[tigerpaw75]

A little background - My wife initially hurt her back years ago while working as a nurse. She would go to physical therapy, take anti-inflammatories, and it would improve. Then it would act up again a few months later. More of the same. Finally in Fall 2008 her disc ruptured and was putting major pressure on her sciatic nerve. We believe the final rupture was caused by a chiropractor who must have had no idea what he was going. He performed several aggressive adjustments and my wife left the chiropractor in more pain than when she arrived. 3 days later she had to go to the hospital in an ambulance (she finally could not walk and I worked 40 miles away). Two days after that she had a hemilaminectomy/discectomy that removed the ruptured part of the S1-L5 disc that was pressing on her sciatic nerve. She still has numbness to this day on the top of her right foot and in several of her toes.

She was relieved of pain until July 2009, when the pain returned, although this time it was specific to the spine area and did not involve any extremity pain. She had an epidural steriod injection that relieved the pain until January, when we tried another epidural. This one did not work at all. MRI and X-ray indicated that both S1-L5 and L5-L4 were bad. All her surgeon here at home had to offer was a two level fusion. The dcotor said he didn't recommend it, but fusion was the only procedure he offered. He knew about ADR but was skeptical about it - his only direct experience had been in Europe in the mid-80s, and he was very concerned about revisions due to ADR material failure after a certain number of years.

So that led us to start researching ADR, where we found this website and a number of others (thanks for all the info). We came across Texas Back Institute, who by most accounts appear to be among the leaders in the U.S. with ADR.

My wife and I traveled to Dallas from Alabama to meet with Dr. Blumenthal at TBI in February and he suggested a hybrid procedure - but interestingly suggested it only because of insurance reasons (insurance would pay for the fusion at S1-L5 and then we would pay for the ADR at L5-L4 out of pocket) - he didn't mention that her previous laminectomy would be a contraindication for ADR at the S1-L5 level...is a hemilaminectomy a contraindication for ADR?

Dr. Blumenthal send my wife for a discogram and a post discogram CT scan. It confirmed that the source of her pain is most likely the two bad discs.

Now the only problem was - how to pay for it. Dr. Blumethal said he thought it would be about $20,000 out of pocket for the L5-L4 ADR with insurance picking up the S1-L5 fusion, the hospital, etc. Well we waited weeks and got bounced around to 10 different people at TBI to attempt to confirm this number. Seems it shouldn't have taken more than a day to do the insurance check? Anyway we were very frustrated with TBI because it seemed that no person was handling my wife's case - and she was having to tell different people the same information multiple times. Finally this week they contacted us and said it would be $30,000 out of pocket...that made us reconsider looking at Wockhardt hospital in India and a Dr. Rajakumar. Their price for two level ADR or the hybrid fusion/ADR would be around $16,000 for everything including a 10 day hospital stay and a 7 day hotel stay after that...I'd much rather do it in the U.S....but with TBI's apparent adminstrative disorganization, bad customer service, and almost double the cost.

Dr. Rajakumar has not seen my wife's films yet, but seemed to think that her hemilaminectomy S1-L5 was a contraindication for ADR at that level. He is proposing to use the O-Mav (oblique entry at 30 degrees from direct anterior) disc...any opinions there? I know I saw a paper than said the oblique entry gave a larger chance of misalignment? Dr. Rajakumar likes that the great vessels can be better avoided by the oblique entry...Dr. Rajakumar has done about 200 lumbar ADRs and many more cervical ADRs...

I hope for the best, but I'm still worried about going overseas for surgery. On the surface, it appears that Wockhardt Hospital - Bangalore is world class facilty - it is JCI accredited and has a partnership with Harvard Medical International...so that makes a person feel a little better. And their customer service has been very attentive. The surgery would be set up through the Taj Medical Group....

Does anyone have any thoughts on what type of risk we are taking here? I know one guy on the forum (Piglet) had cervical ADR with Dr. Rajakumar and he said he is OK...but I haven't been able to get much more info on the net on him in particular...

I think I understand the general risk in leaving the U.S. for a serious medical procedure in technically a third world country...but are there any specific things that we should be looking out for here?

Sorry for the long post...appreciate anyone's thoughts/insights.

Tigerpaw75