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  #1  
Old 03-07-2005, 08:27 AM
David David is offline
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Join Date: Mar 2005
Posts: 455
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I guess I should give some background information first, so please bear with me...

I am 33 years old, and I have been diagnosed with two herniated discs about 10 years ago (L4-L5, L5-S1). I have been through all the "traditional" therapies, such as: physical therapy + drugs, ice, heat, epiderals.

Generally, I have about a 6 month time frame where I am in less pain, and then a 6 month time frame where I am in more pain (rinse, repeat).

That being said, I have gotten to the point where my quality of life is basically non-existant. I can't do anything that I want/like to, yet I am constantly in pain.

So, I went to a group of Orthpedic surgeons in the Columbus area and recently had a discogram done (wow, did that suck). From what I am told, all of my pain eminates from the L4-L5 area, and not from the L5-S1 area.

After looking at the results, the surgeon recommended spinal fusion, primarily because his office was just starting to do the ADR surgery (January 2005), and were starting at the L5-S1 level before working up to the L4-L5 level (at my age, I am generally against having fusion done, and have been following the ADR procedure's progress in the U.S. for the past couple of years).

So, I decided to wait until May to have a follow up appointment to see what, if anything changes in his office between now and then.

That all being said, I guess I have two primary questions:

1. Should I think about looking into other surgeons in the U.S / abroad to potentially perform the ADR surgery? I am noticing that a lot of people fly to Austria/Germany to have this procedure done at about a cost of $27k. I am not entirely against this, especially considering the fact that I speak German (although I should note that my family, with very litle actual knowledge, is very much against me flying to Europe to have this done).

2. What about health care? I have read a lot of posts here and in other places, and I recognize that most (if not all) health care providers are not currently covering the ADR procedure (I have UHC, by the way). Should I think about proactively contacting UHC about this?

Any advice / thoughts / opinions that anyone has to share would be greatly appreciated.

Thanks.

David
__________________
47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #2  
Old 03-07-2005, 09:40 AM
mmglobal mmglobal is offline
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David,

Welcome to the forum!

If you've got good disc height remaining, you might consider less invasive procedures first. There are several methods of thermal annuloplasty that have a chance of resolving discogenic low back pain with minimally invasive techniques. IDET, Neucleoplasty and SED are not the same. Do your homework... make informed decisions!

Mark
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  #3  
Old 03-07-2005, 10:20 AM
Poncho Poncho is offline
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Hi David,

I agree with Mark. When it comes to the spine - less is better. You haven't mentioned any surgeries in your history - however, I'll ask anyways...Have you had any surgery done on your spine?

I had problems at the same levels as you do now. Went through all of the procedures as you have mentioned plus a micro-d and an endoscopic discectomy. Micro-d bought me about 18 months of time before the disc adjacent started giving me problems - then I went for the endo-d because of fears regarding scar tissue in the spine.(with multiple surgeries) After that I ended up having ADR abroad. With this being said, there are many patients out there that do well with the less invasive interventions such as endo-discectomies et al. Unfortunately, I was one of the 20% of patients that a discectomy did not resolve my spine issues and had to move on to ADR.

Definitely do your research before making any decisions. Exhaust the least invasive measures first. Then, if you are still having problems - ADR - if you are a candidate. I agree with you that ADR is a better option than fusion at your age.

I am also from Ohio and familiar with the Columbus area. I think most of the docs if not all of them in the tri-state area are mostly using the Charite or the Maverick in some practices. My personal choice was the Prodisc - and the closest place to get this done here in the US to us is like in Tenn or NY. - I chose to go abroad....

I have done Case Mgt for insurance companies and unless things have changed recently, most are not covering ADR. Many members have had to get the surgery done pay for it out of pocket and go through the appeals process. Some have got partial to full reimbursement from their appeals and others unfortunately have been totally denied. It just depends on your insurance carrier AND exactly what policy you have under them. There are a lucky handful that have had all expenses covered without having to go through appeals, but they seem to be few and far between.

I personally chose to go abroad because my insurance would not cover the procedure regardless if was here in the US or abroad. Going abroad, I would have a more experienced surgeon, cost of surgery would be less AND I would get a longer hospital stay - as compared to length of hospital stays here in the US. (3-4 days post-op hospital stay here in the US vs 10-11 day stay in Europe). Also, the incident of post-op infections is less in Europe than in the US. AND in my opinion, the patient care was better there than here. (I am a nurse by profession). I think the hardest thing to orchestrate other than finances would be obtaining a doc/surgeon that is willing to follow you post-op once returning to the US.

So far I think you have made wise decisions and you are asking excellent questions. Also, coming here proves that you are doing your homework.

Welcome to the forum and I hope to see you coming back posting again soon.
__________________
Sincerely,
Poncho (aka Prodisc Poster Girl)
2 level ADR (Prodisc)
Dr. Bertagnoli May 22, 2004 Rudolfinerhaus Vienna, Austria.
Currently DRUG FREE and living life again!
Knowledge is Power!!!
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  #4  
Old 03-07-2005, 10:21 AM
Patrick Patrick is offline
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David,

Hi I am a newbie to the site also but definately not a newbie to back pain and I see you are not either.

You are more fortunate then you realize. Being in the Columbus, OH area you are real close to one of the clinical investigators of the Charite Disk trials. His name is Dr. Bradford Mullin, I would get in touch with him about your situation. He will have more experience with the procedure since he was involved in the US trials.
__________________
*10 plus years of back pain
*'99 first MRI shows L4-5 bulge
*'04 MRI shows L4-5 grade 3 annular tear & rupture with moderate DDD
*'05 Discogram shows concordant pain at L4-5
*8/18/05 scheduled ADR surgery participant in Kineflex/Charite study
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  #5  
Old 03-07-2005, 10:53 AM
David David is offline
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Join Date: Mar 2005
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Previous surgery:

None.

Less invasive procedures:

Well, I would like to *think* that if less invasive procedures might help, that my surgeon would have recommended them, but that remains to be seen. All I can tell you is that he immediately recommended fusion (actually, they offered physical therapy first, but I really just don't see that point anymore. I would get maybe 6 months of *some* relief, and then the cycle would start over again)

Basically, my philosophy over the last ten years has been that my back pain would never go away, short of having surgery (basically, if you knew my medical history, I require surgery every couple of years for various things).

Until recently, fusion was my only option, and I would like to avoid that at all costs. On the other hand, most everything I read about the ADR procedure seems very positive, especially in my case.

As you can tell, right now I am considering all options, although my goal is to have surgery sometime this year (hopefully within the next 6 months).

I generally lead a (somewhat) active lifestyle, but I am now to the point where I go to work (in pain) go home (in pain), and do nothing else. At 33, this isn't much fun.

Dr Bradford Mullin:

Any suggestions on how I should contact him? I tried contacting another surgeon (Dr. Greg Balturshot), but his office wouldn't talk to me w/o a referral from another physician.
__________________
47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #6  
Old 03-07-2005, 12:01 PM
Patrick Patrick is offline
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Join Date: Mar 2005
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David,

Dr. Mullin has 2 different phone numbers for 5 different offices.

614-868-5185 for an office on E. Broad St. in Columbus.

614-261-0456 for offices in Delaware, Newark, Circleville, and Lancaster

Good Luck
__________________
*10 plus years of back pain
*'99 first MRI shows L4-5 bulge
*'04 MRI shows L4-5 grade 3 annular tear & rupture with moderate DDD
*'05 Discogram shows concordant pain at L4-5
*8/18/05 scheduled ADR surgery participant in Kineflex/Charite study
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  #7  
Old 03-07-2005, 12:14 PM
David David is offline
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Join Date: Mar 2005
Posts: 455
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I guess it doesn't hurt to get a second opinion. I will try giving Dr. Mullin a call to see if his office will even talk to me (doubtful).

[edit: yeah, I was right. I called Dr. Mullin's office, and I can't become a new patient without another dr's office referral]

[edit edit: Primary care physician said he would call Dr. Mullin's office for a referral, so I guess I will see what he thinks. I wonder if I should make sure to take my MRI and discogram results with me?]

david
__________________
47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #8  
Old 03-07-2005, 02:03 PM
Poncho Poncho is offline
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Join Date: Oct 2004
Posts: 422
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David,

I think it is a good idea to get as many opinions as possible. Not only would I get an opinion from a Charite ADR surgeon, but also a Maverick and Prodisc surgeon. Compare and contrast opinions. Also, someone that is involved in minimally invasive measures as Mark mentioned.

As for me - in the beginning of my "spiney hood" journey, I had conflicting opinions from "You're depressed, have some anti-depressants" to "Lets schedule you for a fusion". But keep in mind that all the docs that I seen at the time were trained in similar fashions for surgical approaches to spinal pain - discectomy & fusion. I was not offered minimally invasive interventions either....atleast not at first - even though I was a candidate. ADR at the time was in it's infancy in the clinical trials here in the US.

I hate to say this, but keep in mind how surgeons make their $$$ - SURGERY - I know that they are not all alike, but I have been in the industry enough to know how some of them are. It's a cynical thought, I know... However, you are your best advocate. Ask these surgeons about not only ADR but the other interventions too. Doesn't hurt to inquire. Another big question to ask is how many cases these surgeons have under their belt. You don't want to be a part of their learning curve.

It's your spine and only you will know what is best for you and your situation. I know you are in a lot of pain, but if you can get rid of this pain with a less invasive measure - it really is the route to go.

If you are just completely focused on ADR - then I would make absolutely sure of where all of the pain is coming from with as many diagnostic tests and opinions as possible. A correct diagnosis is just as critical as the experience of the surgeon and the surgery in and of itself.
__________________
Sincerely,
Poncho (aka Prodisc Poster Girl)
2 level ADR (Prodisc)
Dr. Bertagnoli May 22, 2004 Rudolfinerhaus Vienna, Austria.
Currently DRUG FREE and living life again!
Knowledge is Power!!!
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  #9  
Old 03-07-2005, 02:08 PM
Poncho Poncho is offline
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Join Date: Oct 2004
Posts: 422
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Yes, Make sure your MRI and discogram FILMS and REPORTS are with you for your appointment(s)!!!
__________________
Sincerely,
Poncho (aka Prodisc Poster Girl)
2 level ADR (Prodisc)
Dr. Bertagnoli May 22, 2004 Rudolfinerhaus Vienna, Austria.
Currently DRUG FREE and living life again!
Knowledge is Power!!!
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  #10  
Old 03-07-2005, 04:06 PM
Patrick Patrick is offline
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Join Date: Mar 2005
Posts: 82
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Poncho,

"As for me - in the beginning of my "spiney hood" journey, I had conflicting opinions from "You're depressed, have some anti-depressants"


I don't know if you meant that to be funny...but I jus about spit all over my computer screen. Thanks for the laugh, I really needed one
__________________
*10 plus years of back pain
*'99 first MRI shows L4-5 bulge
*'04 MRI shows L4-5 grade 3 annular tear & rupture with moderate DDD
*'05 Discogram shows concordant pain at L4-5
*8/18/05 scheduled ADR surgery participant in Kineflex/Charite study
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