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  #1  
Old 11-26-2012, 05:19 PM
Marita Marita is offline
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Default More "newbie" questions

As you can imagine, the more I learn the more questions surface. I am wondering if anyone can help with questions below. My discs are damaged from c3-4 to c6-7, and even c7-t1 has a small protrusion, and t2-3 might be herniated too. The worst disk is C 5-6 which is pressing my cord, as is c4-5 and c6-7, mildly.

I have a pretty immediate need to decompress my spinal cord, and my plan b - if TBI doesn't work out - is to do this more incrementally. And accept I will need further work down the road. (Is this a really bad way to look at it? )

1) is it true dr.s in the US are not allowed to implant an AD on a level above or below a fusion? Or in a mutiple level degeneration scenario?

2) if I were to get a fusion on one level to get the pressure off my cord, then get adr at a later date at adjacent levels, does that exclude me from doing the adr in the US?

3) how easy is it to get a surgeon to provide follow-up support here in US after having an ADR overseas? Will insurance cover follow- up appts?

4) anyone have different types of ADR's in their neck? (E.g. A Pro disc at one level and an M-6 at another? Is that advisable?

Phew...still can't believe I'm even having to write this message but super grateful for this community!

Marita
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Herniated discs C3-4 - C6-7
Mild - moderate spinal cord compression at three levels
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  #2  
Old 11-26-2012, 05:30 PM
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jss jss is offline
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Marita,

Those are some very good questions.

Quote:
Originally Posted by Marita View Post
1) is it true dr.s in the US are not allowed to implant an AD on a level above or below a fusion? Or in a mutiple level degeneration scenario?
Neither of those are true. I was scheduled for surgery with a US surgeon (Jack Zigler) that was going to place an ADR below my two fusions. There are others on this board that have had multilevel ADRs done in the US.

Quote:
Originally Posted by Marita View Post
2) if I were to get a fusion on one level to get the pressure off my cord, then get adr at a later date at adjacent levels, does that exclude me from doing the adr in the US?
You would not be precluded from ADR in the US at a future date. Some on this board have done that.

Quote:
Originally Posted by Marita View Post
3) how easy is it to get a surgeon to provide follow-up support here in US after having an ADR overseas? Will insurance cover follow- up appts?
US surgeons get really miffed that you don't think that they were good enough to do your surgery, and it could be a challenge to find one that will help you if you have future trouble at the operative level, or even find one that will do a follow up on your surgery.

Quote:
Originally Posted by Marita View Post
4) anyone have different types of ADR's in their neck? (E.g. A Pro disc at one level and an M-6 at another? Is that advisable?
The poster on this site that goes by christinlal has one ProDisc-C and an adjacent M6-C done maybe two years apart. I don't know if that's advisable or not.

You're doing all the right things ... research, research and then some more research. That's how you increase the probability that you'll make the right decision.

Good luck, Jeff
__________________
C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #3  
Old 11-26-2012, 06:57 PM
Marita Marita is offline
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Thank you again, Jeff. You and this site are such a source of strength for me.

Marita
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Herniated discs C3-4 - C6-7
Mild - moderate spinal cord compression at three levels
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  #4  
Old 11-26-2012, 11:31 PM
2Confused 2Confused is offline
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Marita,

Jeff was a huge source of information & reassurance as I wad making a decision as to where to go,what to do and how to get info....
Thank you again,Jeff!!!!

Do your research, ask questions, talk to everyone you can....

One big concern for me was getting a Neurosurgeon who would see me and treat me after surgery out if the country. I met with my Neuro and was very specific with my questions regarding treatment after surgery IF I chose to go out of country for surgery. I asked him "would he treat me after surgery" and I even asked him to repeat the fact he was agreeable to post op treatment. I took my husband with me so that I had a "witness". I have been in to see him since the surgery, he asked for post op X-rays in addition to the ones I brought home from Spain.... So far, he and his staff have been great. But I suggest you make prior arrangements with your doctor for follow up - for ease of mind and so you have a relationship. In all probability,my NS was not thrilled I left the country, but I have to say he & his staff have been great post op....

Hope this helps!
Again, best of luck.
__________________
50 year old female
Rear-Ended in 2009
Disk rupture cervical 5-6 & 6-7
2 level M6 ADR, Dr. Clavel - Oct. 2012
Insurance paid
Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel
Post Op 2+ years
Cross Fit 3-5 times a week
Running 5ks
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  #5  
Old 11-26-2012, 11:47 PM
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laid up doc laid up doc is offline
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i'm not sure if it has to do with being miffed or feeling snubbed as much as taking on some element of risk in following up someone on whom you didn't operate... that's the best i can come up with as far as why a surgeon wouldn't "follow" you.

every surgeon i saw here in the US agreed ADR was a good option for me but that i couldn't and/or shouldn't have a prodisc (some reasons unique to me and some not). keep in mind i had a LUMBAR issue, so not directly translatable to another person and one with cervical issues. the most experience ADR surgeon i saw told me that my best option was to go overseas, but that he couldn't be my official f/u.

i found a pain doc to "follow" me, aka write me orders for PT, do any necessary trigger point injections, and write me scripts for zanaflex, valium, and flexeril. he glances at my xrays but doesn't really know what he's looking at beyond what i tell him. Clavel reviews them very promptly and they're super easy to send.

pre-op dr visit, chest xray, blood work were covered by my insurance, i think my pcp coded the visit to not raise red flags.

i did have a wound issue about 3 wks post-op, had to go to the ED and see a general surgeon then wound dr then plastic surgeon to have it resolved. my insurance covered everything w/o asking any questions. i was totally honest w/ all dr's i saw about what was going on.

all of my post-op PT was covered w/o issue, by 2 different carriers b/c i took a new job.

you won't know for sure what any policy will cover til you file it... but you can find out what your PT benefits are etc beforehand.

all of that being said - you COULD have problems seeing dr's if there are complications... fortunately staying a week or so post-op reduces if not eliminates those risks, b/c once the implant is in, it's in...

hope that helps.
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #6  
Old 11-26-2012, 11:49 PM
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laid up doc laid up doc is offline
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i will add - neurosurgeons are a scarce commodity these days in many parts of the US. they are paranoid as heck about being sued b/c they are sued so often and it's hard for them to even get malpractice insurance. this has led to a severe shortage in some states and iirc, Nevada didn't have a level 1 trauma center for some period of time b/c no one would take neurosurgery call in the area due to malpractice. trauma is a bit of a different beast than spine, but most spine neurosurgeons in the US do still take trauma call as well.
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #7  
Old 11-27-2012, 12:43 AM
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Lillyth Lillyth is offline
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It is the insurance companies who don't want to pay for the hybrid, not the doctors not being able to do it. If you could pay for the doc to do it yourself, it wouldn't be a problem. That being said, my current doc, the one whose name I gave you here in SF suggested I go out of the country to get this done.
__________________
Multiple traumas to spine starting age 13.
1st American to have 6 ADR's in one surgery. C3-4 - C/7, & L5-S1 - L3-4.
Surgery w/ Dr. Clavel, 3/18/13, M6.
Before surgery: severe spinal stenosis C5/C6 (cord "flattened" per stateside doc), + for Hoffman's & Babinsky's.
At time of surgery: 5 yrs MAX before ending up in wheelchair.
Clavel found L5-S1 partially fused. Had to cut it apart to put in M6.
Please excuse brevity - SEVERE carpel tunnel.
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  #8  
Old 11-27-2012, 05:57 AM
Dingie Dingie is offline
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Join Date: Oct 2011
Posts: 146
Default Postop followup

Hi,

I saw two neurosurgeons and an ortho (whom I know socially as well). While the neuros said no, the ortho said he would, but was so unpleasant, I ended up going with my internal medicine doctor. I have my X-rays and send them to Dr. Clavel and take his reports to my MD. Worked for me, I think most surgeons would see you 6 months after....liability. For me, I have a healthcare background and wanted positivity postop. I agree with 2confused, line it up before you go!

Laurie
__________________
50 y.o.
WW athlete- triathlete, runner, tennis
2008-0nset of pain..MRI-DDD L4-L5 annular tear. Pain labeled discogenic with radiation to unilateral hip, no radiculopathy
2009-facet inj, radiograph ablation, SI joint injections, cryoablation stubborn no relief
2010-retired d/t pain. more injections
2011-IDET of L3-L5. Pain unchanged, up 50 lbs!
2011-Lumbar ADR recommended by Ortho and 2 neuros. In appeals w/ins. May choose Europe for M6
Need to lose lbs
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  #9  
Old 11-27-2012, 10:53 AM
Marita Marita is offline
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Join Date: Nov 2012
Posts: 34
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Thank you!
So super helpful. If I go overseas I'll definitely set up follow up before leaving.

Has anyone done an "incremental" approach? E.g. Getting a one- level fusion done knowing that ADRs at other levels would have to put in, in near future. (I know Jeff, sounds like you unwittingly did.) I'm getting very nervpus about my cord compression...really want to relieve it soon, but fusion might be only option. And can't afford ADR yet, if insurance won't help.

Any thoughts from personal experience on this?

Thanks again!

Marita
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Herniated discs C3-4 - C6-7
Mild - moderate spinal cord compression at three levels
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  #10  
Old 11-27-2012, 07:35 PM
SpineInSecurity SpineInSecurity is offline
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Join Date: Jan 2012
Posts: 32
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Have you looked into microdiskectomy? You don't necessarily need an ADR or fusion in order to decompress the cord or other nerves.
__________________
April '98 - Injured @ work
Oct '98 - Declared "permanent and stationary" by workers' comp docs
10 years of PT and chiropractic...
Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop
April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain
May '11 Hey doc, I'm tired of my neck hurting...
Dec '11 - C5-6 Prodisc-C
July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone
July '13 - L4-L5-S1 TLIF
Aug '13 - C7-T1 microdiskectomy
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