medicine!

There are other pain meds that are much more gental for long term chronic pain while you contemplate surgery.

I ended up using Tramadol daily, sometimes with Neurontin and for break through pain days I took Vicodin. No more NAISD's! Just a heads up. You might be hurting your body in the long run.

Also, just one question...do you go to the dentist on a regular basis? I didn't make the connection with my headaches until after I found out I needed a root canal. As soon as that was treated, my headaches went away. I realize cervical disc issues can be very different than lumbar disc problems but it's a possibility. I was blamming the headaches on my lack of sleep from back pain. I was wrong.

Hi Jason- welcome to the board. Good luck on your search for answers.

I too am going through the round of meeting with drs.

My 2 cents worth is - get as many opinions as you can on this - as I figure more eyes on the films and my questions - the better.

Best of luck to you.

Lisa

Updated.

Another update:

I had a CT and MRI yesterday before meeting with my doc again. No problems with the facets and clear single-level DDD between C5/6. He said there was very slight cord impingement but nothing severe.

He pushed fusion fairly hard since i complain mostly about neck pain/headaches. But I explained to him that I just don't do the activities anymore that aggravate my arm pain with the exception of exercise. Even then, I limit which exercises I do.

Once I made it clear that I preferred ADR he was supportive. I think the fact that he's involved in the Bryan disc makes him push fusion so there's no chance that he gets accused of a conflict of interest. I respect him for that.

Anyway, I call first week of September to schedule surgery. Insurance approval may be tricky since neck pain is the chief complaint. I guess I'm not the "ideal" ADR candidate. Dr Heller did say though that some of his european colleagues have had success treating neck pain with an ADR.

I'm hoping that at worst I can resume a normal life and level of activities even if the neck pain isn't resolved. I can live with the neck pain if it means I can resume normal activities.

I do wonder though if I'm jumping the gun on surgery. While the pain is real it's become more of a quality of life issue than anything else. I can still work full time and the pain rarely incapacitates me. Compared to others on this site who had significant radiculopathy mine seems very minor considering I can avoid it most of the time.

I guess my question is whether surgery is worth it just for a lifestyle change. Or have I become so used to the pain over the last 11 years that I don't know how nice it would be to not have it? I'm still inclined to do the surgery and would rather do it now when I'm 35 and relatively healthy vs waiting until it could become debilitating.

Opinions?

Ok, another update.

My surgery is tentatively scheduled for January 29. I've been getting more pain shooting down into both arms but still primarily the right arm. This matches the MRI results. My Dr also said that my right arm is definitely weaker than my left. This worries me since I'm right-handed. So the insurance battle now begins.

The Dr has said that in his opinion I fit the criteria for ADR and do not fit any of the exclusion criteria. I'm hopefull this will make insurance approval easy but realize that's probably a pipe dream. My insurance company has said that the procedure is supported as long as it's medically indicated. My Dr's nurse, though told the same thing, was also told it's approved on a case-by-case basis and wasn't terribly optimistic. Maybe she's just making sure I'm prepared :).

Now, I'm hoping the Bryan disc gets approved shortly. I may delay the surgery as far back as July/August if necessary but apparently there is movement on the FDA front so it might be approved as soon as Jan-March.

Thanks again to everyone who's been posting their surgical outcomes!

Cervical ADR
 

Jason,

I noticed your doctor is listed on an FDA clinical trial with the Kineflex disc. Has he offered you a spot in that trial? It might offset any insurance lapse of coverage.

Good luck neighbor,

Bob

Jason:

I hope that your surgery gets covered on January 29th. Let's hope for some compassionate decision makers in the insurance company. Hang in there and cervical surgeries are much easier to tolerate for the most part than lumbar.

I have two cervical and two lumbar and the cervical has healed up nicely. I hope you have as pain free of holidays as can be and good luck for the upcoming year.

Terry Newton

No, we haven't discussed an clinical trials yet. Maybe if my insurance balks at ADR but I'm hopeful that I'll get approved. One thing that may be in my favor is that my company is self-insured so they may have some say in the approval. Considering my level of current and planned responsibilities it's in their best interest to get me back as soon as possible. My job function is currently single-threaded so missing me could hurt. ADR patients seem to return to work a good bit sooner than ACDF and I may be able to work from home at least part time very quickly.

I cringe to think how quickly I'd get bored with my PS3 and Wii games :).

Thanks Terry! I just noticed I had a typo. It's January 26th. I'm really hoping that the Bryan disc is approved by then. I know I have VERY mild DDD at C4/5(barely noticeable but there) but even so the Prestige might eliminate any chance of taking care of future problems at that level. The Bryan disc would support adjacent level ADR down the road. From my view the basic design of the Bryan disc is better too.

My doc's nurse and I have both been told by the insurance company that the procedure is covered. It just depends on if the medical examiner is willing to accept Dr Heller's reasons as being medically indicated.

I'll tell ya, it was VERY frustrating to see the weakness in my right arm. It was never as apparent as it was today that my left arm, and the lower arm/wrist especially, was so much stronger. That was surprising to me as my right hand is the dominant one.

Your recovery is an inspiration for all of us Terry. I'm keeping my hopes up and the reality check in my back pocket :).

Aren't we all? That is a very good perspective/way to put it. I just read this thread for the first time and I wish you the best of luck in your upcoming surgery. Before long, you will be on the other side of this and telling us about your awesome recovery!
Best Wishes,
Kathy

Insurance denied
 

Well, not terribly surprised but insurance denied the initial request so it's appeal time. What is surprising is that the procedure they approved was just decompression, not even fusion.

I'm sorry Jason that your insurance denied your ADR. Not surprising like you said, but put on your punching bags and get ready for your fight. If we all keep fighting and fighting these appeals, eventually, hopefully, one day they will begin to take notice and change their nonsense denials. Good luck to you in the fight and remember to check out The Insurance Warrior for helpful tips. If you do a search things should pop up for you to read.

Best to you,

Cindylou

Jason,

OUTRAGEOUS :flaming: :flaming: :flaming: !!! AND :raspberry: :raspberry: :raspberry: !!! on them.

And we are only a small group of people who are denied coverage every year. Can't fathom a procedure being approved by the federal government and then insurance companies not paying. There must be something that groups like adrsupport can do??

Sandy

Talk, post, complain, write letters, write more letters, complain some more. Complain to senators, complain to your employer who's paying most of your health care insurance. Use ADR Support to dig up factual information to support your presentations. Basically make it painful for the insurance companies to justify their refusal.

Jason,

it sounds like we had similar symptoms, my level was c55/6 as well, i had SEVERE headaches, arm and shoulder pain and increasing weakness in my right hand/arm, tests showed nerve damage as well. I had the prodisc-c on 11/18 (7 weeks ago today), no headaches so far since surgery (*knocks wood*), minimal shoulder pain, weakness seems to be decreasing in my hand/arm as I recover.

Best of luck to you.

Kristi

Thanks Kristi. I would be in heaven if the headaches went away. I've had one nearly every day since September 1997 and it's something I've just become used to. I manage them now with 800mb of ibuprofen 1-3 times per day or a flexiril if it gets really bad.

I'm sure things will work out. The Dr had already started the appeals process when I called Monday to ask what the next step should be. I was told to call them back today and follow up. No rush though as it doesn't look like the Bryan disc will be aprroved this month and I'll be waiting on that anyway; at least I'll give it a few more months to get approved.

Thanks everyone!

Jason

Ok, another update. 2nd appeal denied. The reviewer, who claims to be a doctor, said that the surgery would be part of a clinical trial and therefore is experimental/investigational. What a cluebag. The prestige disc has been approved for nearly 1.5 years and they think because my Dr's notes show that we discussed the options of adr AND fusion that it MUST be part of a clinical study. He even stated that it was a fact. Guess it was too much trouble to pick up the phone and ask my Dr.

It would be funny if it wasn't so important to me to get the adr. The basic lack of understanding regarding the procedure astounds me. I've already filed a complaint today with my insurance company. Hopefully it will get some traction.

Jason,

My wife was given verbal approval for either fusion or ADR. She has BCBS but is also on my Aetna policy. I'm not sure how they're splitting the bill but it sounded to me like an approval. She's opted for fusion on the 26th.

Bob

I wouldn't count on a verbal approval, get it in writing.

Another update
 

I called my doc's nurse again this morning to see if they had heard anything. She called back just as I was leaving work with some hopefully good news.

After the first appeal denial and asked my HR department if they could assist with the insurance company as we're self insured. They agreed to ask some questions, especially wanting information on why the specific procedure was denied since it was FDA approved, cost about the same, and was preferred by both myself and my Dr. I made sure my HR rep was informed of my opinions and beliefs on the reasoning of the insurance company for denial. The insurance company kept denying based on either long term safety and efficacy or by claiming it was investigational.experimental. The last denial even claimed that I HAD to be part of clinical study.

The Dr's liaison with the insurance companies called my insurance company today to get an update and was told by the insurance company rep that my company had gotten involved and the denial would likely be overturned. Far from being written in stone but the nurse sure was excited. Hopefully I'll hear something in the next few days.

Good luck, I hope you are able to get your surgery soon. The waiting is so agonizing.