Now that I have my discogram results, I met with my local surgeon today and he said that I am a candidate for a two level disc replacement (L4/L5, L5/S1). He doesn't feel that it is worth it to do only one, since they are both causing pain.

Even though this local surgeon trained in Germany and TBI, he cannot do two levels. He referred me to Dr. Zigler and I made an appt for Feb 12th.

Unfortunately, TBI doesn't have a two level disc trial going on, so I'll have to pay for this myself. Luckily, I have Aetna but Aetna only pays for one level. Anybody have any recommendations for asking for them to pay for two? Any other suggestions?

Also, I have been looking in the archives to see how long I would have to stay in Plano/Dallas after the surgery. Back in 2005, Zigler had people stay for one week. Is that still the case? I'm trying to figure out the logistics of having my husband take time off, etc. My local surgeon said he would be comfortable doing the follow-up visits after the initial appts.

Aetna, I'm sure glad I met ya! :-)

Thank you in advance!
Paula

This was posted recently:

Bailey
Karma Chameleon

Posted January 25, 2007 03:30 PM

In The Big Bucket

Greetings!
I finally got the news I was looking for. As most know, been waiting news regarding 2 level Prodisc replacement. AETNA has approved it and now I'm set with a surgery date of 2/19 at TBI. And to top it off, I've called Aetna to confirm, but they are saying that they will pay for 2 level! Being the eternal pessimist I am, am reading the fine print about copays, coinsurance, payment procedures, etc. and expect that a hefty sum will still come out of my pocket, but so far so good! So for those out there who have been arguing and arguing with insurance companies, there is hope. Aetna rep told me, when I asked about 1 level vs 2, was that everyone is getting more educated now. That is great news! And maybe other carriers will follow.
I now look forward to reading up what others of you have recommended pre-surgery and post-surgery. Can't say that I'm excited about it all - though I would call it a true miracle that I'm in the situation that I am. Prayer does work! As everyone else, I'm scared about the procedure, the recovery, the chances that I will be worse off than I am now, etc...But we got to live right and I think I'm making strides at getting back my life again.
More updates later.


1995 L5 S1 laminectomy
2005 2 level herniation L3/L4 and L4/L5
5 epidruals
2006 discogram
2006 - diagnosed DDD - awaiting ADR surgery

Posts: 19 | Registered: November 08, 2006

This was posted recently. Good-luck in getting yours approved also. It always is different State to State and Policy to Policy. I provide Blue Cross to 30 employees and understand the frustrations of different coverage. At least you now know that a precedent has been set with someone else and maybe you can connect and get help for your case.

Terry Newton

Thanks Terry, for helping Paula! Good find...Paula, let's catch up live, give me a buzz when you can. And congrats on your milestone!

Paula,

Not sure I can help you with your insurance question but I am having a one level Prodisc with Dr. Zigler On Feb, 8th. (L5-S1) They told me that I would most likely be released the very next day, could go home (Pittsburgh, PA) the next day as well if everything is ok. Planning on staying until Monday, the 12th, to meet with him then fly home. It may be different with more than one level.

I was very shocked to here of the aggressive release schedule, but I guess if there are no complications , I can lay in the hotel just as easy. Plan on doing my follow-up at home also.
My wife is also making the trip. To be safe, we allowed for a week, if needed.

Congrat's on your insurance. I have BCBS, so I'll be paying cash (choke, choke).

Good Luck, maybe I'll see you there.


Dave

Hi Paula-

I'm having my 2 levels with Dr. Zigler on February 19. He told me to plan on 2 nights at the hospital, but I live in the area so I'm not having to make any other arrangements. Have you talked to his Admin assistant, Joann? If you need additional info, email me privately and I can give you more. As far as the approval for 2 levels go, of course they haven't paid for anything yet, but I had TBI check with Aetna and it seems as if they are approving 2. There letter back says "for 2 level Prodisc, you are eligible for payment", so the drx thinks we are in good shape. I'm cautiously optimistic. Best of luck to you and David Johnson both. I think we are all in good hands with Zigler!

Bailey -

I'll be interested in your surgery outcome because I am interested to see what the distraction pain is going to be like, since we will have it for two discs.

Good luck with your surgery and please post when you can.

Below is my MRI for anyone who is interested. Does my L5/S1 look as bad as it looks to me? [Don't worry, I don't expect any medical advice from this MRI.]

Hi Paula
Your MRI looks similar to mine so I understand how you feel.
Its three years this month since I had ProDiscs at L4/5 and L5/S1 and the new discs are great. Worrying about the distraction pain for me was worse than going through it - fear of the unknown I guess. The distraction pain I got kicked in about three weeks post-op but was manageable and was certainly no worse than the original pains I'd had pre surgery. I viewed it as a something I had to go through to get to the next stage. Not everyone has distraction pain so hope that you are one of those people. I do consider myself very fortunate to have had the surgery and will be forever gratful to my surgeon.
From what I've read you are in very good hands with Dr Zigler which must be reassuring.
I wish you a straightforward operation and an uneventful recovery.

Best wishes

Lynda

Feb 2004 - ProDisc II, L4/5 & L5/S1

HI Paula..
I am NOT trained to read MRI's, but I can tell ya that your MRI looks very simular to mine. If you compare your l4/l5 and l5/s1 to a healthly disc you can see a big difference.

Did you have epidural injections in both discs? if so did you feel different after each injection? I ask that because when I had an epidural in l4/l5 I felt certain (temporary) benefits from it and when I had l5/s1 injected I had totally different (temporary) benefits. When that happened I knew that both discs were gone.

Good luck with Dr. Z this week!

Thanks, Linda for giving me reassurance that the two-level Prodisc will fix my issues. You are right, I'm getting myself worked up about the dreaded distraction pain, but maybe it won't be so bad.

Sean - I did have a L4/L5 nerve block epideral in late 2004 and that gave me relief for a year. Then the pain came back, so they gave me another L4/L5 epideral. The pain came back in six months. At that time, they did another MRI and found out that my L5/S1 had deteriated considerably in a year and a half. So, they gave me a L5/S1 nerve block epideral and that gave me relief for three months. Then they gave me a SI facet joint injection (not sure of the exact term) and that gave me some relief for about a week.

After trying physical therapy and pain meds, the surgeons (finally) decided to do a discogram and determined that both L4/L5 and L5/S1 are pain generators. That's when they told me to look into fusion or ADR.

Does my story sound familiar to your story?

Paula

Same story as mine and my MRI looks very similar though my S1-L5 was totally collapsed.

Went through the epidurals, facet injections. Waste of money in my opinion. Got no relief from any of it.

The surgery is 14 weeks out for me now. Still have some distraction pain that kicks in regularly. The pain is very manageable and nothing compared to pre-surgery.

They can put you on Neurontin or Lyrica to deal with any long-term nerve pain. My personal favorite is Lyrica which acts more towards the damaged nerves rather than acting globally like Neurontin. Many can handle the side effects of Neurontin, I could not as I am very medication sensitive.

It looks like you have done your homework and have a good plan of action. You are so young to have a fusion. I am very athletic and everyone I knew who had a fusion at your level and wanted to be active was miserable with a lot of pain.

I am very pleased with my decision so far. I turn 50 on February 27th and feel as if I got the best birthday present I could have ever gotten. I am putting my discs to the test regularly. We got 25" of snow the weekend before last with a lot of snow on top of that since. I have been snowshoeing constantly since. Did a 5.5 mile hike in the woods yesterday and have a long hike scheduled for today. The real test will be if I can put my 2,000 miles on my bicycle this coming season. I am looking forward to it. The pain level is so much lower now I feel like a constant miracle.

Trust God, your caregivers, and the support of the people here to see you through.

Take care Paula.

Terry Newton