Questions for Mark - or anyone else who might know the answers

[treefrog]

All right, so I have a few questions here, for Mark or anyone who has some answers.

1) How many TDR surgeries should a surgeon have done in his career (per year), to be considered qualified enough to be considered "expert" and a surgeon that I should feel safe with?

2) Are there surgeons in the US who are considered "expert" in multi-level lumbar TDR surgery, whom I could go to for a consult? Who are they, how do I contact them?

3) Are there US surgeons who do multi-level lumbar TDR surgery? Who? (I guess the question here is cost?)

4) I haven't found any clinical trials in the US for 2-level lumbar TDR, are there any? Are there any elsewhere in the world, that I should consider?

5) As far as images of x-rays/mri/etc, what format should I ask for them in, so that I can easily send them for consultations (or for setting up a profile on GPN)?

6) If I decide to have surgery someplace outside of the US, what kind of protections do US patients have in case something goes wrong (like leaving a sponge inside, that kind of thing), or are there any?

Those are all I can think of right now. Thanks in advance. I appreciate any help I can get.

[mmglobal]

1) How many TDR surgeries should a surgeon have done in his career (per year), to be considered qualified enough to be considered "expert" and a surgeon that I should feel safe with?

I know ADR surgeons with > 1000 procedures that I wouldn't let operate on my dog. There may be a handful of extraordinary surgeons that get good very early in their career. I saw a paper presented at NASS a few years ago. They studied placement of all study and continued access Charite' patients and discovered that it took on average, 40 procedures before the surgeons achieved reliable placement within tolerance (IMHO the tolerance is too generous). I don't know how you can tell about your local surgeon.



2) Are there surgeons in the US who are considered "expert" in multi-level lumbar TDR surgery, whom I could go to for a consult? Who are they, how do I contact them?

Some of the study surgeons have a pretty large cohort of mulit-level patients. There are so many issues that need to be understood... also, I could not provide a comprehensive list. I'll be happy to discuss this offline.


3) Are there US surgeons who do multi-level lumbar TDR surgery? Who? (I guess the question here is cost?)

The cost issue is huge and can be a big unknown. I know people who've been quoted a reasonable price that has been met. I also know people who have been quoted a reasonable price and discover pre-op that it's twice what was quoted. I know others who expect a surgery to cost 40k.... they are out of pocket 60k and the hospital is coming after them for an additional 140k. It's a free-for-all and there are so many providers involved. One friend of mine had his surgery approved and paid for. After the fact, the insurance company rescinded their approval and billed him. He won, but it cost him 5k for lawyers.


4) I haven't found any clinical trials in the US for 2-level lumbar TDR, are there any? Are there any elsewhere in the world, that I should consider?

I don't keep a comprehensive list in my head... activ-l was going to do a multi-level arm. It's very expensive and I'm not sure that there is a huge upside for them to do multi-level.


5) As far as images of x-rays/mri/etc, what format should I ask for them in, so that I can easily send them for consultations (or for setting up a profile on GPN)?

Most of the docs I work with prefer imaging < 6 months old and will start with mri and xrays, including flex/ext. I don't like to tell people what I think they'll need. You don't want to have an expensive or risky test only to have the doctor to say that he would have preferred something different. Start with what you have (unless it is > year old or if your status has changed since imaging). Let the docs say what they want.

6) If I decide to have surgery someplace outside of the US, what kind of protections do US patients have in case something goes wrong (like leaving a sponge inside, that kind of thing), or are there any?

none. That's about what we have here. Our legal system seems to work for the crooks... not for joe the plumber. Avoid problems as best as possible by getting it done right the first time. Unfortunately, even for the best candidates, doing the right thing with the right doc... any spine surgery is still not a slam dunk. You can increase your chances, but not guarantee success.

[treefrog]

Mark, what I meant by image format was...jpeg, bmp, tiff, gif??? Or is it pretty standard?

Thanks for the responses.

[mmglobal]

You probably don't have an option other than disc or film. Many imaging centers have stopped printing films. At GPN, we can process either for an online profile.

Mark

PS... I try to keep GPN business off the forum and prefer to answer questions about our services via phone or email.

[treefrog]

Mark, I understand your wanting to keep business talk off the forum, and I respect that.

My question though, is not specific to your services, but in general. I know that people get their films (from MRI, x-ray, etc) copied onto disc, so they can take them to other doctors, or just to have for their own records. And the question is, is there a digital format that I should ask for, or is it standard? Images can be converted to different digital formats, and some can only be viewed with proprietary software. Or I should say that some software can only use a specific format.

But don't worry about the answer, I'm sure I will find out when I ask the doctor for copies of the images. I just prefer to know what I am asking, particularly if the person I am asking might be unsure what I am asking for. That way I can be specific.