ADR @L4-L5/L5-S1 or ADR@L4-L5 / fusion@L5-S1

David · #1 01-17-2006, 07:35 AM

With the approval of single level Prodisc U.S. usage (probably within the next month), I just realized that I actually do have another choice.

a. Wait for Y months for multi-level Prodisc approval and go with that.

b. Wait for Y months for multi-level Prodisc approval, and hope that Activ-L / Prodisc study is really multi-level.

c. Prodisc @L4-L5 and fusion at L5-S1.

As I recall, fusing L5-S1 isn't horribly bad, since L5-S1 doesn't have that much range of motion to begin with.

Anyone have any more input / thoughts? Obviously, I am really tired of waiting, but if option (a or b) is a better choice than option (c), then I really should consider being patient (maybe wait 6 months, for example).

I do have a dr's appointment next month, and I am presuming he is going to present me with that option, since we didn't discuss it last time.

Thanks.

David

annapurna · #2 01-17-2006, 09:14 AM

Fusing L5/S1 is "less bad" if you don't have any sacroiliac joint issues. The sacroiliac joint doesn't move much, but is sensitive to overstress just like the spinal motion segments or any other joint. If you've tested positive for SI joint pain on a diagnostic injection, I would go avoid fusing L5/S1 if you have other viable options.

Best,
Laura

Mariaa · #3 01-17-2006, 10:10 AM

I'm so glad to hear this last statement Laura as I have some further ammo to fight WC with in terms of fighting a fusion .. or at least should it be necessary to do so..

My PT's over the years have told me that I have SI joint probs and I always have adjustments for this however, my OSS said my SI joint looks fine on films...

I'm inclined to go with what the PTs have determined over the years...

mmglobal · #4 01-17-2006, 11:50 AM

In many cases, the patients are completely hamstrung by financial or legal issues and cannot consider any options that are not covered by insurance. In your question you are not mentioning whether or not your insurance company will pay for the surgery. Most insurance companies are not paying and many in the industry don't expect that to change too quickly, even with ProDisc approval. For the insurance companies, it's not about FDA approval or about appropriate medical care, it's about money.

I've had people tell me that they cannot afford to get the most appropriate surgery done because they can't afford it... then hop into their car which cost twice as much as the surgery they need. On the flip side, I've known people who were living paycheck to paycheck (or disability check to disability check) who have managed to beg/borrow/steal enough cash to get their life saving surgery done.

Even in the best of circumstances... best candidate... best device... best surgeon... etc... spine surgery is not automatic. Many of us will fail. Five years from now, if one is looking in the mirror and see a grimace of pain instead of a smile, having saved 30 thousand dollars will seem pretty insignificant.

Again, I realize that many of us do not have the option and my heart goes out to those who's medical decisions must be based on something other than best care available. However, I know too many people who are looking in the mirror at that horrible grimace, and wondering if they could have made a difference in their outcome.

Mark

JeffreyD · #5 01-17-2006, 03:31 PM

Well said, Mark.
-Jeff

David · #6 01-17-2006, 03:50 PM

Mark,

Agree 100%. I would like to think that Prodisc + fusion would work just as well as Prodisc + Prodisc (or Activ-L + Activ-L, for sake of discussion), but I doubt that is true.

Obviously, I don't want to rush into any decision, but (also obviously) I am getting just as frustrated as most everyone else is here waiting for my "best" option.

Now that I have waited since October for Prodisc approval, I wish I could go back in time and just have scheduled Prodisc surgery with Dr. B.

That of course being impossible, I guess that my next best option is probably "wait more and see how long multi-level Prodisc approval takes and hope that the Activ-L study will still be multi-level as well."

I really had my hopes up that the immediate Prodisc approval would be for both single and multi-level, and it sucks being wrong

My next hope is that multi-level Prodisc approval will be in the next 6months to a year, which is of course, a huge guess / hypothetical estimate on my part...

[edit: In my particular case, I am realistically expecting my insurance company (UHC) to not cover multi-level Prodisc surgery anytime soon after multi-level Prodisc surgery approval. I am basically gambling on either multi-level Prodisc vs. Activ-L study, or Prodisc + fusion. I would love to be wrong about my insurance company, or have the ability/strength of character to go to Germany, but neither is true right now]

David

Mariaa · #7 01-17-2006, 04:34 PM

Mark,
I agree wholeheartedly with what you've stated~

Thomas · #8 01-18-2006, 11:24 PM

David :
IF only one level ADR's will be approved in the USA for the forseeable future ,I am also dreaming of an alternatve which has fusions at L5/S1 and at L4/L5 "topped off" with an ADR at L3/L4 to help prevent the need for future fussion in the above levels . ( Money for a 3 level ADR in Germany is not an issue for me , BUT some of the recent 3 level ADR patient reports are scaring me )
I suspect others on this board will educate the both of us on the disadvanatges of our thoughts.

Juli · #9 01-19-2006, 02:51 PM

Well, financially, the problem is not whether multilevel ADR is FDA approved, it is that still most insurance companies are not paying for ADR no matter one level or multi-level. Doctors ARE doing both one level and multilevel with the Charite, anyway here in the U.S.

I had fusion at L5/S1 and then two level ADR on top of that in September. I am feeling 90 percent right now and hope that may continue to improve. I did not, however, have the choice of ADR at L5/S1 but would have considered fusion from the get go if that was the only level involved before I found out ADR was not an option at that level. I had to pay for the two discs and the surgeons fee but the rest of it was covered by my insurance company because of the fusion, so I was able to do it here in the states.

Everyone has to consider their own case, but I don't think fusion at L5/S1 is a big deal, it already has the least range of motion and there are no adjacent levels beneath it, that is such a concern at other levels.

I was strongly against a three level fusion, however.

Anyway, good luck to you!

Judy · #10 01-20-2006, 05:19 AM

Did you ever send your films to Dr. B in Germany for a consult? He is great and did my surgery and as you can see I had 2 ADR's along with a fusion in between.
I have now received payment from my insurance company after one year of appeals. They did in fact pay for all of the fusion, actually everything but the discs themselves.
I had Dr. B invoice me on four different invoices, one for his fee, one for the hospital, one for the fusion hardware and last for the discs themselves. Again after appealing Cigna for a one year they paid all three invoices. It was not an easy fight but worth it. The surgery cost approximately $40K and they paid about $27K, which is much better than nothing.
I feel great, I do have upper left thigh nerve pain but that does not stop me from doing anything. I take neurontin and tramdol daily to calm the nerves but I would take this nerve pain for the rest of my life versus the pain I had prior to surgery.
If you have any questions please feel free to e-mail me.
Judy