So confused; ADR or Fusion?

[Running11]

I am not sure if I am posting in the right forum. So here goes...

I got 4 opinions from orthopedic surgeons that call themselves spine specialists. Two said I had cervical and lumbar stenosis; this was diagnosed with an MRI only.

The third doc ordered a discogram and an EMG study. He confirmed in addition to stenosis I have C 4-5 and C 5-6 herniated . He recommended ADR even though my neck is curving forward.

The fourth doctor said I have Cervical compression with two nerve roots compressed. He recommends bi-level fusion at C 4-5 and C 5-6; ADR won't be stable enough because my neck is curving forward . Fusion is the workhorse. Insurance will pay for it ; ADR can be tricky.

I have just been denied by BC BS on my first appeal for ADR. I don't have the money to go oversees . I am so confused. Any recommendations. I value all your thoughts and opinions having walked in my shoes.

[Buckeyeback]

Hi,

My "vote" would be fusion if there is valid proof of problematic stenosis in the cervical spine along with those herniations. Decompression of the posterior structures won't happen during an ADR surgery and an ADR isn't installed to stabalize the spine "technically". The spinal cord is obviously a critical body component and frankly the less chance of instability, the better. I believe that fusion is more easily adaptable in the cervical spine than the lumbar spine due to the forces that are being transferred through them. Good Luck with your decision.

~Buckeyeback

[Lillyth]

Originally Posted by Running11

I am not sure if I am posting in the right forum. So here goes...

I got 4 opinions from orthopedic surgeons that call themselves spine specialists. Two said I had cervical and lumbar stenosis; this was diagnosed with an MRI only.

The third doc ordered a discogram and an EMG study. He confirmed in addition to stenosis I have C 4-5 and C 5-6 herniated . He recommended ADR even though my neck is curving forward.

The fourth doctor said I have Cervical compression with two nerve roots compressed. He recommends bi-level fusion at C 4-5 and C 5-6; ADR won't be stable enough because my neck is curving forward . Fusion is the workhorse. Insurance will pay for it ; ADR can be tricky.

I have just been denied by BC BS on my first appeal for ADR. I don't have the money to go oversees . I am so confused. Any recommendations. I value all your thoughts and opinions having walked in my shoes.

Who do you have your insurance through? Perhaps HR can assist with the claim? Oh, and whatever you do, do NOT do the Independent Medical Review through the state. It is binding and permanent. One surgeon I went to screwed up and sent me in for the IMR too early. It is now against the law for him to do a hybrid on me. Plus, the people that work for the state are liars and con artists just set up to LOOK like they are helping. The man I talked to flat out told me the process was NOT legally binding that I would have another review if this was denied. I clarified with him five or SIX times. Then, he flat out lied to his boss telling her he had never said any such thing.

Bottom line, leave the state out of it.

OH! Dr. Jeffrey Coe down in Campbell is doing a trial with a brand new diamond disc. You can only have one level done with no adjacent DDD, but perhaps he could do your lumbar?

[Running11]

I have Blue Cross/Blue Shield PPO and have been to 4 orthopedic surgeons (spine specialists) and a neurosurgeon. I just found out the Doctor who denied my first appeal for Blue Cross Blue Shiled only works with foot , knees and hips. He isn't a spinal surgeon. i am about to start my second appeal and wonder if this new found information would help get it approved? I would even consider a hybrid at this point.

[Running11]

Buckeyeback, thanks a lot for your opinion. I really value and appreciate your feedback. You've walked in my shoes. About 6 doctors have said that I have 6 degrees of kyphosis between C4 and C6;which is a curvature. All agree on moderate-severe cervical and lumbar stenosis. Nerve roots C5 and C6 are compressed. C4-5 and C5-6 have moderate stenosis.

I'm sorry for this dumb question . I am still learning. Are you a candidate for ADR when ONLY the disc can is damaged? I have the stenosis and curvature going on in addition to the the discs that are flattened. My doc says I have two flattened tires.

Bukeyeback How are you doing? You had your ADR recently?

[Buckeyeback]

Let me be Frank with you. I have artificial discs and I wouldn't have the same surgery in my neck. I know a gentleman who was my post office mailman who had a two level fusion at c4-5 and c5-6 (I believe it was) who has told me that he hasn't lost any motion that he remembers having and hasn't had any problems with the fusion for the last 6 years. In my most humble opinion, fusion in the cervical spine is not worth fretting over. The novelty of ADR may not be worth it. Consult one neurosurgeon that has both treatments in their proverbial toolbag that you trust and decide. Good luck


~Buckeyeback

[Buckeyeback]

Originally Posted by Running11

Buckeyeback, thanks a lot for your opinion. I really value and appreciate your feedback. You've walked in my shoes. About 6 doctors have said that I have 6 degrees of kyphosis between C4 and C6;which is a curvature. All agree on moderate-severe cervical and lumbar stenosis. Nerve roots C5 and C6 are compressed. C4-5 and C5-6 have moderate stenosis.

I'm sorry for this dumb question . I am still learning. Are you a candidate for ADR when ONLY the disc can is damaged? I have the stenosis and curvature going on in addition to the the discs that are flattened. My doc says I have two flattened tires.

Bukeyeback How are you doing? You had your ADR recently?

Yeah, I had lumbar two level ADR and it just makes sense that the lumbar is a different animal in comparison. If you have stenosis, then decompression of the posterior elements are in order. An anterior ADR won't address those issues. I am finding that out myself with my surgery (I think). Fusion is not a death sentence and I think it is glorified as such sometimes. Take your time to decide. What is most important, regardless of technology used to fix the problem, is the surgeon doing the surgery. Good luck.

~Buckeyeback

[Lillyth]

Originally Posted by Running11

I have Blue Cross/Blue Shield PPO and have been to 4 orthopedic surgeons (spine specialists) and a neurosurgeon. I just found out the Doctor who denied my first appeal for Blue Cross Blue Shiled only works with foot , knees and hips. He isn't a spinal surgeon. i am about to start my second appeal and wonder if this new found information would help get it approved? I would even consider a hybrid at this point.

BCBS is notoriously bad at paying for stuff. If you haven't already watched it, watch Sicko. These doctors? They are PAID to deny claims. That is their job. The more claims they deny, the more money they make. I wish I were making that up, but I'm not.

And, if it makes you feel any better, the doctor that denied my hybrid was a sodding pee doctor. (HA! I got around the no swearing rule by doing it in British!)

How did you get your injury?

Also, you might be able to push a hybrid through, and get Dr. Coe to put the new diamond disc in your lumbar spine, (they said no adjacent levels, and the cervical is NOT adjacent) then you could get all three levels taken care of. I like Dr. Coe, and if I were going with one or two levels I would totally feel comfortable with him operating on me.

One of the other questions to ask each doc is if they have ever been able to get a hybrid approved.

Also, I may not have communicated the question I was really asking. I am wondering if you get your insurance through an employer or what. My husband works for a prominent company, and they have their own customer service line, so I got to thinking that maybe HR could breathe down Cigna's neck. And they were, until we realized that I had too many levels to push through. Two we could maybe have done, but not six! Perhaps whoever you get your insurance from would be willing to help?

AND, finally, and yes, I am totally serious, I am thinking of contacting Michael Moore. I wonder if he would be willing to do a documentary on all of the technologies being kept out of the country. They showed in Sicko where one guy wrote in to Cigna saying that Michael Moore was doing a documentary and he would tell Michael all about the hearing device they were refusing to give his daughter. Guess what? Cigna approved the device! I was wondering if we could do something like that for the people on here who don't have the resources to leave the country.

If we have people here who are in on the idea, I'll email him. The worst he can say is no.

[Buckeyeback]

Sorry, I missed a question there. From what I understand and my experience,...the best candidate for ADR is one who has an isolated disc problem where the other posterior elements are in great shape. Theoretically speaking.

[Lillyth]

Originally Posted by Buckeyeback

Yeah, I had lumbar two level ADR and it just makes sense that the lumbar is a different animal in comparison. If you have stenosis, then decompression of the posterior elements are in order. An anterior ADR won't address those issues. I am finding that out myself with my surgery (I think). Fusion is not a death sentence and I think it is glorified as such sometimes. Take your time to decide. What is most important, regardless of technology used to fix the problem, is the surgeon doing the surgery. Good luck.

~Buckeyeback

Wait, I'm confused. The ADR doesn't do anything for the nerve that is being pinched?