Wear and Tear

gil · #1 01-06-2013, 08:45 PM

My story isn't as complex as some I've read. I'm 55 and, I assume because of age, started having pain in left shoulder going down my arm 3 months ago - since has gone to tingling and numbness. The surgeon has recommended, after viewing the MRIs with me, fusion at the C5/6 - C6/7 levels because of bone spurs and slight spinal impinging. Very good surgeon who said this was a personnal decision as to what I had done and when to have done. Admitted he only investigated through seminars about ADR when FDA first approved in the US. His only comment was lack of track record.

So I have a second opinion scheduled in a week with a practice that does ADRs (Virginia Spine Institute, Reston VA). My insurance, Aetna, pays for ADR.

Questions I have: 1. Are multi-level ADRs approved yet in the US? If not, is there a timeline for approval? 2. Approval for M6 prosthesis in the US? 3. Any insight to M6 versus Prodisc? 3. Is a hybrid (fusion and ADR) worth considering?

I'll search to find the answers on the forum, unless anyone wants to reply.

thanks,
gil

gil · #2 01-11-2013, 06:27 PM

I just had my first go-around with Aetna. I had seen a well thought-of Aetna participating surgeon who said I should have C5/6-C6-7 surgery and he does vertebrae fusion. He acknowledged that he is not familiar enough with ADR and recommended I see an ADR specialist for a second opinion. I could not find, and also an Aetna rep after 20 minutes of searching, could not find a spinal surgeon with ADR experience within 50 miles of my house - so I submitted going to a non-participating surgeon (Virginia Spinal Institute, Reston, VA). My request was turned down today. Interestingly, the non-participating surgeon cost less for consultation than Aetna pays participating surgeons.

I had to the call Aetna member line and state my case. Got a very good rep who actually called 5 surgeons in the Aetna list and try to find someone with ADR experience. She was unsuccessful and wrote a formal appeal while I was on the phone.

Just a note about initial reviews - many are done with customer service people looking at insurance company guidelines. It usually takes further appeals to get nurses and doctors looking at requests.

The big pain (pun?) is Aetna has 30 days to respond and will propably take all 30 days.

Is it correct that US surgeons can do two level ADRs but the insurance companies may only pay the cost of on level? Does anyone have experience with Virginia Spinal Institute, Reston, VA?

Lillyth · #3 01-12-2013, 12:02 AM

1) No. Timeline last I heard was at least a decade for multi-level and the M6. They were in trials (with M6), but stopped.

2) See above.

3) No cushioning with prodisc. Do some googling about it. There is a reason all the European docs are using the M6.

4) IMO, only if your insurance paying for it (and they most likely won't) is more important than your mobility to you.

How many levels are you looking at getting done?

annapurna · #4 01-12-2013, 02:43 PM

Cushioning with a cervical disk may or may not be a problem due to the lower loads. I'd suggest reading about the biomechanics of the two disks. The M6 was designed to more accurately mimic natural disk motion and thereby decrease loads on the surrounding structures.

Harrison · #5 01-12-2013, 04:10 PM

Just a reminder that cervical fusion patients with single or dual level procedures seem to well post-operatively for many years; at least the ones that do not have other confounding health conditions. But then again, see this study:

http://www.adrsupport.org/forums/f50...ct-epub-11884/

But Jim's point is well-taken, cervical loads and torsion (kinematics) are very different in the cervical spine than the lumbar.