Quote:
Originally Posted by Lillyth
I have not heard of a single insurance company that would pay for a hybrid. You should ask if they have been successful at that before with your particular insurance company.
|
Insurance is a valid point. Cigna as an example has a coverage statement / policy that includes single-level lumbar ADR/TDR, but not a "hybrid" (adr+Fusion). Cigna might cover two (2) level fusion w/supporting paperwork. Hybrid in this instance is defined as:
L5-S1 = Fusion
L4-L5 = ADR/TDR
Success is based on patient outcomes and some biomechanical studies. ADR/TDR placement will affect the surgical success and clinical outcomes.
Fusion at the bottom-level of a lumbar operation as above avoids the wedge effect at the bottom level of the spine. The biomechanics articles describe it as compressive shear at L5/S1 because of the natural/normal angle of the vertebrae. The powerpoint from Dr.LeHuec/France on hybrid lumbar surgery was on the hard disk, but I can't find it now. Dr.LeHuec was president of the ISASS.
adrsupport Hybrid Lumbar Patients:
HGrantnz
http://www.adrsupport.org/forums/f47...grantnz-11134/
M1013828
http://www.adrsupport.org/forums/f47...age-bmp-11716/
JStuckey
Healthy Back 2011
valandguin L4-L5 ProDisc L5-S1 ALIF (anterior fusion)
Kinematics of a selectively constrained radiolucent anterior lumbar disc: comparisons to hybrid and circumferential fusion.
Clin Biomech (Bristol, Avon). 2012 Oct;27(8):759-65. doi: 10.1016/j.clinbiomech.2012.05.010. Epub 2012 Jun 27.
Daftari TK, Chinthakunta SR, Ingalhalikar A, Gudipally M, Hussain M, Khalil S.
Resurgens Orthopaedics Spine Center, 270 Chastain Rd, Kennesaw, GA
Kinematics of a selectively con... [Clin Biomech (Bristol, Avon). 2012] - PubMed - NCBI
Hybrid construct for two levels disc disease in lumbar spine
European Spine Journal February 2010, Volume 19, Issue 2, pp 290-296
Stephane Aunoble, Robert Meyrat, Yasser Al Sawad, C. Tournier, Philip Leijssen, Jean-Charles Le Huec
Hybrid construct for two levels disc disease in lumbar spine - Springer
PubMed: Hybrid disc replacement
Hybrid disc replacement - PubMed - NCBI
2012 BritSpine
P235
COMPLICATION RATES IN THE ANTERIOR LUMBAR RETROPERITONEAL APPROACH: A SINGLE SURGEON SERIES IN A TERTIARY REFERRAL CENTRE
http://www.adrsupport.org/forums/f50...-2012-a-11654/
2011 UCSF
CME {Continuing Medical Education, cervical}
http://www.adrsupport.org/forums/f50...-2011-a-11648/
2012 ISSLS Annual Meeting
P309
Hybrid: TDR + Fusion (ALIF) 385 Patients, Combined Arthroplasty and Anterior Lumbar Interbody Fusion (Hybrid Procedure) in 385 Patients with a Minimum of 2 Years Follow-up
http://www.adrsupport.org/forums/f50...-2012-a-11608/
MAVERICK™ (17.9%) (A-Mav: Medtronic) and
In Motion Lumbar Artificial Disc™ (40.8%) (Depuy Spine), and
CHARITÉ® (Depuy Spine) (41.3%).
2010 ISSLS Annual Meeting
GP176.
HYBRID COMBINED TOTAL DISC REPLACEMENT AND FUSION PROCEDURES IN THE LUMBAR SPINE: CLINICAL AND RADIOGRAPHIC OUTCOME
Retrospective
http://www.adrsupport.org/forums/f50...stracts-10667/
2009 NASS North American Spine Society, Annual Meeting,
Poster #158.
The Hybrid ADR: Long-Term Analysis of Sagittal Motion and Clinical Outcome after Concurrent ADR + ALIF (Minimum 2-Year Follow-Up)
Alexandre Rasouli, MD 1, Rick B Delamarter, MD 2, L.E.A. Kanim, MA2, Nomaan Ashraf, MD 2, Brandon Strenge, Sr., MD 2;
1 University of California, Irvine, Newport Coast, CA, USA;
2 The Spine Institute at Santa Monica, Santa Monica, CA, USA
Biomechanical comparison of two-level Maverick disc replacement and a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion,
The Spine Journal 2009
http://www.adrsupport.org/forums/f50...-2009-a-10162/
2009 Spine Arthroplasty Society
http://www.adrsupport.org/forums/f51...-program-9928/
Abstract: 536
Hybrid Surgery: Fuson and Disc Arthroplasty Is Superior to Two Disc Arthroplasties in the Lumbar Spine
J.C. Le Huec1, S. Aunoble2, P. Leijsen2
EuroSpine 2008
SP 3
Hybrid construct: fusion L5S1 and disc arthroplasty L4L5 for DDD.
3 years follow up
• JC Le Huec MD PhD, S Aunoble MD, R Meyrat MD, C Tournier MD,
http://www.adrsupport.org/forums/att...4-l5-3-yrs-pdf
2008 German Spine Congress
P 50
Clinical outcome in primary bilevel cervical intervention with disc replacement, hybrid supply or fusion
M.G. Detzner1, F. Weber1
1 Städtisches Krankenhaus Köln-Merheim, Klinik für Neurochirurgie, Köln
Objective: Safety, clinical outcome and complications of 105 bilevel cervical interventions with disc replacement, hybrid supply or cage interposition for fusion are compared.
Methods: The patients data were obtained retrospectively from 882 patients operated for cervical disc herniation or combined cervical stenosis between 2004 and 2007 at the department for neurosurgery in Cologne-Merheim. Primary interventions in two cervical levels were necessary in 105 Patients. Clinical follow up occurred on an average of 7,6 months.
AANS / CNS 2008 Annual Meeting (Link)
AANS = American Association of Neurosurgeons
CNS_ = Congress of Neurosurgeons
Abstract: 321
Outcomes Analysis of Hybrid Disc Arthroplasty (Lumbar 32 patients)
Pablo R. Pazmino, Rohit Verma, Todd Hopkins Lanman, John J. Regan
http://www.adrsupport.org/forums/f50...g-2008-a-7279/
http://www.adrsupport.org/forums/f50...1-2008-a-4757/
2007 AANS / CNS
http://www.adrsupport.org/forums/f50...s-2007-a-6744/
Hybrid Constructs
2005 Orthopaedic Clinics N.America
Rudolf Bertagnoli, MDa,*, Patrick Tropiano, MD, PhDb, Jack Zigler, MDc, Armin Karg, MScd, Sandra Voigt, MScd
Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: a finite element analysis.
Eur Spine J. 2012 Jun;21 Suppl 5:S663-74. doi: 10.1007/s00586-010-1382-1. Epub 2010 Apr 2.
Schmidt H, Galbusera F, Rohlmann A, Zander T, Wilke HJ.
Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstrasse 14, 89081 Ulm, Germany
Effect of multilevel lumbar disc arthroplasty on... [Eur Spine J. 2012] - PubMed - NCBI
We hypothesise that:
(1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension;
(2) deviations from the optimal implant position lead to strong instabilities.
Charite' - specific testing
The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition. Deviations from the optimal implant position lead to unfavourable kinematics, to high facet joint forces and even to lift-off phenomena.