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  #1  
Old 10-18-2014, 06:29 PM
reqmt reqmt is offline
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Join Date: Oct 2014
Posts: 14
Default Hi! New here, introduction and questions

Hello everyone,
I'm really glad to have found this group because no one really understands severe chronic back pain, and everything that goes along with it, unless they have also experienced it.
I have been battling my chronic pain for 6 years now. I'm 32 now. The believed cause is a post for another time, today I would just like to introduce myself and ask a couple questions.
I have a herniated disc at L4-5 causing radiculopathy and stenosis. My L5/S1 is almost completely gone ( docs believe it had ruptured years ago and continued to degenerate) so in addition to the vertebre starting to rub together, my facet joints rub and are turning arthritic. I have truly run the gammit when it comes to treatments, from natural to medical.
Now my next step is to have a hybrid surgery, which is where they fuse the L5-S1 and ADR at L4-5, but I cannot have it done until I switch insurance after Novemeber. Oxford seems to think of this surgery as experimental and will not cover it.
So one of my questions is : has anyone had this surgery and had it covered by Aetna? They seem to be the only insurance that will.
The other question is : if anyone has had this surgery, has it been a positive outcome and what was the recovery like?
Honestly, for me, I can't imagine the outcome being anything else other than much better than the pain I live every day. Needless to say, I'm very hopeful about the surgery.
Thanks in advance for any info
__________________
6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present.
Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5.
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  #2  
Old 10-18-2014, 07:41 PM
henry4956's Avatar
henry4956 henry4956 is offline
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Join Date: Oct 2013
Posts: 250
Default

That's very tough, to have severe back pain for so long at such a relatively young age. I certainly understand your desire to have it covered by insurance, but IMO you should have an open mind to the possibility having it done in a scenario in which it's not covered. The Aetna folks will have to let you know what your odds are for getting coverage in the US.

In my case, once I knew I could borrow enough to have it done by whoever I felt gave me the best chance for success I put the money issue out of my mind. I then focused on researching the best ADR surgeons in the world (not the US).

You will find a variety of opinions about the hardware aspect in this forum (M6, Activ-L, ProDisc). I think that should also be a consideration as well, but not the overriding one. Find who you think is the best for you.

IMO, based on what I read here and on personal experience in the case Of Dr. Zeegers & the Activ-L - here is the real short list of devices and corresponding top surgeon that uses them, in order of # years the device has been on the market.

ProDisc - Dr Jack Zigler or Dr Blumenthal from Texas back Institute
Activ-L - Dr. Willem Zeegers (Netherlands, works out of Germany)
M6L - Dr. Pablo Clavel (Barcelona, Spain)

Good Luck,
Henry
__________________
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
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  #3  
Old 10-19-2014, 11:46 AM
NJ Gene NJ Gene is offline
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Join Date: Feb 2013
Posts: 376
Default

reqmt, I'm sorry to hear about the pain you're having. Do you have multiple opinions about the hybrid approach? Regardless of your answer, I would recommend consulting some of the doctors that Henry suggested, especially Dr Zigler and Dr. Blumenthal at TBI. You have a chance of insurance coverage with them. However, if you decide to go to Europe, you can get extensive tax deductions, which I can attest to as a C.P.A.

Since this is a board that is for ADR, I don't want to push fusion. However, I will mention that I had 2 levels of fusion in my lumbar spine at L3-L5. It was done in a minimally-invasive way, so I felt better immediately upon waking up from the surgery. I just had to take it easy for 12 weeks to let everything heal. My surgery in the lumbar spine was 4 years ago (Dec, 2010) and I've been fine ever since. Most of my issues have been in the neck.

Good luck whichever way you decide to go!!

Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4
1998 Larger Herniation and Cervical Fusion C3/C4
2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007
2008 - Foraminotomy at C6/C7 on left side
Feb, 2010 - Cervical Fusion C4/C5
Dec, 2010 - Lumbar Fusion L3/L5
2013 - Bulge on C5/C6; herniation C6/C7 right side
Mar 26, 2013 - Foraminotomy at C6/C7 on right side
May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
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  #4  
Old 10-19-2014, 01:52 PM
colorado babe's Avatar
colorado babe colorado babe is offline
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Join Date: Aug 2014
Posts: 345
Default

REGMT - I am so sorry to hear about your back pain. I can surely sympathize with you. I am going in tomorrow to get a fusion on my L5-S1 and a multi-level ADR at the cervical (C5-7) using the mobi-C. I was suppose to get ADR in the L5/S1 but the bone scan came back with some concerns in the lumbar.

I highly recommend that you do your research and also make sure you get MRI's and a bone scan. I am on Tricare Prime and my insurance denied me at first and I appealed and they denied me again. I took it to a third party and they reversed the decision so don't give up on your insurance -- Keep fighting and don't give up!

I am not sure where you live but the surgeon who is performing my surgery was the first person to ever do the ADR, 2 Level ADR, and 3 level ADR and he also is invested in the stem cell institute here in Colorado. Some people may say he has a big ego but I would too if I was highly known internationally for his work. I have complete confidence in him and the other two surgeons who will be assisting.

Please make sure that you feel confident with your surgeon. If something doesn't feel right - don't use him/her. It took three referrals before I chose my surgeon and as soon as he walked in the door I knew he was the one.

Good luck and please read all the threads on here. I have learned so much and give all the credit to my fellow posters for helping me through this process.

Colorado Babe
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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  #5  
Old 10-21-2014, 11:27 AM
reqmt reqmt is offline
Junior Member
 
Join Date: Oct 2014
Posts: 14
Default

Quote:
Originally Posted by henry4956 View Post
That's very tough, to have severe back pain for so long at such a relatively young age. I certainly understand your desire to have it covered by insurance, but IMO you should have an open mind to the possibility having it done in a scenario in which it's not covered. The Aetna folks will have to let you know what your odds are for getting coverage in the US.

In my case, once I knew I could borrow enough to have it done by whoever I felt gave me the best chance for success I put the money issue out of my mind. I then focused on researching the best ADR surgeons in the world (not the US).

You will find a variety of opinions about the hardware aspect in this forum (M6, Activ-L, ProDisc). I think that should also be a consideration as well, but not the overriding one. Find who you think is the best for you.

IMO, based on what I read here and on personal experience in the case Of Dr. Zeegers & the Activ-L - here is the real short list of devices and corresponding top surgeon that uses them, in order of # years the device has been on the market.

ProDisc - Dr Jack Zigler or Dr Blumenthal from Texas back Institute
Activ-L - Dr. Willem Zeegers (Netherlands, works out of Germany)
M6L - Dr. Pablo Clavel (Barcelona, Spain)

Good Luck,
Henry
Hi Henry,
Thanks for the info, I will keep those docs in mind, but as of now going over seas or to another state will be an absolute last resort. Though, if it comes down to that it is good to get some references so thanks again
__________________
6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present.
Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5.
Reply With Quote
  #6  
Old 10-21-2014, 11:49 AM
reqmt reqmt is offline
Junior Member
 
Join Date: Oct 2014
Posts: 14
Default

Quote:
Originally Posted by NJ Gene View Post
reqmt, I'm sorry to hear about the pain you're having. Do you have multiple opinions about the hybrid approach? Regardless of your answer, I would recommend consulting some of the doctors that Henry suggested, especially Dr Zigler and Dr. Blumenthal at TBI. You have a chance of insurance coverage with them. However, if you decide to go to Europe, you can get extensive tax deductions, which I can attest to as a C.P.A.

Since this is a board that is for ADR, I don't want to push fusion. However, I will mention that I had 2 levels of fusion in my lumbar spine at L3-L5. It was done in a minimally-invasive way, so I felt better immediately upon waking up from the surgery. I just had to take it easy for 12 weeks to let everything heal. My surgery in the lumbar spine was 4 years ago (Dec, 2010) and I've been fine ever since. Most of my issues have been in the neck.

Good luck whichever way you decide to go!!

Gene
Hi Gene,
I did get many many opinions over the last few years, ranging from shoulder shrugs to 2 level fusion, but what set my decision in stone was seeing the top orthopedic surgeon in Stony Brook Hospital, and one at HSS in NYC. Both agreed that the hybrid surgery would be the best because at the L5/S1 level the facet joints are causing pain as well, so if they did an ADR at that level I would still be in pain from the arthritic facet joints still being able to rub together, so stabilizing that would reduce pain there. Then the ADR at L/45 would get rid of the discogenic pain there, and I would no longer have stenosis with everything being put back in place. Of course both ( as any good doctor would ) said they cannot guarantee the outcome as recover is up to me - but I knew that already.
So 12 weeks for recovery - that is a long time but i'm glad to hear you have no more problems there, so it is definitely worth it!
Thanks for the reply!
__________________
6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present.
Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5.
Reply With Quote
  #7  
Old 10-21-2014, 12:03 PM
reqmt reqmt is offline
Junior Member
 
Join Date: Oct 2014
Posts: 14
Default

Quote:
Originally Posted by colorado babe View Post
REGMT - I am so sorry to hear about your back pain. I can surely sympathize with you. I am going in tomorrow to get a fusion on my L5-S1 and a multi-level ADR at the cervical (C5-7) using the mobi-C. I was suppose to get ADR in the L5/S1 but the bone scan came back with some concerns in the lumbar.

I highly recommend that you do your research and also make sure you get MRI's and a bone scan. I am on Tricare Prime and my insurance denied me at first and I appealed and they denied me again. I took it to a third party and they reversed the decision so don't give up on your insurance -- Keep fighting and don't give up!

I am not sure where you live but the surgeon who is performing my surgery was the first person to ever do the ADR, 2 Level ADR, and 3 level ADR and he also is invested in the stem cell institute here in Colorado. Some people may say he has a big ego but I would too if I was highly known internationally for his work. I have complete confidence in him and the other two surgeons who will be assisting.

Please make sure that you feel confident with your surgeon. If something doesn't feel right - don't use him/her. It took three referrals before I chose my surgeon and as soon as he walked in the door I knew he was the one.

Good luck and please read all the threads on here. I have learned so much and give all the credit to my fellow posters for helping me through this process.

Colorado Babe
Hi Colorado babe,

Good luck with your surgery, I hope it really does wonders for you, let me know how you feel afterward and what improvements it makes for you.
I'm in NY so the plan is to go to HSS in NYC, they have a great spinal care facility, an everyone I spoke to locally said that is place to go.
"keep fighting" - yes, definitely, I have no choice. There is no way I can go on like this.
At one point I had considered going to Regenexx in Denver but it was expensive and my back was too far gone by then. I had PRP injected into my L4/5 disc but it didn't do as much as I expected. Probably because there is so many things causing my low back pain.
Anyway - Be well!!
Reqmt
__________________
6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present.
Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5.
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  #8  
Old 10-24-2014, 08:47 AM
colorado babe's Avatar
colorado babe colorado babe is offline
Senior Member
 
Join Date: Aug 2014
Posts: 345
Default

Quote:
Originally Posted by reqmt View Post
Hi Colorado babe,

Good luck with your surgery, I hope it really does wonders for you, let me know how you feel afterward and what improvements it makes for you.
I'm in NY so the plan is to go to HSS in NYC, they have a great spinal care facility, an everyone I spoke to locally said that is place to go.
"keep fighting" - yes, definitely, I have no choice. There is no way I can go on like this.
At one point I had considered going to Regenexx in Denver but it was expensive and my back was too far gone by then. I had PRP injected into my L4/5 disc but it didn't do as much as I expected. Probably because there is so many things causing my low back pain.
Anyway - Be well!!
Reqmt
My surgery went quite well and I am getting stronger each day. Was out of bed a few hours after the surgery and most of my pain is coming from the incision site. I've been able to eat solid foods since the day after surgery. I even gained a pound. I have been walking a lot and can even climb three flights of stairs at my house with absolutely no problem. I have noticed some sciatica in the right leg but it only happens when I am sitting in this particular position. I am so happy I went the U.S. route and through my insurance. Now I can save that 80K for some more cruises. My surgeon is Dr. Kenneth Pettine in Johnstown, Colorado. He is awesome and I wouldn't use anyone else. I am praying that you find a good surgeon who you connect with and I know all will go well like my surgery.
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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  #9  
Old 10-24-2014, 02:52 PM
reqmt reqmt is offline
Junior Member
 
Join Date: Oct 2014
Posts: 14
Default

Quote:
Originally Posted by colorado babe View Post
My surgery went quite well and I am getting stronger each day. Was out of bed a few hours after the surgery and most of my pain is coming from the incision site. I've been able to eat solid foods since the day after surgery. I even gained a pound. I have been walking a lot and can even climb three flights of stairs at my house with absolutely no problem. I have noticed some sciatica in the right leg but it only happens when I am sitting in this particular position. I am so happy I went the U.S. route and through my insurance. Now I can save that 80K for some more cruises. My surgeon is Dr. Kenneth Pettine in Johnstown, Colorado. He is awesome and I wouldn't use anyone else. I am praying that you find a good surgeon who you connect with and I know all will go well like my surgery.


Awesome!!! So happy for you! It must be such a relief !
I do have a very good surgeon at HSS, he is very caring, which is so important, and they have a great spinal care center. I had seen one surgeon a couple years ago that made me leave in tears because he told me I shouldn't be in as much pain as I am but to call him if I want to go ahead with some kind of surgery. Blah! He was horrible.

Anyway, do you have any advice for getting insurance to cover surgery?

Keep up with the good recovery!
Rachel
__________________
6 year struggle with herniated L4/5 w/ annular tear, ruptured L5/S1 that is now degenerated to where the bones rub, the lack of height is causing the facet joints to degenerate and cause pain at that level. Stenosis and radiculopathy to the left leg also present.
Now waiting to switch insurance so that I can get a hybrid surgery. Fusion of L5/S1 and ADR at L4/5.
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  #10  
Old 10-24-2014, 07:43 PM
colorado babe's Avatar
colorado babe colorado babe is offline
Senior Member
 
Join Date: Aug 2014
Posts: 345
Default

Quote:
Originally Posted by reqmt View Post
Awesome!!! So happy for you! It must be such a relief !
I do have a very good surgeon at HSS, he is very caring, which is so important, and they have a great spinal care center. I had seen one surgeon a couple years ago that made me leave in tears because he told me I shouldn't be in as much pain as I am but to call him if I want to go ahead with some kind of surgery. Blah! He was horrible.

Anyway, do you have any advice for getting insurance to cover surgery?

Keep up with the good recovery!
Rachel
Have your doctor's office put in a request for surgery. If Insurance denies you, pm me and I'll help you with the second appeal. My surgery took three appeals but I won. So -- Don't give up!
__________________
1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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