Amy,
What a terrible story! And condolences on the loss of your spinal health due to this intoxicated driver.
I don't know which course of action is best for you, but it sure looks like you've done your homework and put together a list of reasonable options. I had a cervical fusion in 2000, another in 2002 and in 2009 was told that I needed three more! I put together pretty much the same list of options that you have and ended up choosing your option 3; having a double M6 ADR abroad.
On getting your insurance to cover the hybrid procedure... It is common now for insurance carriers to cover a hybrid, and I'm a little surprised to hear that yours doesn't. We see many cases on this board of people challenging their insurance company that doesn't cover ADR to cover; but we see very few successes. The poster that goes by the handle "gymnast1981" was successful. She posted a great deal about it in the "Insurance Hell" forum. If you need more information than she's posted there, you can always send her a PM.
On the double fusion... In his 1999 landmark study,
Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis, Dr Alan Hilibrand followed 409 patients that received cervical fusions; 374 single level, and 35 multil-level fusions (like yours and mine). He found that of the single level fusion patients that 25 percent would require an additional surgery at an adjacent level within 10 years. An interesting observation gleaned in his work is that that proportion of required follow up surgeries was "significantly lower" in patients that received multiple adjacent fusions. Yes, 35 is a small sample, but it looks like adjacent segment disease is not as prevalent after a two level fusion as it is a single level.
On going abroad for ADR... It will cost less, you can choose a respected and renowned surgeon, and in my view will probably have the best outcome that it is possible to have. But, as you have noted such an act is abundant with risk that you won't have if you stay here in the US. Here are the ones that come to mind:
- In the event of complications the provider will want payment at the time of service, before you leave the hospital; which could be tens of thousands of dollars
- If you come out of surgery worse than you went in (it happens), getting back home will not be as simple as a car or ambulance ride
- If there is negligence, you will not have the protection or recourse provided by the US legal system
- When you get home, finding a doctor to treat any future spine issues, or even perform a simple follow up could be difficult
Doubtless you've observed the very high probability of an overseas surgery by members on this site. The aforementioned problems are rare (except for the last one), but I've seen all but one of them experienced by posters on this site.
On waiting too long for surgery and incurring permanent nerve damage... I've done that myself. I'm three years post surgery and my left hand is still, and will likely always be mostly numb. The problem is that you can't know that you've waited too long until after you've waited too long.
In 2009 I had a double M6 ADR in Barcelona. I was in the hospital two nights. Except that no one spoke English (and I mean NO ONE but my doctor and his two associates) and that I was hooked up only to an IV in recovery, it was just like being in Medical City Dallas for my two fusions years earlier. I left the hospital completely ambulatory and spent the next ten days touring Barcelona an Paris, 8+ hrs per day, on foot. Some cervical patients can do that and some can't. I had one post surgery check up before leaving Spain, an 18 month check up with a local surgeon in the Dallas area, and will have a 3 year check up tomorrow. So far, so good. The surgical cost was just under $30k (it costs more now) and the travel/logding related expenses were about another $5k.
The poster on this site that goes by DAnn had a cervical hybrid at TBI. I know that she'd be happy to share her experience if you PM her.
Good luck, Jeff