More "newbie" questions
 

As you can imagine, the more I learn the more questions surface. I am wondering if anyone can help with questions below. My discs are damaged from c3-4 to c6-7, and even c7-t1 has a small protrusion, and t2-3 might be herniated too. :( The worst disk is C 5-6 which is pressing my cord, as is c4-5 and c6-7, mildly.

I have a pretty immediate need to decompress my spinal cord, and my plan b - if TBI doesn't work out - is to do this more incrementally. And accept I will need further work down the road. (Is this a really bad way to look at it? :confused:)

1) is it true dr.s in the US are not allowed to implant an AD on a level above or below a fusion? Or in a mutiple level degeneration scenario?

2) if I were to get a fusion on one level to get the pressure off my cord, then get adr at a later date at adjacent levels, does that exclude me from doing the adr in the US?

3) how easy is it to get a surgeon to provide follow-up support here in US after having an ADR overseas? Will insurance cover follow- up appts?

4) anyone have different types of ADR's in their neck? (E.g. A Pro disc at one level and an M-6 at another? Is that advisable?

Phew...still can't believe I'm even having to write this message but super grateful for this community!

Marita

Marita,

Those are some very good questions.

Neither of those are true. I was scheduled for surgery with a US surgeon (Jack Zigler) that was going to place an ADR below my two fusions. There are others on this board that have had multilevel ADRs done in the US.

You would not be precluded from ADR in the US at a future date. Some on this board have done that.

US surgeons get really miffed that you don't think that they were good enough to do your surgery, and it could be a challenge to find one that will help you if you have future trouble at the operative level, or even find one that will do a follow up on your surgery.

The poster on this site that goes by christinlal has one ProDisc-C and an adjacent M6-C done maybe two years apart. I don't know if that's advisable or not.

You're doing all the right things ... research, research and then some more research. That's how you increase the probability that you'll make the right decision.

Good luck, Jeff

Thank you again, Jeff. You and this site are such a source of strength for me.

Marita

Marita,

Jeff was a huge source of information & reassurance as I wad making a decision as to where to go,what to do and how to get info....
Thank you again,Jeff!!!!

Do your research, ask questions, talk to everyone you can....

One big concern for me was getting a Neurosurgeon who would see me and treat me after surgery out if the country. I met with my Neuro and was very specific with my questions regarding treatment after surgery IF I chose to go out of country for surgery. I asked him "would he treat me after surgery" and I even asked him to repeat the fact he was agreeable to post op treatment. I took my husband with me so that I had a "witness". I have been in to see him since the surgery, he asked for post op X-rays in addition to the ones I brought home from Spain.... So far, he and his staff have been great. But I suggest you make prior arrangements with your doctor for follow up - for ease of mind and so you have a relationship. In all probability,my NS was not thrilled I left the country, but I have to say he & his staff have been great post op....

Hope this helps!
Again, best of luck.

i'm not sure if it has to do with being miffed or feeling snubbed as much as taking on some element of risk in following up someone on whom you didn't operate... that's the best i can come up with as far as why a surgeon wouldn't "follow" you.

every surgeon i saw here in the US agreed ADR was a good option for me but that i couldn't and/or shouldn't have a prodisc (some reasons unique to me and some not). keep in mind i had a LUMBAR issue, so not directly translatable to another person and one with cervical issues. the most experience ADR surgeon i saw told me that my best option was to go overseas, but that he couldn't be my official f/u.

i found a pain doc to "follow" me, aka write me orders for PT, do any necessary trigger point injections, and write me scripts for zanaflex, valium, and flexeril. he glances at my xrays but doesn't really know what he's looking at beyond what i tell him. Clavel reviews them very promptly and they're super easy to send.

pre-op dr visit, chest xray, blood work were covered by my insurance, i think my pcp coded the visit to not raise red flags.

i did have a wound issue about 3 wks post-op, had to go to the ED and see a general surgeon then wound dr then plastic surgeon to have it resolved. my insurance covered everything w/o asking any questions. i was totally honest w/ all dr's i saw about what was going on.

all of my post-op PT was covered w/o issue, by 2 different carriers b/c i took a new job.

you won't know for sure what any policy will cover til you file it... but you can find out what your PT benefits are etc beforehand.

all of that being said - you COULD have problems seeing dr's if there are complications... fortunately staying a week or so post-op reduces if not eliminates those risks, b/c once the implant is in, it's in...

hope that helps.

i will add - neurosurgeons are a scarce commodity these days in many parts of the US. they are paranoid as heck about being sued b/c they are sued so often and it's hard for them to even get malpractice insurance. this has led to a severe shortage in some states and iirc, Nevada didn't have a level 1 trauma center for some period of time b/c no one would take neurosurgery call in the area due to malpractice. trauma is a bit of a different beast than spine, but most spine neurosurgeons in the US do still take trauma call as well.

It is the insurance companies who don't want to pay for the hybrid, not the doctors not being able to do it. If you could pay for the doc to do it yourself, it wouldn't be a problem. That being said, my current doc, the one whose name I gave you here in SF suggested I go out of the country to get this done.

Postop followup
 

Hi,

I saw two neurosurgeons and an ortho (whom I know socially as well). While the neuros said no, the ortho said he would, but was so unpleasant, I ended up going with my internal medicine doctor. I have my X-rays and send them to Dr. Clavel and take his reports to my MD. Worked for me, I think most surgeons would see you 6 months after....liability. For me, I have a healthcare background and wanted positivity postop. I agree with 2confused, line it up before you go!

Laurie

Thank you!
So super helpful. If I go overseas I'll definitely set up follow up before leaving.

Has anyone done an "incremental" approach? E.g. Getting a one- level fusion done knowing that ADRs at other levels would have to put in, in near future. (I know Jeff, sounds like you unwittingly did.) I'm getting very nervpus about my cord compression...really want to relieve it soon, but fusion might be only option. And can't afford ADR yet, if insurance won't help.

Any thoughts from personal experience on this?

Thanks again!

Marita

Have you looked into microdiskectomy? You don't necessarily need an ADR or fusion in order to decompress the cord or other nerves.