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Old 11-07-2012, 08:37 PM
AmyM AmyM is offline
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Default 3 discs damaged in car crash by intoxicated driver in So Cal...what to do?

Hi all,

I've visited this site several times looking for answers, but I think it's time I posted my story to see if anyone has any advice. I can't sleep for worrying about my situation & what to do, and I really need to make some decisions. I hope someone here can help!

Background - On April 11, 2011 I was hit not once but twice by a woman who was on narcotics (this was at 5 pm on a Monday as I was heading from a PTO meeting to my youngest son's tball game). She was arrested & later convicted. I was taken to the ER by ambulance in a neck brace & on a backboard, where they x-rayed me & released me with a diagnosis of whiplash. The next day they called me back for a CT-Scan but again, said it was whiplash. My doctor suggested acupuncture & chiropractic care, which I did 2x-3x week for 2.5 months. When the pain did not resolve, my doctor then prescribed physical therapy & massage. I had a massage once a week and PT 2x a week for 2.5 months, then my physical therapist released me since my condition did not improve. At this point it had been 6 months since the accident and I was no better, so I retained a lawyer and had a MRI, which showed severe disc damage at c 3/4, 4/5 & some lesser damage at 5/6 (my doctor's review of my MRI read "ouch!"). She & my physical therapist both then referred me to a pain specialist. I had paid for everything out of pocket up until this point - about $15,000 - but my lawyer arranged for a lienholder to cover my epidurals. I had three steroid epidurals in Nov/Dec '11, but my condition did not improve. The headaches were pretty much mostly gone by this point, but I still had neck pain and my right shoulder & top of my arm ached constantly (the 2nd time I was hit by the intoxicated driver I was looking back over my right shoulder, so the damage is mainly on my right side).

I took a few months off hoping that maybe things would resolve if left alone, but they did not, so in spring of 2012 I went to a neurosurgeon in Orange County. He recommended a 2-level anterior cervical discectomy with plating & fusion. I was shocked as I truly did not think I would ever need surgery. I decided to get a 2nd opinion from another neurosurgeon in La Jolla, who said he could go in through the back & clean out the discs, and that I would "probably" be fine. As I really did not want surgery, in July of 2012 I decided to try a different kind of epidural procedure through the front of my neck using a different kind of medicine. I had high hopes but it did nothing.

The pain doctor who did my last epidural suggested I see an orthopedic surgeon since perhaps they could do something less invasive. So in August '12 I saw an orthopedic surgeon in Oceanside who also said I needed a 2-level fusion (no one wants to touch the 3rd disc, as it's not as bad as the others). I didn't have confidence in this doctor's facility, so I decided to do one more consult with Dr. Regan in Beverly Hills in Oct. '12. Dr. Regan said he could do a 2-level fusion, but there was another option - a 2-level cervical disc replacement. I had never heard about this procedure before, but I liked what he told me, especially that I would not have to worry about adjacent disc disease - a real concern since I have that third damaged disc - and I really just want to go through this once. I went home, did my research & decided that was the surgery for me. I called to book it a week later, but was unable to do so as I needed approval from my lien holder. He was reluctant to back it since disc replacement is so new in the US, and not all insurance companies cover it so he wasn't confident I would get a settlement large enough to cover his costs. So I looked into my Cigna (which I had not yet tapped into for anything related to the accident), and found they do not cover cervical disc replacements, but that they might if it was one level only. Since I needed to repair two levels, I was back at the mercy of my lien holder.

After much discussion with my lienholder, and waiting 4 days for my doctor to call me back, we decided on a compromise - a hybrid surgery of a disc replacement at 3/4 and a fusion at 4/5 (again, they want to leave 5/6 alone). From what I have read, while not as good as a 2-level ADR, a hybrid is a better option than a 2-level ADCF. So again, I tried to schedule the surgery. Then I got the lienholder's estimate and it's $260,000!!! They say it's "worst case scenario" and it will be negotiated down, but I can't risk my family's financial health on this.

I have asked Dr. Regan's office to submit my insurance for pre-qualification, and they told me they can try, but that Cigna will not cover a disc replacement if you need work on more than one level, even if you are doing a fusion on the other level. Honestly, I don't think they are even going to try.

I will very likely get a settlement from the woman who hit me, possibly up to $300,000 which sounds like a lot (it IS a lot) but my lawyer will take 1/3 and if my medical bills are more than $200,000, I will end up OWING. This is to say nothing about getting compensation for my pain, time & emotional distress over the last 18 months.

I should also mention that my symptoms have been changing over the last 4-6 weeks. Where I once had pain just in my shoulder & in my arm, it's now all the way down to my hand & my fingers tingle constantly. I am very worried that I will end up with permanent nerve damage if I don't act soon. The last two doctors I saw both told me my muscles in my right side are beginning to atrophy, and I can definitely tell I am not as strong on that side. Even typing or writing for more than a few minutes hurts. So I am feeling pressured to do something soon before it's too late. Emotionally I am a wreck trying to figure this out.

My husband & I sat down last night & came up with these options:
1) I have the hybrid surgery with Dr. Regan this month and hope that the lienholder will be able to negotiate the cost down. It would be nice to at least be able to recoup the cost of the car we had to buy to replace the one that was paid off but totaled.
a. I can continue to push Dr. Regan's office to work on getting it covered with my insurance, but I am not very optimistic that they are putting much effort in it. I can't count on it happening.
b. I could find another surgeon that does ADR whose office staff might be more receptive to working with insurance, but that would take more time & could end up with the same options. I would prefer to get this taken care of sooner rather than later since it HURTS...which is a big reason for not wanting to fight with Cigna on my own.
2) I have a 2-level fusion here in San Diego. I would be pretty much guaranteed that Cigna would cover it so I wouldn't need a lienholder, and I would walk away with some cash after paying my lawyer & medical bills. However, I am greatly concerned about developing adjacent disc disease and eventually needing more surgery. I also don't love the idea of reduced mobility and the longer recovery. Finally, I think I would be really bummed out to settle for this option when I know there is something better out there (ADR).
3. I go abroad & have the 2-level ADR or a hybrid there. Pros - qualified surgeons, cheaper, likely that we could get the costs eventually covered with settlement. Cons - we'd have to pay for this out-of-pocket up front, it would take longer to arrange, plus we'd have to factor in travel time (time off from work for my husband to accompany me), inconvenience & costs, dealing with child care while we're out of the country, plus the scary what-ifs that could pop up (follow up care, what if there is a problem, etc).

None of these options are great. There's not a clear-cut answer. This is taking over my life, between the pain and having to make the right decision. Can anyone tell me what their abroad experiences have been like? How much was it, how long were you there & what about follow-up? Or has anyone had a hybrid surgery? How do you feel? Or if anyone has had a 2-level fusion, what's recovery really like? I have so many questions, and not enough answers. I am still delving into this board but would greatly appreciate any words of wisdom.

Thank you!

-Amy
Car acccident 4.11.11 - damaged c 3/4, 4/5 & 5/6
pain in neck (ha), right shoulder, arm & tingling hand
debating between 2-level ADR abroad, hybrid here in US or 2-level fusion
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  #2  
Old 11-07-2012, 10:56 PM
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Harrison Harrison is offline
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Wow, Amy, sorry about your situation. Like many here, you've had so many challenges. Have you already made up your mind about going abroad?
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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  #3  
Old 11-08-2012, 08:44 AM
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jss jss is offline
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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
__________________
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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  #4  
Old 11-08-2012, 04:06 PM
adrigail adrigail is offline
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Hi,

I too have Cigna as my companies insurance administrator. Specifically I can't speak to your situation, but I WAS approved for a single level ADR (Prodisc) by Cigna and am currently scheduled.
My company self-insures and I'm not sure how that affected the decision to approve ADR surgery.

My approval came on the first submission. I have a similar conservative treatment history as you (massage, PT, Epi's) that spans about 8 years. This too might have streamlined the approval process. My approval actually came on the first submission, didn't even need to appeal.

I suggest you keep hammering away at Cigna. It appears that they are becoming slightly more inclined to approve ADR surgery as an alternative to Fusion.

Mike
__________________
Mike
49

2006-2011 Chiro, epidural steroids, nsaids, PT for L4-5 bulge/annular tear
April 25th 2012 35MPH rear end collision, blows out L4-5 and ADDS a tear in C4-5
Cancelled ADR to continue conservative therapies
April 10th 2013: Insurance re-approved and I'm scheduling lumbar ADR for end of the month!
*schedule* ADR Prodisc L April 29th 2013
5-2-2013 ADR using Prodisc L
7-10-2013 New MRI on neck. Surgeon DOES NOT recommend ADR for Cervical.

"I'll be your Huckleberry"
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  #5  
Old 11-08-2012, 07:37 PM
2Confused 2Confused is offline
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Default ADR cervical

Hi Amy,

Wow, you've done your homework and sounds like you are ready to move forward.

I also was in an auto accident, whiplash & damaged discs just over three years ago and went through every option hoping to avoid surgery. I finally gave in, realizing I could no longer live in constant pain & made the decision to have surgery. Then discovered that I would have to jump many hurdles to get insurance to pay....

So, we made the decision to go to Spain, Dr. Clavel. My surgery was 15days ago & my neck is mostly pain free!!!! Still dealing with some nerve damage & nerve pain, but I made the right decision and am so happy that I chose to have the ADR surgery.

I encourage you to do what YOU feel is best for you based upon your research & what your doctors say....

Best of luck.

I also sent you a PM.
__________________
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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  #6  
Old 11-19-2012, 08:10 PM
newleaseonlife newleaseonlife is offline
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Amy,

I am so sorry that you are having to go through this. I was in a similar situation with my car accident, although the woman who struck me was not on drugs. I fought with insurance agents and had to eventually resort to hiring a lawyer. Turns out, the woman didn't have enough coverage. I researched having an ADR done, and knew it was the surgery I wanted with regards to my age and lifestyle. My BCBS insurance refused to pay for the surgery. The cost would have been $150,000+ for the ADR, plus I needed to have an additional surgery on my L5/S1. I was beside myself and became desperate for pain relief.

I too heavily researched all the options and decided to go with option #4. I chose to travel to Cyprus to have my ADR done. My local surgeon, Dr. Peterson, told me about a program he was involved in. Basically, I would have all my pre-op stuff done here at home. We would then fly to Cyprus and have the surgery done there, and then he'd to all my follow up care once I went home.

I wasn't sold at first, but I knew I couldn't deal with the pain too much longer. I got the maximum payout from the woman's insurance company ($100,000 although my lawyer got to have her 1/3) and then started pricing ADR surgeries overseas.

I knew that Europe was ideal for the ADRs. I looked into Spain, Germany, and England, but decided that Cyprus was the best bang for the buck. I was quoted an ADR price of 30,000 Euros. That included my surgery, medications, and my stay and all meals in a 5 star hotel for my husband and I. Also, part of the program that the surgery was under included visits to ancient ruins and cities, shopping trips, and any sight seeing that I wanted to do. My "guide" was the most wonderful person. She was British Cypriot and so she translated for me. She has a proper British accent, so she was easy to understand We became such good friends that I still Skype her once a month.

All the other countries were 40,000 Euros and up when I priced them. I also wanted to go someplace warm and sunny to recover. It was beautiful 80-85 degree weather and it was amazing!! The food was delicious and the people were wonderful. Since Cyprus is a former British colony, almost everyone speaks English as a second language. We were able to get around because the bus line was really easy to use and there were plentiful and cheap taxis everywhere. All the signs are in English, so it was easy to find out where I wanted to go. The people were really easy going, and accommodating. I swam/floated in the Mediterranean prior to my surgery, got a lovely suntan, and gorged myself on the most delicious baklava I have ever tasted.

Since Cyprus is part of the EU they have to meet certain standards. The hospital that I used was one year old and was impressive. It was all state of the art and super clean. I had a private room and my own little TV. I will say that the hospital food wasn't too bad either. I was out the next morning and back in my beautiful hotel room. My surgeon, Dr. Peterson, checked on me before and after the surgery and talked with my husband about everything. It was just like being back home.

I would be more than happy to tell you more about my experience and the program I used, if you want to know more.
__________________
02/2010- Car accident resulting in C4/C5 & L5/S1 bulging and extruding discs.

06/2012- Successful ADR surgery for C4/C5 disc in Cyprus using PCM by NuVasive. Performed by Dr. Mark Peterson through the help of AIMIS.

09/2012- Successful Disctectomy of L5/S1also performed by Dr. Mark Peterson.
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  #7  
Old 11-19-2012, 09:11 PM
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Lillyth Lillyth is offline
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I'm in the same boat as you ladies, only my driver was uninsured.

I have Cigna too, and the reason they don't like cervical ADR is that the guy who shapes their policy is a lumbar ADR specialist. If only it had been our lower backs, we might be approved.

CIGNA is telling me the same thing, but we are having my husband's HR people put some pressure on them.

I would love to know the program in Cyprus, and if they used the M6.
__________________
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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Old 11-19-2012, 09:43 PM
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Lillyth Lillyth is offline
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Also, what about Cyprus's proximity to Turkey, Syria, and Israel? My husband and I are worried about being so close to war torn countries.
__________________
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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  #9  
Old 11-20-2012, 07:27 PM
newleaseonlife newleaseonlife is offline
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First off, please let me say that I'm not a salesperson for the company or anything like that. Eve I'm just a satisfied customer who went over on her own dime and had surgery done. I only want to help others.

That being said, the company I used was called AIMIS. It stands for the American Institute of Minimally Invasive Surgery. Their website is AIMIS - World Leading Spine Centre Organization. You can upload your MRIs to their surgeons to review, and then the surgeons can recommend the best implant for your scenario. I am not familiar with the M6 device, so I can't say anything to that. I do know that since the surgery isn't done in the US, you have access to other implant options that are available in Europe. I know that if you aren't in an area where there is a AIMIS member surgeon nearby they offer video conferencing. My surgeon happened to be local, but not everyone is as fortunate on that count. I know that Dr. William Smith out of Las Vegas is one of the top guys to work with. He travels to Cyprus multiple times a year to perform ADR or TDRs as they are called in Cyprus. He probably does more procedures a year than most American doctors do in their lifetime.
As for the safety of Cyprus, I too was worried. However, since Cyprus is part of the European Union, they aren't considered a part of the Middle East, but Europe. They are closer to Greek in their politics, except for the whole bankruptcy issue going on in Greece. The people of Cyprus are mostly Greek Orthodox, and there is very little issue with the religious groups. Turkey controls the northern top of the island, but it is a mostly peaceful sharing of the island. The Cypriots are the kind of people who perfer to argue politics over dinner and a glass of wine than with guns and missiles. It is odd to think of being so close to the fighting going on, but really Cyprus is like an insulated bubble when it comes to the fighting over there. If you have any questions about the political climate, I could refer you to my friend. She lives in Limassol and could help allay any worries you have.

As for local crime, I felt very safe there. I walked alone and rode busses with cash in my handbag during the day and at night with my husband, and never felt any danger. Crime is relatively low there. People rarely gave me a second glance. Truthfully, I felt safer in Cyprus than I did in Amsterdam.

The hospital was built in 2011, I think. It is in a nice area. Again though, AIMIS uses a private hospital. That means you get the top of the line care. The day I went in to surgery I waited all of ten minutes after the nurse put in my IV before I was wheeled down to the operating room. Checking out was a breeze. I had my own dedicated nurse while I was there.

Wow! I didn't realize how long my post had gotten. Oops!! I don't want to hijack this thread, so please feel free to PM me.
__________________
02/2010- Car accident resulting in C4/C5 & L5/S1 bulging and extruding discs.

06/2012- Successful ADR surgery for C4/C5 disc in Cyprus using PCM by NuVasive. Performed by Dr. Mark Peterson through the help of AIMIS.

09/2012- Successful Disctectomy of L5/S1also performed by Dr. Mark Peterson.
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  #10  
Old 11-20-2012, 08:43 PM
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laid up doc laid up doc is offline
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i do know that there are a fair # of US surgeons looking to establish an out of country hub to use different implants, stem cells, etc... some of my local orthopedists have been very curious about my experience.

oh the FDA... ugh.

as far as Cyprus - first i have heard of such a setup, glad it worked out so 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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