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mattbrand new member introduction
Hello All;
I am mattbrand (real name Matthew Brandstetter) and I am looking to have a 1 level ADR done at L5-S1. I have two issues I am looking for feedback on. The first is insurance, the second is potential facet joint pain after ADR surgery. (I have no facet joint pain now but have been told this will be a problem in my case after ADR.) Insurance: Both my insurance providers, TRICARE and the Veterans Administration (VA)--the VA here in the US and their Foreign Medical Program (FMP) in Europe--have said they will not pay for ADR. I have been told that for an appeal to be successful it helps to have a list of people who have had the same insurance provider pay for their ADR as a part of the appeal package. So, has anybody out there had their ADR paid for by TRICARE or the VA? If so, could you please let me know and provide your full name, surgery date, diagnosis, and the details of the payment from TRICARE or the VA. Here is an example used by Laurie Todd (The Insurance Warrior) in her book: 1. Martin Miller (surgery date 4/2/09). Diagnosis: carcinoid tumors of appendiceal origin Acme (CA) signs single-case contract with Dr. Sugarbaker and pays WHC. Any help anyone can give me with these issues is greatly appreciated. Please respond anyway you want--via this forum or my e-mail address is: (deleted - please use private message) Thanks again and the facet joint issue is explained below. Matthew Facet joint pain: Can anyone give me any information about facet joint pain being caused if an ADR is done and there is VERY little disc space left between the vertebrae? I have seen EIGHT (8) neurosurgeons. All in the Chicago area except two who I sent my MRI to. ALL of them said I have such little disc space left I am sure to have extreme facet joint pain that I will never be able to remedy if I do have ADR surgery. Supposedly the facet joints have settled and are used to not moving around and if they are suddenly stretched out in ADR surgery to a great extent (which happens if you have very little disc space left) then his extreme stretching combined with all the motion they have to do now after being immobile and compressed for years will cause extreme pain. Some of these surgeons said there is a class action suit out now with patients who have been afflicted this way. Supposedly the manufacturer of one or some of the discs are being sued since they should have known this and stated this as an ADR exclusion factor to the surgeons who did not know that this would be a problem. The only surgeon here in the US who would even consider ADR for me is Dr. Delamarter in Santa Monica/Los Angeles California. However, before he determines if he will do ADR on me he wants me to fly out there for an appointment. Since I am in Chicago I am holding off on that. Dr. Bertagnoli in Germany has said he will do ADR on me so I am currently leaning towards him. However, I am still concerned the other surgeons may be correct and the facet joint pain will be an issue even thought these two think it would not be. Thanks again to any respondees. Matthew |
Hi Matt, welcome.
Can you provide a bit more information? Specifically, what is your spinal diagnosis? What was described about your spinal health from your imaging studies? The radiologists do a good job of "spelling out" the problems in the patient's spine. You can and should obtain these written reports (including the imaging on CD) from your provider. If you continue to go to the same imaging centers, they will generally review previous studies and make note of the changes to your spine on these reports. E.g., changes in stenosis, disc degeneration or arthrosis are often noted. What does yours say? Also, if you've not already reviewed this topic, pls do: ADR Risks, Complications, Disqualifications. As you know, just because you can purchase a surgical service, it doesn't mean you should... Generally speaking, advanced arthrosis of the facets is a contraindication. Unfortunately, we've seen patients with: - no detectable arthrosis develop problematic facets (meaning pain or arthrosis); - various stages of facet arthrosis have no facet problems or pains; - various stages of facet arthrosis have serious facet problems or pains! So as you now know, this is a tricky issue with many variables. So drill down on your situation and try to get the docs to at least stage your level of spinal disease(s), especially your facet arthritis. I hope this helps...I know its confusing. ;) |
Hello Harrison,
Thanks for the warm welcome and concern for my case. I basically have some sort of degenerative disc disease at almost all levels in the spine. Those that are particularly bad are in the lumbar region, with the worse ones being at the bottom and lessening in severity as they go up. So, L5-S1 is almost totally destroyed and the vertebrae are almost (if not actually in some places) bone on bone. L5-L4 and L4-L3 are the next worse and borderline in whether it is a good idea to replace them or not with ADRs at this time. The language used to describe the facet joint condition at the L5-S1 level is "There is mild bilateral facet degeneration, causing mild indentation of the anterior thecal sac, partial effacement of the proximal S1 nerve root sheathes in a subarticular recesses, and moderate bilateral forminal stenosis." I also believe that one of the doctors did tell me the facet degeneration was in his view a level 1. (IF I remember correctly.) The two German surgeons I have seen have indicated this should not be a problem, while as I have said, the US ones mostly have refused ADR for me on the facet issue. So, as you mention some have facet joint pain and some don’t after surgery without regard to the state of the facet joint prior to surgery. So I am gambling that I will be one of the lucky ones that have little or no facet joint pain. The German surgeons have extensive experience but it may have missed their attention that those with little disc height like mine almost ALWAYS have severe facet joint pain in all cases. As I mentioned, supposedly there are US studies out there that prove this point—with the little height I have left others who had ADR with the same small height—95% suffered from severe facet joint pain that could not be alleviated. I have yet to actually see these studies or the supposed class action suit either. I have read that there are class action suits out there but I have not seen the specifics—that small disc space is one of the exclusion factors not recognized by the disc manufacturers at first and many who had ADR should not have had it because of this reason. Thanks again for any help or further insight you can give. Matthew |
Just a couple of points, Matt.
1. How little disc height do you have left at L5-S1? Most discs are usually about 10mm. 2. Have you had a discogram? The reason I ask is that sometimes a very badly degenerated disc may not be causing much pain, but rather the pain may be caused by some of the lesser degenerated discs at levels above. 3. If the discs above are causing the pain, one solution could be a hybrid procedure with fusion at L5-S1 and then ADR at L4-5 and/or L3-4. 4. You can fairly reliably tell if the facets are causing pain right now by having medial bundle branch blocks with anesthetic done under x-ray guidance. This will not ultimately determine if you will have issues post-op but will give some guidance. Unfortunately, the correlation between xrays and facetogenic pain is quite poor. |
Eskimo,
Thanks for the advice, information and guidance! Not too sure how much disc height I have left--it is almost bone on bone though. I was more concerned with future facet joint pain. I hear this is the 800 Lb Gorilla with ADR (fusion's being increased stress at adjacent levels that rapidly destroys those discs) and I can't find ANY studies anywhere that tell how many and when ADR patients start to get facet joint pain from the excessive movement ADRs cause. Any info in this respect Eskimo (or ANYONE reading this?) Thanks. Matt |
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If your disc space is that obliterated, the limited evidence suggests that a hybrid surgery may be best for you if the superior levels are definite pain generators. Anyhow, it is certainly something to investigate thoroughly before going under the knife. |
Thanks again!
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