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  #1  
Old 10-25-2011, 11:40 AM
ventura43 ventura43 is offline
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Default Denied ADR, Need Help!

Short Synopsis: Minor neck issues for a couple of years. Woke up in excrutiating pain 7 weeks ago. Found out I have a herniated disc at C 6-7. Had a course of pred., along w/ painkillers. Referred to NS by my primary Dr. NS had me try traction, only lasted 5 days because of headaches. In consult yesterday I was offered three options.
1. Epidural shot- would help w/ pain but not a fix per se
2. One level fusion at C6-7
3. One level ADR

I have been doing A LOT of research over the last 7 weeks. I don't like the shots. I have had them for other issues ( foot & knee) and ended up w/ surgery anyway. C5-6 is iffy and I'm scared fusion will hasten the problems with the disc above. I decided to go w/ ADR for that reason and because the recovery time seems to be shorter. I have a job that would be very difficult if I was out 6 weeks. I was concerned that my insurance, BCBS of AL wouldn't cover ADR. (I live in FL) NS said no problem, BCBS of FL will approve with no issues.

Well, got the call this AM that BCBS of AL does not allow for ADR. It is not covered at all under my plan.

SO.....I'm looking for opinions. I was so prepared to move forward. Now I'm confused and don't know what to do. My pain is not debilitating, but definitely affects my day to day life.

Do I get a shot now and wait and see if BCBS changes there mind next year ( and hope I'm not doing any nerve damage by waiting) or go for a fusion?

Open to all opinions.
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Ventura 43

Herniated C 6/7
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  #2  
Old 10-25-2011, 11:49 AM
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laid up doc laid up doc is offline
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i would at least try a couple of the epidurals, as well as PT - you really want surgery to be your last resort - no matter which type of surgery you end up doing.

i would also ask - how old are you? are there any other bony issues in your neck, or JUST the disc?
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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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  #3  
Old 10-25-2011, 11:50 AM
ventura43 ventura43 is offline
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Sorry, I meant to post my MRI results:

C2-3 Normal

C3-4 Slight disc bulge

C4-5 Very small osteophyte complex present

C5-6 Broad disc osteophyte comlex present with mild central canal and left forminal stenosis

C6-7 Left paracentral disc herniation which extends directly in the left lateral recess and abuts the left margin of the cord, with obliteration of the left CSF space and moderate left foraminal stenosis.

C7-T1 Normal

Impression: Left paracentral C6-7 disc herniation with severe left lateral recess, moderate left spinal canal, and moderate left foraminal stenosis.

I am a 58 yo female, active in sports and outdoor activities but slightly overweight.
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Ventura 43

Herniated C 6/7
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  #4  
Old 10-25-2011, 04:43 PM
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laid up doc laid up doc is offline
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you really need to have your doc(s) go over your MRI personally... i really don't know what "disc osteophyte complex" is - could mean that it has auto-fused? you want to know if they think it will degenerate more.

it SEEMS to me that older people (say, over 45-50, more degeneration/stenosis present) do better with fusion - my own uncle is an ortho surgeon (not spine) and he had a 2 level fusion.... never even considered ADR seriously. he was late 50's at the time. but i am NOT a surgeon and nowhere near as knowledgeable about degenerative or disc matters of the cervical spine as i am the lumbar... all of my lumbar knowledge is from my own learning, about my own condition. i don't do chronic pain/disc stuff in my field of speciality.
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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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  #5  
Old 10-25-2011, 05:21 PM
ventura43 ventura43 is offline
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We went over the report and the images at length. He said the disc osteopythe complex meant something similar to bone spurs. What he showed me was some bony growth on the anterior side of the vertebrae. None of these appear to be pressing on nerves. The disc is mildly bulging ther, but not herniated or pressing on nerves. For that reason he sugested ADR or fusion at one level only.

My reasoning for leaning toward ADR was the fact that a fusion could put more strain on the level above.

I have asked his PA whether a fusion at C6-7 would preclude ADR at the C5-6 level if I have an issue later. No answer back yet.
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Herniated C 6/7
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  #6  
Old 10-25-2011, 07:52 PM
annapurna annapurna is offline
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I'd second the idea of trying the pain management route for a short while. If it helps, you can buy time to research all of your options and find the best one. Don't pursue pain management blindly, though. Pick an amount of time or number of treatments that you and your doc agree you should be seeing improvement by. That way, if it works, you've bought time, and if it doesn't, the pain management stuff will not be a continuing distraction from finding a long-term solution.

You'll see a recent indictment of the Prodisc C at C56 on this discussion board. I'm not sure if it's a true problem with the device or with that level. Either way, it does mean that your eventual decision for C67 is going to have to made with with the concerns at C56 in mind. With the osteophytes at C56, it suggests that it's too far gone for the stem cell and stem cell-like treatments that are out now. C34 might benefit from them but probably not C56 unless someone suggests trying it to stop further degeneration (instead of trying to completely reverse it).

At 58, you're in a grey realm: too old to be sure that a damaged C56 would definitely need treatment in your life and too young to be sure it wouldn't. Laura's family history had almost everyone dying in mid-90's and beyond. It was a pretty sure thing that adjacent level concerns would manifest for her. I had a boss in his late 40's with a family history of no male making it into their 60's; the call for him would have been just as easy for him. If it helps, adjacent level concerns aren't certain in the c-spine. Fusion certainly places C56 at risk but not as much as it would for the lumbar.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
General joint hypermobility

Jim - C4/5, C5/6, L4/5 disk bulges and facet damage, L4/5 disk tears, currently using regenerative medicine to address

"There are many Annapurnas in the lives of men" Maurice Herzog
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  #7  
Old 10-26-2011, 04:39 AM
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laid up doc laid up doc is offline
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i also have a family history of longevity, even my great-grandmother lived to be 97? - when life expectancy was far shorter than it is today.

thanks annapurna for piping in on cervical issues - i had some muscle issues (had a very unremarkable MRI - 2 "very mild" disc bulges that didn't correspond to the pain i was having) in my lower C/upper T spine that magically disappeared after my lumbar ADR - as I thought they would.

agree w/ annapurna about people w/ prodisc issues - i would think that if there was a more widespread problem that there would at least be a case series out there in the literature. hard to say by analyzing self-reports. but if your insurance won't pay for US ADR, i would start looking into overseas - the M6 for instance, which is what i just got in my lumbar spine. nary even a neutral word about it, but it's relatively new. it would be cheaper in the UK w/ Boeree or Spain w/ Clavel than in the US, if you decide you do not want fusion.

BUT -- as many of us often pipe in - you want surgery to be your last resort. disc issues aren't like a torn Achilles tendon - just b/c it's broken doesn't mean you want someone cutting you.
__________________
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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  #8  
Old 10-26-2011, 11:20 AM
christinlal christinlal is offline
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Join Date: Nov 2010
Posts: 103
Default Bcbs

I don't know if I would wait for BCBS to start approving anything. I waited and trusted insurance companies and have regretted my decision pretty much every single day.
__________________
12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
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  #9  
Old 10-26-2011, 12:41 PM
ventura43 ventura43 is offline
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Overseas isn't an option for me right now and I am certain BCBS is not going to help.

My next question is whether waiting will cause more damage/ issues? I have had cortisone injections for a bad toe joint and a knee injury. guess I've had about 5-6 shots over the years but never got more that 1-2 weeks relief. Either that's my body's response to cortisone or those problems were non responsive. I was in bad shape for about 6 months with my knee which resolved as soon as I had surgery. I would hate to go thru that again!
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Ventura 43

Herniated C 6/7
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  #10  
Old 10-26-2011, 05:11 PM
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laid up doc laid up doc is offline
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if your main symptom is PAIN and not neurological deficit - i would say there isn't much risk involved in waiting. talk more to your surgeon and/or pain doc about that though - that's just a general statement.

usually you'll get a series of 3 epidural injections over 6-8 wks... and response to those is often used in your evaluation for surgery as far as levels and whatnot. like i said - you do NOT want to have surgery as your first option unless you have a neuro deficit!!! any good surgeon should tell you that, but not all will and not all are good.
__________________
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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