Surgery approved! But now what to do?

Eastex · #1 (**permalink**) 01-12-2009, 08:47 PM

It has been a while since I have posted anything, and I appreciate all the help and encouragement I have received in the past on this forum. I received a call last Friday that United Healthcare has approved my ADR surgery for L5/S1. The doctor that I was seeing never mentioned anything about fusion so I started seeing someone at Texas Spine and Joint Hospital. Well he did, but it was very negative. I got to where I was willing to have a fusion done to hopefully have some relief. TS&J Hospital scheduled me to have a discogram on 1/21. Then they will tell me my next option. I told them how I was denied the ADR with the other surgeon, and they said fusion may be my only option left. Now since I have been approved for ADR surgery should I go back to that surgeon or stay with TS&J Hospital? I really felt comfortable and informed better with TS&J. Is it strange that the first surgeon never wanted to do a discogram?

str8shooter5 · #2 (**permalink**) 01-12-2009, 09:27 PM

hello first off i wish you the best of luck, I also had a discogram and now i am in the prosses of getting approved for surgery they told me i need an ALIF so i was wondering what an ADR is? ?here is a link to see the alif ALIF: Anterior Lumbar Interbody Fusion Video - 27k

melodyl · #3 (**permalink**) 01-12-2009, 11:42 PM

You will have to choose which dr. you feel the most confident will provide you with a good, long term outcome. I had a 3 level ADR surgery recently and never had a discogram. My surgeon actually strongly cautioned me to not have one when the pain management dr. I was seeing recommended it. My surgeon told me that discograms were not only painful, they were not accurate and could actually be harmful. Isn't it strange how many different opinions different drs. have about a single subject? Good luck with your decision. Let us know what you decide and how it turns out for you.

Melody

dshobbies · #4 (**permalink**) 01-13-2009, 02:18 AM

First... a discogram is necessary to reveal pain generators. We've been around the block a couple of times and a doctor will not remove a disc that causes no pain. I've only heard of a couple discographies that actually caused damage but in most cases, the benefit outweighs the risk.

Second, str8shooter5, I assume that you're serious in not knowing what an ADR is? It is an artificial disc replacement as opposed to an ALIF, which fuses two vertabae together. Your diseased or damaged disc is removed and replaced with a motion preserving device and today, various manufacturers offer several choices of design. If you really don't know what this is, do not commit to the ALIF surgery until you do your homework and can decide for yourself which is better for your specific circumstances. Your doctor may not recommend this for several reasons including those that may be self-serving so educating yourself is very necessary. Now would be a good time to contact Mark. For many of us, it gave us back our lives. You do not have to agree that this procedure is better or will benefit you but you can't make an informed decision without knowing and understanding all your options.

I'm not telling you that you have a bad or incompetent doctor and you may not be a good candidate for an ADR but your not knowing what it is raises questions that can only be answered by a second and/or more opinions, and by doctors that are well versed in both surgeries.

Good luck to all, Dale

Eastex · #5 (**permalink**) 01-13-2009, 06:35 PM

First off, Str8shooter5, please listen to these people on here and get all the information about your options on surgery. Go to the Charite` web page and read up on it. I am not saying that is the one to use, but it will explain a little about ADR Surgery. There are many to choose from. Get informed. Now back to me. The ADR surgeon called today and I told him I would let him know something by the end of next week. They need to know because they have to schedule the general surgeon to move my "inards" out of the way. I decided to tell him that since my disco is next Wednesday. After the disco, I see the TS&J surgeon that afternoon for the results. I am going to tell the surgeon at TS&J about my insurance approving a ADR with the other surgeon. I am scared about the disco. The surgeon told me it will feel like I have had a twelve pack while they are doing it. I could live with that! But the crap poking me in my back doesn't sound fun. Is it like a Spinal epidural injection? I can handle those.

ans · #6 (**permalink**) 01-13-2009, 08:41 PM

Maybe others can chime in but I'm not sure if they know what's the best route for the L5-S1 level, ADR vs. fusion. Of course, there's various ADRs and fusion techniques. Good luck to you. This level has messed my life nicely.

mmglobal · #7 (**permalink**) 01-14-2009, 01:53 AM

It's so hard to trust the information we are getting. Many surgeons still can't perform ADR. Many have been to training and have done some cases, but the hospital's risk management dept doesn't want them doing ADR because of the pending lawsuits.... or the hospital administration doesn't want them doing ADR because reimbursement issues are still a free-for-all.

I'm not horribly afraid of a single-level fusion, but for MY body... I'll choose ADR over fusion if I'm a good candidate.

Do your homework.... you'll have to live with the results.... not the claims adjustor... not your doctor.

Good luck!

Mark

str8shooter5 · #8 (**permalink**) 01-14-2009, 11:47 AM

thank you to all that have replied the dr that is doing my alif has
participated in the clinical trial that led to FDA approval of the first artificial disc so i am hoping that he wants to do the alif vs. adr cause i will bennifit better from it I HOPE !! now about the disco i had one done and if your problem is not in the disc you wont feel anything they did 3 discs on me an i only felt it on the bad disc ( and i really felt it not to scare you but as soon as i did they put me out and i woke about an hour later and i was ok just mild discomfort

Cindylou · #9 (**permalink**) 01-15-2009, 10:41 PM

Eastex, I don't mean to scare you either, but the discogram is more painful than an epidural injection. Quite a bit. I had 3 bad discs so each one that was prodded I screamed bloody, like a drunken sailor, at the top of my lungs. All three had significant tears and had to be replaced. Now mind you, I've had natural childbirth 2 out of my 3 pregnancies, so I have a high pain threshold. But the absolutely great news is: it only takes a second to put the needle in. And then it's over. Discograms definitely have their place diagnostically, to discover pain generators. Some people receive more of a sedative than others. The point is, you don't want to be too drugged or you'll never get to the bottom of your "painful discs." Hope that helps.

Cindylou

SandyW · #10 (**permalink**) 01-16-2009, 12:45 AM

I am sooo confused. Dr. Fenk-Mayer recommended 3 cervical replacement discs - not discogram C4-7. However she informed me that I might need a 4th so would do a discogram prior to surgery on C3-4 only. I had no pain because the dye went in and out, no pressure, no pain nada. Why are you saying that the test is painful? Was C3-4 ruptured? not buldging? The other disc's were making a dent in my spinal cord, that why I thought surgery was recommended. I posted earlier that I need some questions answered, so if you all have time I'd love to hear from you. Sandy

mmglobal · #11 (**permalink**) 01-16-2009, 12:56 AM

Willow, read about my discography here:

http://www.ispine.org/forum/ispine/6...y-results.html

If there are obvious structural problems at 3 levels, especially with spinal cord involvement, then there is no need to do discography on them. There is no "take it or leave it" decision to be made... they are going even if they are not painful. However, you can have these structural issues that need to be addressed, and they may not be your pain generators. If there is a disc next to the obviously needing replacement levels that is bad, discography there will keep them from leaving a disc that is causing substantial symptoms.

This is not all black and white and discography is not perfect, but it is a useful tool to help YOU to make informed decisions.

Mark

PS... obviously, this is all hypothetical... not specifically about your case.

Eastex · #12 (**permalink**) 01-21-2009, 12:20 AM

Tomorrow is the day of my disco. I will post how miserable it was!! We will just see how it goes. I am not that scared, because I know it is a start of the healing process and that is all that I want now.

Cindylou · #13 (**permalink**) 01-21-2009, 02:02 AM

Eastex,

Good for you. Right attitude! You will do fine. Are you having it done in Longview or Tyler? (I know East Texas well, having lived there for years and gave birth to my youngest at Mother Francis) Let us know how all fairs tomorrow.

Cindylou

Maria · #14 (**permalink**) 01-21-2009, 03:00 AM

Discograms. I've had 3 done on lumbar levels and multiple (3) levels tested.
Bad pain at L4, and worst at L5S1 but not any worse pain than when my back would go out on it's own and actually quite fleeting pain.

The 2nd time after the procedure I had Marcaine injected at the levels injected for some relief and the 3rd time I had an ESI after the procedure for even longer lasting relief.

But even after the 1st time when I had nothing done to alleviate pain afterwards the pain I had lasted only 3 days and I was back to work on a Monday feeling even better than I had felt before the procedure which I thought was perhaps my discs had been hydrated a bit... who knows, just felt better.

I'm not really a glutton for pain it's just that there's been a time span over which these discograms have been done ranging from 2001-2006.

I did not proceed with the proposed spine surgery in 2001 (3level global fusion) or in 2003 (2 level ADR in trials) or in 2006 (hybrid surgery with ADR at L4 and fusion at L5S1).

I'm not telling anyone to wait but at least to make as informed a choice as you are able and feel as comfortable as possible with your decision in terms of surgeon and surgery because as mentioned no one has to live with your results except you (and your family maybe) but not the doctor or the claims adjustor (they each have plenty of patients but you've only got one).

Eastex · #15 (**permalink**) 01-22-2009, 06:49 PM

Well, that was fun!! It confirmed L5/S1. I used my share of curse words during the pain. It felt like all of my back pain intensified for a few seconds. They gave me something by IV and it made me feel like a had drank a 12 pack. When the pain hit, I sobered up!! They gave me some type of Ice pack that you activate. What a piece of crap. It went in the trash. So I didn't have ice until I got back home. I am sore today and I almost stayed home, but I am trying to save all of my hours for surgery. I am real tight and it hurts more in the hip, and lower back muscle area. I may go home early to get on ice.I had it done at Mother Francis because the doctor was scheduled to be there that day. We tried to have it all done at Texas Spine and Joint, but the schedules didn't line up. I saw Dr. Gordon later and he told me it was up to me for which surgery I wanted. Now I decide and wait on insurance approval. Leaning toward the fusion, since it is that low on my spine. I am leery of the unproven longevity of ADR.

mmglobal · #16 (**permalink**) 01-22-2009, 07:20 PM

Good news that you had unequivocal, concordant pain. That will give you and your surgeon more confidence in whatever you ultimately do to deal with that disc. Were other levels tested?

Unknown longevity of ADR vs. the guaranteed longevity of what? I still like to watch the tennis video on the GPN website... 23 years post-op for ADR patient #1.

IMHO, longevity of the device is directly proportional to the quality of the implantation. You should not be able to wear out a properly positioned, properly functioning disc. The only device problems I've seen have to do with poor implantation, poor patient selection, and I've now heard of one true device failure... adamaged prosthesis in someone who was a competitive weightlifter and was lifting a bazillion pounds.

(just my layperson's opinion)

Mark