what to do, what to do?

[David]

(actually, I already know what to do, I am just venting....)

Talked to my neurosurgeon today, and he agrees from my discogram and CT scan that L4-L5 and L5-S1 need to be replaced.

He did note that multi-level disc replacement is my best option, and he said he has done a couple, but only when absolutely necessary, and he wouldn't do one for me (I am guessing that if I had him do a multi-disc replacement for me, it would probably cost me around $100k).

His overall suggestion: wait another year, at which point in time the Prodisc study should be completed, approved, and multi-level disc replacements should be available here in the U.S.

*sigh*

I happened to mention going to Germany to have it done, and his only response was, "well, the European doctors don't have the FDA" (implication: without the FDA, one can't possibly have a surgical procedure). [I decided to ignore his comment as opposed to try and get into debate about the skill level and efficiency of (certain) European surgeons.]

I also happened to ask him if he would do follow-up work if I went to Germany, and he very much declined (which I pretty much expected).

So, I guess my choices are:

a. Wait another year (in pain when I do absoutely nothing), and *hope* that everything will work out for me in the prodisc area.

b. Do nothing (yeah, right)

c. Continue my follow-up with Mark and see what Zeegers and Bertagnoli say.

Any suggestions?

Thanks.

David

[Alastair]

Go see Dr Zeegers and Bertagnoli. Obviously the USA is NOT ready to do this from some sort of FDA admin stuff.

They don`t care, all they want you to do is wait until everything is right for them it would seem.

Every patient who goes to Europe is a nail in a USA surgeons pay day.

If you are in pain then GO. You are the customer - - -strange they seem to have forgotten that
Good luck
Best
Alastair

[David]

yup, pretty much what I was thinking as well.

Even if I were to wait a year, Zeegers and Bertagnoli are still more experienced right now in multi-level adrs....

Thanks.

David

[annapurna]

David,
Look at the condition of your facets and other surrounding structures. What are the probable results of another year of improper loading on these? If you've got borderline facets, instability, discs with lots of height lost, then time may not be on your side. I'm really struggling right now with pain issues in the L5/S1 area three years post-ADR with facets or SI joints as the most probable pain generators. Both of these got severely overstressed during the many years I ran around on an L5/S1 disc that was <40% of normal height. Can I prove that the two are related? No, of course not. At the same time, I can tell you that facet/SI pain can be just as bad as discogenic pain and without the option of a prosthesis replacement -right now, anyway.

If I were you, I'd bring up the issue of damage to your posterior elements and surrounding structures with every surgeon you consult with. If things are already looking a bit borderline, then I wouldn't wait. Besides, as others have pointed out, do you really want to be someone's tenth or eleventh multi-level ADR case?

Best,
Laura

[Kat]

More food for thought...even when the Prodisc gets FDA approved doesn't mean health insurance will pay for it anyway so why wait.

Hugs,
Kat

[David]

100% agreed.

I am very concerned that even *if* prodisc were approved tomorrow, when and if UHC might start thinking about covering multi-disc ADRs.

To my knowledge, most (if not all) UHC 1-level ADRs are still being denied by UHC, and the 1-level procedure was approved by the FDA around 10/04, I believe.

Thanks.

David

[ans]

Laura: How to rule out facet/S1 pain? By facet injections or other means?

$100K sure seems steep. For an April 2005 scheduled operation w/Regan, I was told that a two-level at your levels would cost $60K.

Good luck, Allan

[Danielle Shawgo]

I have spent a lot of time researching my German surgeon. To be quite honest, my doctors told me that it would be safer for me to have the surgery in Germany because they are more experienced. The Charite disk was developed in Berlin. I personally think that a lot of the European doctors are safer than some of them here mainly because of the number of surgeries that they have done. That is just my opinion. Good luck to you!

[David]

Ans: $100k is just my rough estimate. To be fair, I probably should say between $50k - $100k, based on the various #'s that I have seen posted here from others.

If the cost of a Charite disc is approximately $12k here in the U.S., and I need two, then I am starting with a base cost of at least $30k (again, just estimating, based on Charite).

Danielle: thanks for the input. I think the crucial things to keep in mind (that I keep telling myself) are:

a. It costs less to have a German surgeon do the procedure, even factoring in travel, accomodations, and food (even comparing $50k to my estimate of $30k - $35k estimate of the German "route")

b. The German surgeons are *much* more experienced.

c. If I really wanted to go the U.S. route, I would probably be waiting longer to find a qualified surgeon to do the procedure, especially if I wanted to go the prodisc route (as far as I know).

Honestly, I think my decision has already been made. I just think it helps me talk it through with others....

David

[Alastair]

Hi David,
Look in the "Surgical outcomes" for real 2 disc replacement costs from the USA all inclusive. Usually Europe is MUCH cheaper than the USA and safer - - -no infections
Best
Alastair