Recommendation(s)?
 

Hello all,

I need to find the "best" spine surgeon practicing in the Northeast U.S. as soon as possible. I do realize that particular opening sentence is in many ways a non-starter as a post, so perhaps I should state that I am at least seeking "recomendations" from the many experienced people as to who I should try and seek out.

Although my quality of life is just as terrible as it has been, now I am facing unemployment in about 10 months - the company for which I'd worked for over 25 years has been sold. I MUST address my back issues while I have some financial means and medical insurance, as no one in their right mind would hire me as a new applicant with my current medical issues (I wouldn't!)

I am not educated or wealthy enough to be particularly "picky". My most significant issues have always been at my two adjacent lumber disc levels L4/5 and L5/S1. They are both torn. I am open to two-level fusion, two-level ADR, or a Hybrid - as long as the surgeon is confident enough to make me feel so as well. I am strongly leaning towards a location/surgeon somewhere in the Boston area, as I have visited several New York City surgeons previously (in addition to 3 in Connecticut where I live). I cannot fathom nor afford the medical tourism route.

I am not ignorant enough to believe in perfection: perfect surgeon, perfect procedure, perfect outcome, perfect anything! I have got to do something, and the time is now. All my time and energy spent attempting to research via other sources have gotten me nowhere.

I believe the group of people on these boards have far more "real life" information than just about anywhere else I could possibly look. If anyone has any suggestions in regards to a surgeon I should specifically look into, please let me know.

Thank you in advance - Jeff

Jeff,

Condolences on an unfortunate situation.

Fabian Bitan is a spine surgeon in NYC whose name, in positive terms, comes across this forum perodically.

Good luck, Jeff

Thanks, Jeff
 

Thank you, Jeff.

Yes, I recall reading his name in other posts. He will be next name I start with my "Search" within the forums, and then start looking further ... I'd forgotten about him - perhaps due to the fact I was trying to avoid another visit to New York City, but that isn't a very logical reason!

Thanks again - Jeff

James.....

I understand your need to rush.

If i was you and wanting to get it done ASAP...I would contact Texas Back Institute, send them your films and let them know it's urgent. When i reached out to them i got a response by phone that same day. If you want a disc, you WILL get a Prodisc. IF you want it covered by insurance, they will give you the best possible chance of coverage due to there extensive, long term experience with the procedure. You can see if your insurance will pre-authorize it. Get it scheduled, buy a ticket, fly over there and get it done.

One of the US doctors I consulted with was Egon Doppenberg. Leading Medical Offices and Hospitals in Chicago | NorthShore
He was very good at explaining the pros and con's of ADR vs anterior fusion vs posterior fusion.
I was given his name by a family medical connection.

I did an edit and included some of his points. Sorry for the bad formatting.
> 1. 3 level total disc arthroplasty to replace 3 discs. This is a surgery
> through your abdomen that has pros and cons, including an approximately 2-5
> percent chance if permanent sexual dysfunction in men. Also, there is a very
> small risk of life threatening injury to the major vessels including aorta
> and iliac veins
> Downside is that revision surgery can be very complicated if you do not have
> good relief of pain.
> Advantage is mobility, less chance of other discs becoming problematic in
> the future.
>
> 2.
> Anterior lumbar interbody fusion.
> Same as 1. Except the vertebrae are fused and there is a more predictable
> outcome. . Downside is slightly reduced mobility ( which you may have
> already to begin with) same complications as 1.
>
> 3. Transforaminal interbody fusion with posterior instrumentation.
> Through the back. No risk of complications as described above.
> Does require possibly slightly more recovery time, but outcome is more
> predictable. Again you will lose some mobility, with approximately 5 percent
> chance of developing trouble at other levels in your life.

Northest surgeons!
 

Hi JJames, I saw many spine specialists in NYC-NJ-PA area, and liked the following:
- Dr. Fabian Bitan (NYC), actually scheduled surgery with him for Cervical Hybrid (Prodisc+Fusion), but backed out as I am now seeking the M6 instead, means outside the US, unfortunately!
- Dr. Roger Hartl (NYC)
- Dr. Alexander R. Vaccaro (Philadelphia)
Currently working with Dr. Carl Lauryssen (Los Angeles) who would use the M6 but surgery will be in Switzerland

Wishing you relief soon,
Dema

Thank you
 

bwink23, Stonewall_Boris, & Dema,

Thank you all for your replies, thoughts, and suggestions. Dr Bitan is currently in the lead within this thread. I started some other research on him, but need to check the most important: If he's in my new medical insurance provider network! LOL.

I so wanted to avoid another NYC trip! During my last trip there to consult with a different surgeon, there was actually an attempt by two strangers to abduct my daughter:eek2:. That's still not my reason for avoiding NYC, as I've been there quite frequently before and after that horrible experience on my own for business.

Texas Back Institute (TBI) has always been very high (perhaps top) on my list when money and time weren't quite as pressing considerations for me. I really like the idea of having a surgeon who is capable at performing all possible surgical options on me, and is able to make me feel confident in the one chosen (even if it turns out to be incorrect). I'm not sure how I could obtain the confidence, information, tests, "gut feeling", etc I need to proceed with a surgeon so far away without having to make several flights back-and-forth. At minimum it seems there would need to be one for a consult and another for the actual surgery. I'm not certain how any/all additional tests, scans, and so on are handled and paid for ... :(

I was really hoping that there may be some recommended surgeons in Boston, MA. MA General Hospital and Brigham & Women's Hospital have been suggested as highly regarded surgical locations by some medical professionals I've asked, but they were unable to provide specific doctors ....

Thank you all once more - Jeff

Found a spine surgeon in Boston
 

JJames,

When I was considering ADR, I looked at surgeons throughout the United States and Europe. One I was considering was Dr. Paul Glazer, who practices out of Beth Israel Deaconess Medical Center in Boston Spine Surgeon, Neck & Back Surgeon - Boston, MA 02215 - Home

I'm live in the NYC area, so I ended up staying local. As it turned out I didn't need ADR. I saw excellent reviews of him on Healthgrades.com and on Doctor Reviews and Doctor Ratings | Compare & Find Doctors | Vitals

Good luck!!

Gene

Dr Paul Glazer
 

Thank you for the suggestion, Gene.

So far what little research I've had time to conduct on Dr Glazer has been very positive, and he even appears to accept my medical insurance. I am a bit hesitant though, as from what I've read so far on him, he does not perform any disc replacements - only fusions. I'd really like to have a surgeon who can suggest/perform any of the three surgical possibilities for me.

Thank you again - Jeff

JJames,

I believe Dr. Glazer does some ADR, but I believe it's only in the cervical region, which doesn't help you. I think Texas Back Institute may be your best bet. I believe someone else already suggested that on this thread. Besides being some of the top ADR doctors in the U.S., several of them are in-network. Furthermore, I have family in Plano, TX and they've used TBI for less invasive procedures. They were very pleased with them.

Good luck with whoever you choose!!

Gene

Dr Yue, Yale New Haven, CT
 

Thank you again, Gene.

I'm considering returning to my previous surgeon - Dr. Yue, now that I haven't smoked in over two years. That was a portion of my parting conversation with him since I still smoked at that time.

I don't see his name much on these boards - good or poor opinions. By any chance does anyone have any information one way or the other in regards to him?

I at least have some history, several previous tests & imaging, and his office(s) are only a little over an hour to get to.

Thanks again - Jeff

1 Day Away from Appt with Dr Yue
 

Okay, so I have an appointment with Dr. Yue (Yale, New Haven, CT) this Thursday, 02/20/2014. As stated earlier in this post, and I believe in one other recently, due to my impending loss of employment & medical insurance after September, my intention is to accept whatever surgical option is suggested ASAP which will be acceptable to my current insurance provider (BCBS). I feel that a bi-level ADR will be immediately refused, as it was when I tried years ago to get that covered with Dr. Yue. I am hopeful that a Hybrid may be covered - L4/L5 ProDisc ADR & ALIF for L5/S1.

As the days approach towards this appointment, my anxiety level is rapidly increasing. Naturally, a major surgery should create some anxiety and fear. Worse though, are my feelings that I am not thinking everything through clearly.

I have been able to survive all this time without surgery, but only due to an understanding employer (due to my 25+ years of dedicated service) and medication. My quality of life sucks, but there is little guarantee that any surgery is going to change that. It is quite possible that surgery could make things worse. I've been backed into a corner in which I don't think I have any choice but to roll the dice. I'm quite angry about that fact, but need to think ahead as to what future employment options would be in my current condition without a surgically corrected back and no meds. I honestly wouldn't even hire me.

My secondary concern is that I have made the decision to return to Dr. Yue. I know an appointment is just a consultation, and doesn't mean that I have to pursue anything further if I have doubts. I'm curious as to why when I was first directed to Dr. Yue (by my Ortho surgeon) back in 2008 or so, he seemed to be one of the most highly regarded ADR surgeons around, and since then I hardly ever see his name on these boards or anywhere else. Unsurprisingly, the many various "patient-review" sites on the Internet contain mostly the comments of the disgruntled, and must be taken at face value - most of those I've found pertaining to Dr. Yue are complaints about his office staff. I don't really care if the receptionist is super nice to me or not as the purpose of my visit is to see the surgeon! I'm not certain how much weight to give to this feeling like there may be something I'm missing, but should be aware of.

Lastly, I suppose it is mostly due to the fact that after failing in my initial appeals to get a bi-level ADR approved years ago, I haven't given a whole lot of thought about the recovery process for whatever surgical option may be taken. I've been reading and re-reading the post-op threads with a different viewpoint lately, and it truly scares the **** out of me! I was already overweight when I quit smoking back in January 2012, and gained more weight after quitting. Now I'm meeting with failure at all (continuing) attempts to lose it. I am fully aware that this is not only bad for my general health, but bad for me as a surgical candidate, bad for my speed of recovery, bad for my future back health, etc, etc.

Ugh, and then there are the legal issues which I must at least consult with a lawyer about in regards to exactly what may occur in regards to my severance package if I am still recovering from surgery, possibly on FMLA, when that date arrives!

Sorry for the rant. I guess I just needed a "sounding board" today. I feel like no one - spouse, family, etc - can really understand all of these feelings and issues. That's not to say they don't care, just that only those here really know what it is like to have a chronic, painful condition takes over at least a part of every thought, activity, and portion of your life....

Thank you all again ...

So much confusion & pain ...
 

Since visiting with Dr. Yue last February 20, 2014 I was required by my medical insurance provider to once more go for several weeks of Physical Therapy before a new MRI would be allowed. Although I didn't honestly expect yet another round of PT at a different facility to "cure" my problems, I sure did my best once more - trying to do all of the stretches and excersises provided at home between appointments. No surprises - this didn't relieve any pain, and actually may have been detrimental in that now being 3 weeks removed from my last appointment I can barely exist without greatly increased pain in my lower-right back, right hip, and right leg.

My additional concern is my new MRI, which I was at least able to finally get done on March 20th. I must wait to go over these results with Dr. Yue, but in reviewing the imaging and the printed report, even after all these years nothing looks or sounds like I should be living in so much pain! This has always bothered me. I have no medical background, and feel that I am more ignorant than most on these boards and in the general public.

Has anyone else with LBP bad enough to go through surgery had an MRI report which "seems" (to me) to state that nothing too serious is wrong?

MRI LUMBAR SPINE WITH AND WITHOUT CONTRAST
Comparisons: MRI lumbar spine 12/28/06
Findings:
There is no MRI evidence for vertebral body fracture. There is no subluxation.
L1-L2: There is no significant neural foraminal or canal compromise.
L2-L3: There is no significant neural foraminal or canal compromise.
L3-L4: There is a mild disc bulge and facet arthropathy with mild bilateral neural foraminal narrowing, greater on the left.
L4-L5: There is a left laminectomy. There is minimal enhancement within the postoperative bed, compatible with mild granulation tissue. There is facet arthropathy and mild bilateral neural foraminal narrowing. There is no evidence for recurrent disc.
L5-S1: There is mild disc bulge but without significant neural foraminal or canal compromise.
There is no MRI evidence for spinal canal stenosis. The conus is at L1 and appears within normal limits.
Impression:
Postoperative changes L4-5, without evidence for disc recurrence
Mild discogenic degenerative change at L3-4 and L4-5

In reading the word "mild" everywhere, I can't help but wonder if I should really be considering such an invasive surgical option for this pain! I'm not truly asking for medical opinions here - I understand that I will need to discuss this with Dr. Yue - but does any of this mean anything to anyone?

Ugh!

Jeff,

We've seen images here, that even to our untrained eyes, looked terrible; except the poster was having only "mild" symptoms. We've then seen images posted that didn't look bad at all; but the poster was in debilitating pain. Everyone is different and perhaps you're one of the unlucky ones that needs only a "mild" pathology to cause incapacitating symptoms?

Your history shows two positive discograms. Does Dr Yue believe the two level surgery will address your pain generators?

Good luck, Jeff

One thing people forget to mention is MRI's are taken lying down.
When you stand or sit especially if someone is overweight the load on your spine is increased.

Thank you Jeff & pittpete
 

Jeff,
Much earlier in my painful journey, it was Dr. Yue who had ordered the discogram which resulted in the determination that the 2 discs were torn and were concordant pain generators (L4-L5 & L5-S1). He strongly felt that ADR was the proper treatment back then, but my medical insurance won on that front and denied it. Now that I have quit smoking (January 2012), and remained a non-smoker still, I am thinking that if bi-level ADR is once again shot down, I may at least have the option of the hybrid surgery.:confused:

pittpete,
I actually had a "sitting" MRI once as I'd discussed that very issue with Dr. Yue. Unfortunately, it didn't show anything more conclusive than a typical MRI in my case.

I most certainly realize I am putting the cart before the horse in a way here - I need to see what Dr. Yue says. I am just somewhat of a pessimist I suppose - he is a surgeon, and will almost certainly suggest a surgical fix. Even surviving in so much pain, I can't stand the ambiguity of test results like these! I'd prefer a more straight-line, clearly identified problem with a standard solution, even if the problem and solution were not "pleasant". Test results which read like these do make me feel like the pain is all in my mind - like I have some sort of mental disorder causing this miserable agony :insane:. I'm sorry if I'm not making much sense. Way too much going on in my mixed up, roller-coaster life these days!:sulkoff:

Thanks again for your replies. The people here are quite an incredible bunch, even if the reasons we've all come together isn't very pleasant.

Jeff

For what its worth, as short as a few days ago, a member here who just had overseas surgery told of a radiologist arguing with his surgeon saying surgery wasn't necessary. Meanwhile, the surgeon pointed at his patient lying on the floor. *ahem* Lying. On. The. Floor.

Point is, MRIs while not entirely meaningless, are not very meaningful when it comes to VAS scores. And there's also an argument that VAS scores are meaningless since they are subjective and arbitrary. And we all have good days and crummy ones.

So... the best way to look at it is this way. Functionality. What can you do and what can't you do? Can you sit for long periods of time? Can you drive a car? Can you stand? Can you lay down? How long can you lay down before pain starts to impede?

Functionality is the only real way to determine whether or not you need surgery. Not VAS scoring. Not MRIs. Not even pain necessarily since it drifts in and out, but function. How is your function limited by pain? What are the actual constraints placed upon your life at this point?

Me? I never sit down, ever. I have other people drive me around. I don't go out to a restaurant. I don't carry heavy things. Not even moderately heavy things. I don't go to movies(because I have to sit).

So... then I have to ask, how much is sitting to me worth??? Is it worth the money and risk of surgery? Just to sit? At least eventually? I can live a life without sitting no problem, but what if it advances to another level and I can no longer stand either?

Lose Track
 

JJames,

First, this is NOT in your head.

(lose track, I lose track of the threads, I do not come here every day, sorry, thought this was another one, but here is my take)

I have pulled many a muscle in my back and other areas, and when you damage a disc and this impinges on nerves, or better yet, the nerve root, the pain is no comparison and this can increase and decrease, all times of the day.

I can wake up in the morning, and walk around for awhile, and by the time I get ready for work, drive to work and get my first cup of coffee, I can have tears in my eyes.(the worst of times)

For Me, The ADR is the way to go, Hoping to have this done soon.

The more movement you have, the more you will relieve pressure on the other parts of the spine.

Jerry5 & drewrad,

After all of these years of back pain I "know" that you are both correct. My daily pain and poor quality of life cannot be allowed to go on forever unchallenged. A large part of my frustration is that I feel additional anger and fear about being forced into this corner to get something done while I am still employed and have medical insurance. The future beyond October 3rd - my severance date from my employer - seems to be so rapidly approaching, and will already place me in completely uncharted waters.

Follow-up appointment scheduled with Dr. Yue in about two weeks. For now I guess I just need to wait and see what he has to say ...

Thanks again all - Jeff

Hang in there, man. I know all about the anger, frustration, sense of betrayal and lonliness. BTW, there is always COBRA extensions post employment up to 18 months I believe, not that that's any consolation to your situation.

So confused & concerned!
 

I am certainly glad that I started my post (biography, diary, story, ???) under the "General Discussion > The Big File" category of the board, as I am feeling less and less optimistic that this chronicle of events will ever actually end!

I had my follow-up appointment with Dr. Yue the first week of May to review my most recent MRI and discuss what surgical options may be available for me to address spine issues. Although a very thorough account of this visit may more clearly explain my great frustration, I don't have the patience to try and type it nor would I want to put anyone through reading it all! In short, due to some confusion created by a P.A. who initially spoke with me at the start of this appointment - Dr Yue finally came in and looked at the MRI images, then stated who wonderful they were and that there was no reason I would be unable to do anything - run, jump, climb, and on and on and on. I stared blankly in a state of shock, unable to think or speak! My wife took the much more direct approach almost shouting:rant:, "What!? Are you kidding us? Why were we working so hard to get a bi-level ADR surgery approved for you to perform if there is nothing wrong?"

Only then did Dr. Yue seem to notice it may have been a decent idea to peek into my very large file / medical chart before he walked in! He quickly back-peddled trying to explain that he was only referring to the fact that the MRI shows no cause for my leg pain! Based on whatever his P.A. said or wrote, he thought that was the purpose of the visit! He then stated that due to my past discogram with concordant pain indicating my L4/5 and L5/S1 were my pain generators that we should line up a CT scan and try to move forward with getting the bi-level ADR or a hybrid procedure done! He added that I should get tested for Lyme disease as well, as my leg pain could somehow be related to an issue like that.

For me, this appointment couldn't have gone much worse. I really needed to confidently believe that a surgical intervention for my problems was the "right" thing to do, and that I had a surgeon who was also confident in that fact. Instead, I feel like he is simply going along with what I (we) are asking for.

I suppose I need to pull myself together (once more), go ahead with the CT scan, and seek out some additional surgeons for their opinions........

Sorry to hear that...
It seems like Mr Yue wasn't prepared to give you a diagnosis but continue to string you along with more tests.
If it was me i would find another doctor in the city.
Anyone from TBI in your healthcare plan?

Just my two cents re the 'right thing to do'. You will never get such reassurance, nor would you want it, from a doctor. You get it strictly from yourself first, and the doctor is merely a confirming echo chamber. They do not live inside your body. Only you do, and while pain can be subjective, it is your pain tolerance itself that you're either capable or incapable of living with in the end.

There's nothing predictive that you can place your chips on the table and bet on re any surgery. These are all qualitative decisions which are something that doctors are incapable of providing clear guidance on, unfortunately.

That said, there are a few outliers where this is not so by any outwardly observable means: caudal equine syndrome, bladder problems, loss of motor control of limbs(foot drop etc). Those are easy for any doctor to base a decision on since they are his liabilities also in a court of law. Short of that, us in the grey area must make these decisions alone. Sounds like you have a great wife though to help you along and confirm your own decision.

James,

I apologize for not reading your first post carefully. Three of my spinal surgeries were done by Daveed Frazier, MD. He is the director of orthopedic surgery at St. Lukes-Roosevelt Hospital in NYC. Here is his main website: New York City Minimally Invasive Spine Surgeon | Daveed D. Frazier, MD He also works with a group based out of Northern NJ. That website is Dr. Daveed D. Frazier, MD - Spine Surgeon | Atlantic Spine Center He has a very impressive biography that on that site that you should read. Finally, he offers a free MRI review through his NY office. If you ultimately decide to see him mention that I was the patient who he talked out of going to Germany for ADR in March, 2013. I ended up getting an endoscopic foraminotomy instead. This was fully covered by insurance and I feel great.

Good luck to you!!

Gene

File Claim
 

Not an insurance expert, but make sure you have some claim by the end of June, so you can appeal within 30 days.

I am an ADR person, and will go the distance to NOT fuse, I have had one level disctectomy/laminectomy.

Solved the disc pressure at the site, but the nerve damage and the bad disc remain.

:(

Possible suggestions
 

Hi JJames -
I am in the NYC area and finding any really experienced ADR surgeons here is pretty tough. I heard from a medical insider that the NorthEast tends to be much more conservative than the western States, hence all the innovative surgeons in TX, California, Washington, etc. I heard from a friend that Dr. Paul Glazer is amazing though seems to be fusion. I liked Dr. Bitan but he seems to be very picky and cautious with doing ADRs these days. Stay away from Jeffrey Goldstein. I saw him twice and he has the bedside manner of a Troll, no compassion and not that many ADRs under his belt. ( He also writes his own online reviews.). You could try HSS though my luck with them has not been great. I think Cammisa and Girardi are the most involved in ADR but would also do a really good fusion.? Also Dr. Noel Perrin at NYU. Strictly fusion but a very good surgeon from what I know. Nice guy too. That is it and why I am going into debt seeking out surgeons really far away in the US. I heard Anders Cohen in Brooklyn is a good guy too.
Best of luck to you.

Cdw
 

I also was offered a fusion, but refuse to fuse, this is not necessary, and have had more than one doc, say they have problems 3-5 years down the road.
Not sure what level you have,

{'added' sorry, had to back up and read, yea, the Lumbar is a bad place, not to take away anything from the cervical}

but the Mobi-C is doing real well for people. Cervical.
Again, there are MANY types, just finding the experienced docs, like the Physio-L, this was one of the first types, other than the Charite, that I read about, then the M6, and the LP-ESP, I made inquiries about the LP-ESP, and no response.

...therefore, I am going with the M6. Two Level.
Go For reimbursement.

Misleading mri
 

Hi James, I just read this thread for the 1st time.

In a earlier post by Drew 'Drewrad' I am the guy he referred to as the one where the radiologist and surgeon arguing in german about my mri as I lied on the floor in agony. Seems to me that you are instinctively aware that you have something seriously wrong (like me) and your mri is not showing anything conclusive, ( again like me). So I am here to tell you that I am glad that I trusted my instincts and gave my surgeon the go ahead. He made his diagnosis partly based on some abnormalities on mri but more so based on physical exam and other factors. Personally I am glad my surgeon has over 20 years experience to tap into. Undoubtedly I'm sure he drew on one or more of his previous cases and made the right call with me.

The 2 discs he replaced were 'completely gone' in his words on the surgery report. 'Dried toothpaste' is how he described their condition. Sure enough I am about 10 weeks post op and the terrible 'Belt pain' I had is gone. See my signature (I was bed ridden for about 22 hrs/day for 3 years). I could not stand up for more than 30 minutes without collapsing before the surgery. I truly hope you get yourself a good experienced surgeon. My wife and I were fortunate enough to borrow the $ because we have excellent equity in our home. I know you are 'on the clock', but you do only have 1 chance to get this right. I live in Connecticut and I decided not to see Dr Yue ( 1 hour from my house) because my research on him left me with the impression that his record is spotty.

If you go the ADR route (which most of us here have chosen to do then you most likely have to pay out of pocket anyway) I suggest that IF you forego fusion then find one of the several great adr surgeons, don't settle for someone just because he's local. Just my opinion

I hope it all works out for you