Good Morning Everybody!
Tomorrow, my girlfriend (TexasT as some of you may know her as on this board) and I are going to see Dr. B in NYC. For those that have seen surgeons for the ADR surgery, what advice could you give to us regarding our visit tomorrow? Specifically, what questions should we ask, what information can we expect to be given, etc.?

Any advice would be greatly appreciated!

Oh boy Jeff--so many possible answers to that, and so little time!!! http://adrsupport.org/groupee_common...icon_smile.gif

You've also given us no info on your girlfriend's case, so hard to advise. I'd say go through the FAQ here and see what applies to her case/symptoms; you'll probably come up with some good questions there.

If Dr B in New York is Dr Bertagnoli, he's reputed as one of the world's best, so bring pen and paper and take notes if you need to (you can always look up related info/ terminology later on).

It's hard to whittle down a concise response to your questions, given the enormity of ADR issues and lack of specifics in your case, sorry.

But I've found that it's really necessary to research both ADR and one's particular pathology (ies) before, after, and in between medical consultations...

In short, I've found that with ADR issues: the more you know, the less you know--but the more you're then able to ask (if that makes any sense):

Good luck and keep us posted--

Trace

Hi Jeff,

Harrison asked if I would share my list of questions. Here is a list that I have shared behind the screen many times because it is a bit taylored to me and my situation but there are questions that may be good for you and others. Good luck on your appointment.

1.If you agree that a disc replacement is the preferred approach to fix my problem. Am I a candidate for a Prodisc @ L5-S1?

2.In your opinion looking at my films do you think that I would have a good result? Are there any anatomical issues with my body that you think could pose a problem with an ADR?

3.Do you see any stenosis or other abnormalities on my films?

4.Can you explain the facet joint issues that show up on my MRI? What grad would you give my facet degeneration at this time?

5.Do you believe the prodisc will fit in my body? If the smallest Charite core size is 7.5 and adding the end plate you get a prosthetic apx 10 mm how small is the smallest prodisc?

6.Dr Bertingoli says that my case would be better for a Prodisc due to the less distraction needed to put it in vs the Charite. Do you agree or disagree with this.

7.As a professional athlete do you feel I will be able to get back to the ski profession after ADR. Is the Prodisc or the Charite better for an athlete please explain.

8.How many Prodisc have you implanted at this time?

9.Do you use nerve monitoring during the surgery?

10.How long would the hospital stay be? What kind of post surgical experience will I have there? What kind of pain medication will be available to me immediately after ADR? I don�t want to be in a position where I don�t have enough pain medication after the surgery.

11.Approximately what % of your patients have had good results or in other words are significantly improved in Oswestry and VAS scores 6 months after the artificial disc replacement?

12.What % of your patients have had complications (what type of complaints?) or required surgical revisions to either a fusion or a new disc replacement?

13.Is a revision possible with a Prodisc, have you done it and what what was the outcome?

14.What do you make of the differences between the Prodisc and the Charite?

15.Regan says that the Charite is a superior product due to its un-constrained design. He says that the Prodisc may split the vertebra in a catastrophic fall. Do you agree or disagree with this?

16.How do you determine the correct size during surgery? I have heard about problems with someone getting a disc too large for their body and having distraction pains�

17.Do you remove the annulus during ADR surgery? Why or why not.

18.Who is your vascular surgeon? Can I choose from your vascular surgeon choices? Dr. Wagner has come highly recommended?

19.What is your opinion of the Charite?

20.What are you indicators post ADR of when its ok for them to go back to work? I have a very physical job if reasonable accommodation are needed for me to get back to work will you work with my employer to develop these accommodation so I can get back to work?

21.My health insurance is Health Comp/Universal Health Net. They have approved me for ADR surgery with my local doctor and now the Dr Regan. What is the chance they will consider approval of ADR the prodisc.

22.What is the FDA status of the prodisc? Why do they continue canceling meetings? When did you believe approval would come?

23.Do you feel if my insurance will not cover the prodisc until FDA approval would waiting be an option for me or would it cause more damage to my body causing contraindications towards ADR in the future?

Since you are a non-network provider to them, they will pay for 60% of customary and reasonable charges. Will you accept their customary and reasonable payment; this would make me responsible for the remaining 40%?

Thanks to everyone who responded. We are both nervous about tomorrow and have done a ton of "homework" to be prepared.

Here's my info: I have a tear at L5/S1 and may also have another tear at L3/L4. I've been hurting since I was 9 (trampoline injury caused trama; DDD and later herination) and have had significant problems since a MVA (caused tear) last year. The pain generator is L5/S1. I cannot walk very far anymore because my leg's buckle and must use a cane. My EMG is normal. Discogram shows tear at L5/S1, adnormal (DDD) L5/L4 but no pain only pressure and a possible tear at L3/L4 with no pain only pressure. I had a failed IDET at L5/S1 in 2003. I am now 25 and want to move on with my life.

My doctor here in VA is a big fusion guy and is very negative on ADR. From what I've read and from my tests etc. I am a very good candiate for ADR at L5/S1.

Thanks again to everyone,

Thanks for helping y'all, good luck Tricia. Let us know how it goes... http://adrsupport.org/groupee_common...icon_smile.gif

you should find doctor bitan a fine doctor http://adrsupport.org/groupee_common...icon_smile.gif
good luck tomorrow
chuck

Tricia,

Good luck tomorrow. Remember, you are interviewing the doctor as much as he is interviewing you. Don't leave until he has answered your questions in a way that you can actually understand what he is saying. Don't be shy!! By the way, I sent you an email through the forum with the surgeon that I used here in houston. His name is Dr. R. Eric Santos. I have had three surgeries by him and think the world of him. I sent more details in the email. Let us know if we can help with any other questions.

Gene (in Houston)

Wow Pauletteski--now THAT's a list of good questions!

I'd be interested especially in seeing what kind of response you'd get on these two:

I asked related question twice to DR Fenk-Mayer via email, only about the ProDisc Vs Mobi-C (why does he prefer the Pro, and how does it compare to the Mobi-C?) and got the same 'pre-fab' response twice, to the order of (not verbatim, but close):

'Dr Bertagnoli generally prefers the semi-constrained concept of the Prodisc, although he has implanted all types. Indeed, he has modified the Prodisc to suit his needs..but can implant all types according to need...however, we do not think this will be the case for you".

I think he just prefers Prodisc,especially after using it so much and modifying it, period. The Mobi-C people gave me much the same response on their product as well, also stopping short of comparing it outright to another disc on the market.

I forget who first said it (Maybe Alastair, but don't quote me? Confirm/deny Alastair?), but it was something to the order of 'pretty much all the discs out there today are based on a few basic designs and principles; you're much better focusing on the surgeon's capacity more than the prothesis itself' ????????

Probably in a few year's time, we'll know more about the pros and cons of each design variation, but right now I tend to believe ADR is too young to know much in that line.

Trace

Yes Trace, I firmly believe that all the prosthesis are very similar and no prosthesis makes a terrific difference to the patient.

I believe the doctor and his experience and skill is 99.9% of the whole deal. In the UK the use of the different protheses is a franchise -- -- -- a little bit like Kentucky fried chicken -- -- -- it's the individual preferences of the surgeon and what suits him as well as you.

There are a few isolated cases for the Maverick and we have one specific doctor in the UK using that for specific conditions -- -- -- but beyond that I reckon there's no difference in performance, between all of them, the Charitee, Pro Disc and Maverick.

The Charitee really has the longest history, but I think that the engineering progress since the 1980s has been huge and they've caught up with it because the Charitee was inspirational at the time

T & A,

As I stated above the questions were tailored to my case and the information I had received from my many doctor�s appointments. BLW I did not include everything here.

Re: Question these were the answers I got from the doctor to the best of my recall.

14. The ProDisc is the next generation artificial disc and has improved features over the Charite and they learned from the Charite. It also has the coating unlike the Charite disc that you can get currently at the time in the US. The snap in core will protect the facet unlike the un-constrained design of the charite.

15. He disagreed with this statement.

I am not interested in having a prodisc vs charite debate (been there done that use the search tool) just trying to help out with doctor�s questions, by request. http://adrsupport.org/groupee_common...icon_smile.gif