HELP ADR or fusion?
 

Hi,

I (46 yr old male) have severe stenosis in cervical spine. I am scared/confused/.... These are my choices


1) I saw another experienced surgeon (who is nearly 70 years old, 30+ yr experience). He was recommended by a friend who had cervical fusion with him. He said "come back when you are ready for surgery". He is not under my insurance, but as I have PPO he is covered indirectly but his office is not co-operating with billing to the backup insurance.

2) An othro spine surgeon who has 12 years experience. I ran into three of his patients (one at work and two at the hospital). They were all happy with him (Another ortho who i really liked) also said he was good. He is moving to a new hospital that is 2 hrs away. I am concerned whether he would have different helping surgeons or PA's... I am willing to drive. He asked me to wait... but pain is getting worse.

3) I have also thought about ADR as cervical ADR patients report so much success and even research paper shows ADR patients have better responses at 2 or 5 year followup. As far as ADR, I probably have to go to Spain or somewhere as insurance would not cover two level ADR. I would be willing to do that based on 90% ADR pateints live next 5 years without complexity where as only 60%-70% fusion patients do (nonfusion, C5 palsy, next level fusion, other complexities).ADR becomes very complex when bone rejects the metal or bone starts to melt. Redo of ADR is very hard. Not many would be able to do that.

I was leaning towards either solution number 2 or 3. Please advice... specially if you live in SoCal and had cervical surgery in the area. (My T-spine and L-spine MRIs are good).

Insurance
 

Have you tried to get a 2-level ADR covered by your insurance? Mine was covered, and I know more and more people are having success with getting the procedure covered.

2 level ADR
 

Brandis: I talk to my BCBS (PPO) plan today but they told me that only one level is covered and I can pay for the next level myself. They will pay for the anesthesi and hospital stay perhaps.
Do you have any recommendations for any good neurosurgeon with ADR surgery in U.S.
I heard Mobi C is better and there are clinical trials for M6-C currently underway in U.S

not sure about neurosurgeons with lots of ADR experience...
 

...it seems that the surgeons well known for their ADR work are all orthopedic spine surgeons. The Texas Back Institute in Plano, TX is well known for their experience with ADRs, but Hyun Bae in LA apparently has the most experience in the US with the Mobi C (he was involved in the design of the device).

The only neurosurgeon that I'm aware of that is also known for ADR work is in Germany (Dr. Bierstedt).

This is just based on my own research so far.

Dr. Richard Wohns is my neurosurgeon in Puyallup, WA. He has multi-level ADR experience.

Hetrotrophic Ossification with 24 month followup
 

Thanks for the information from various members and it is very informative.
I just read an article in which it was mentioned that almost all the ADR material currently available causes heterotrophic ossiification (HO) that start affecting the adjacent levels. I also read that it can be of various degrees of ossification. I wonder if it depends on how does the procedure and skills of the surgeon?
Best
Shawn

Sukhre, just checking on the latest. Any news?

I had two level ADR approved by my insurance after three appeals. I had the mobi-c placed between C5-7.

From what I understand HO affects the operated levels, not adjacent ones. And while the studies do confirm that HO is quite prevalent, for all the currently available artificial discs, it also doesn't necessarily cause any adverse symptoms or reduced range of motion.

I asked a few of the spine surgeons I met with about HO (including some well know for their ADR experience), and they downplayed the concern about it. According to them, HO is not a reason not to go the ADR route, the worst thing that can happen (other than device migration or other very rare events) is autofusion due to bone growth, which will occur naturally over time anyway.

two level Mobi C
 

You can appeal this, two level mobi c is approved by the FDA.

If you are in real bad shape, have it done and then go for reimbursement.