Other German hospitals ?

[B13s]

Hi,
I'm reading this forum for quite a while (registered only recently) and noticed that everyone who goes to Germany for surgery gets it done at Alphaklinik which is THE most expensive one in Germany. Any reason for this ? There are also other ones (say Orthozentrum München - and no, I have no connections with them except that had my surgery done there) that have doctors with a lot of experience and costs are much lower. Just curious.

Btw. what a refreshing forum this is compared to a similar German one...

[chasswen]

pro spine in bogen Dr. Bertagnoli cost means nothing when it comes to your well being period....
chuck

[Maria]

B13s,
Posters usually write about doctors/clinics/hospital/facilities they've gone to for consultations/treatment/surgery or are in some way familiar with be it contacts, localities and so forth.

If you'd like, share your info. Sure there will be interested readers!

Hope you had a good outcome with your surgery~ I've had 2 spine surgeries to date, more recommended but rather disasterous results long ago have me scared off more surgery (at least for now). Ever questionable when it comes to results w/spine surgery tho we each go with whomever we think is the best to do the job w/in our individual constraints (insurance, pocketbook, ability to travel, knowledge of where to go, etc).

Thanks for your initial post. It gave me something new to google and check out!

[dshobbies]

When talking about spinal surgeries, while cost is a definite consideration for most, we all want the best doctors and go where they practice. The facility is important but the choice of doctors is primary.

Dr.s Zeegars and Bertagnoli have the best reputations and most experience of not only those in Germany but throughout the world. This is not to say that other doctors aren't skilled from whom you could expect a favorable outcome. Both the above mentioned Dr.s operate out of the Alphaklinik and Dr. B also operates out of hospitals in Bogan and Straubing.

How about sharing some of your specifics? By your post, I assume you're doing better?

[B13s]

Well, after reading stories of others here and other forums - I should consider myself quite OK My first encounter with herniated disk was in 2004 - didn't even know what this means back then... Was playing with my son and did bizarre sideway run - next day couldn't move from the pain in the back and legs - thought that did something to my muscles, took painkillers, spend couple days in bed and started exercising and in a month or so was quite ok - only had leg pain from time to time - didn't go to any doctors at that time. Eventually decided that everything is back to normal and stopped my exercises. In 2006 back pain came back - this time I decided to go to see a specialist - and until this date still cannot decided if I made the right choice or not. Anyway first got only X-rays, injections (not ESI), massage etc. This didn't help at all, in fact I was getting worse. Got MRI done which showed huge central herniation, however doctors advised against operation at that time and sent me to rehabilitation instead. Tried ESI's but they didn't make any difference. One day I got real strong massage I couldn't stand straight anymore and next MRI showed that herniation increased again :/ In addition to pain being only in left leg I started having it in the right one as well. Since all this was going on for months already - doctors suggested to do operation. Initially I was also thinking about Alphaklinik, send my MRI's to them, got quotation (I think it was something like 8-9K euro), however at the same time I discovered German forum - and there Alphaklinik wasn't something spectacular - some had very good experience, some not, some had to be operated second time elsewhere. Also found some statistics that showed that patients after endoscopic operations had the highest probability to be operated second time. And also my insurance was covering only half the cost at Alphaklinik, so in the end I decided to look at my other options and decided to go with Orthozentrum München (not sure if I'm allowed to put links to other sites - but here you can see comparison between German hospitals regarding amount and kind of yearly spine operations http://www.diebandscheibe.de/umfragen/adressen_kh.php ). Operation lasted around 30 mins, went OK, however few weeks after it I started having burning pain in both of my legs - never had it before in my life. In addition to burning pain I started having leg muscles spasms, bizarre sensations etc. Got MRI done again which didn't show anything special except some scar tissue (btw. scar tissue is the biggest fear in German forum, I didn't see much about it here) - however it didn't explain pain in the right leg and next MRI couple months latter didn't show scar tissue anymore. Got my nerves measured (forgot how it's called - where they put needles in your muscles ) - that showed some delays but nothing extraordinary. Nobody could find anything... in the end I end-up with pain management doctor who put me on all sort of different stuff - Neurotin, Katadolon, Novalgin, Cymbalta etc. - not sure if they really helped or just made easier to deal with a pain - since I was half asleep most of the time. 6 months latter legs got better and I slowly stopped taking everything. I was feeling so great that decided that I'm fit enough to help my friend to fix his bike - and ended up with second herniation in the same place - however much smaller than first one and a month latter was again OK. And once again I had stupid idea that I'm fit and decided to carry my son on shoulders a bit... A week latter my long forgotten burning pain came back... And this is where I'm now - burning pain changing with extremely cold legs - not sure if it's related, but never had them before operation... Now exercise in the morning and the evening and consider options for the future since L4/L5 is completely black as well...

[fuzzy]

I thought the doctors charges are pretty regulated in Germany. So you must mean the hospital charges? Yes, I do prefer the single rooms, I am a grumpy introverted pesky thing, especially when I hurt.

I have studied many hospitals in Germany in fact one of the ones listed on that website is within shouting distance of my appartment in Hannover, I watch their helocopter land on the roof all the time and was operated there as a kid, very good place. But look as how many operations many of these places have done...Dr Zeegers (the adr surgeon) at Alpha wins sky high in experience over most (Bertagnoli also). That was an important reason to go there, not the money.

I had severe neurological leg problems for years, worse every year. It turned out that pieces of the L5 disc had made their way towards the nerves. Not all so obvious on MRI but Zeegers knew where the trouble was, the mri picture of a "mild" degeneration (US doctors) was enough to explain the trouble to Zeegers together with my complaint history. Leg problems were immediately better after surgery, not gone but are improving daily.

Experience experience...it could make the difference.

[B13s]

State doctors regulated - yes, private - sky is your limit What regulates charges are insurances - well, I won't talk about state... normal privates - up to x3.5 of the standard charge, super duper privates usually no limit, however its really hard to afford them if you have family and kids (if you are normal person that is )
I may also go for a second opinion to Alphaklinik if don't see any improvement, however from my experience patients with private insurance way too often are treated like a sack of money...

[mmglobal]

When I went to the AlphaKlinik 5 years ago, I was always waiting for the other shoe to drop. When was I going to discover what the real cost would be. I had the perception that a 2 level lumbar procedure in the US would be over 100K... the estimated price at the AK was 22K... soup to nuts. In the 5+ years since then, the price has gone up 50%... only because 22K Euros now costs $33K US. The prices now are in line with what they used to be. I've seen hundreds of people go there and found what I found. The other shoe never drops. No surprises. The price is reasonable and in line with other clinics. There is some "you get what you pay for" in going to the best... but in this case the difference in cost between the best and the others is miniscule. The cost of failed surgery has no upper limit financially and as far as I'm concerned, having lived through years of disability and failed spine surgeries, our lives are at stake. Going to the best is no guarantee of success and going to the worst still comes with substantial chance of success. However, I believe that going to the best increases one's chance of success. I used to think that 90% was a slam dunk... but I meet the problem patients every day. The toughest ones to watch are the ones who have problems that would have been avoided by going elsewhere. I was talking to Zeegers a couple of days ago and he was lamenting the fact that he's seeing so many complications that were unnecessary (placement, sizing, patient selection). "They are making the same mistakes that I made 15 years ago", he said.

I've seen an AK patient have serious problems at the hotel and get an hour visit by a doctor with a state of the art electronic backpack... ekg, body scan with a guided tour of all her organs, several meds, a couple of shots. We laughed about the bill... 190 euros.

I've seen a Pro-Spine patient need 2 nights in cardiac ICU and several treatments by cardiologist for a problem unrelated to the surgery. She checked out of the hospital expecting a bill with 10k more... we laughed about her having to pay 800 euros over the estimate.

I've got many more stories like this. I've also seen that the even though the doctor knows the patient's circumstances, the starving student who's brother mortgages his house and 401k to save his sister's live pays the same amount as the patient who flies in on his own Gulfstream G5.

I wish that in the US, healthcare was provided in an honest and upfront fashion. I don't have time now to post the horror stories of rescinded insurance payments or of patients who went were promised reasonable prices for cash pay patients, only to discover that they were on the hook for 30K more than they thought. I also know of reasonable cash pay prices in the US... I'm not saying that here is bad, there is good... I'm probably over reacting to a small point because I have so much experience with these clinics I've never seen anything but up front, as expected. Yes, people have to pay for services and having to do a 3 level instead of an expected 2 level costs more, but the delta cost is reasonable. I've not once seen $$ rolling in the eyes of the surgeons... private does not meen fleecing

I wish I could write more now.... gotta run.... all the best....

To all the new members... welcome... B13, I'm very pleased to hear of your success and hope to see the other clinic on one of my trips to Munich (I'm here now.)

BTW, I looked at the website that lists the clinic info. It's an interesting concept, but making decisions on internet info is somewhat dicey. (here too... and what I say too.... take everything you read with a grain of salt. The information listed regarding the AlphaKlinik has absolutely NOTHING to do with Hoogland and Zeegers' business. Dekkers operates a separate spine center and Toft operates a separate knee business. I don't know about the info on the other clinics, but the information on the AK is incorrect.

All the best... pain free vibes out in all directions.

Mark

PS... fuzzy... call my German cell before you leave Munich... I hope I get to see you standing up straight with a smile on your face.

[fuzzy]

I would like to add:

5 xays plus follow consultation with Dr. Zeegers at the Alphaklinik.

Cost $150 euros. Sounds very reasonable. The only thing they could charge extra for (they told me) over standard german rates is the fact that they have a digital xray, new technology, 5% extra. Even the privates are more regulated then one might think in germany. I was told his many times.

The xray job would have cost over $600 in the US. Xrays + required radiologist review + doctor visit.

[B13s]

Well, did another MRI today - have new herniation again in the same place (middle of L5/S1 pressing on the spinal cord only, not the roots) - doctor suggests to go with ADR since disk looks like triangle (if you look from the side) - one side is ok, another one - something like 1-2mm left. I have no normal pain - neither in legs nor back, only burning in both legs and a bit in a back. Not sure now - do I try to wait, or go with ADR - according to doctor the earlier you replace it - the better chances of recovery. However since I'm only 35 - don't think that any ADR will last my lifetime...

[mmglobal]

Sorry about the recurrant herniation... 1-2mm herniation is pretty small. I went through the same thing after my first discectomy... radiologist said recurrant herniation... my doc said normal post-op MRI. The surgeon turned out to be correct... radiologist wrong.

Why don't you think ADR will last? What are the options and how long are they guaranteed to last? (I'm not suggesting ADR... spine surgery should be avoided if possible.) What does the rest of your spine look like?

All the best,

Mark

[B13s]

What I mean is that there is only 1-2mm of disk height left on one side, herniation itself is ~6-7mm in length & width (like bubble). It's something like here http://www.spineuniverse.com/display...supre2a-BB.jpg , only herniation is bigger and left side is higher (so angle is even bigger).
Mine L4/L5 is also dark (similar to L3/L4 in the picture) - I compared it to the MRI that was done two years ago and looks like it didn't became any darker. The rest is fine (at least for now). During my first post-op herniation in the summer the same doctors who did first op advised against second op saying that it won't help much, however herniation wasn't so big at that time. At the same time they mentioned ADR, but also said that it's up to me since there are not enough long term studies. I'm going to see them again next week with new MRI. Also have another appointment with different hospital in January, but don't think that they have enough experience and they do Prodisc only. Probably will go to Alphaklinik as well. In any case I can go for op only in October and have only max 18 weeks to be out of the job. I'm in IT - no physical work required - hope 18 weeks don't sound too optimistic.
My personal opinion is that fusion at L5/S1 only would destroy L4/L5 in no time. ADR at L5/S1 probably wouldn't last long as well. I guess I'd need to go either with fusion at L5/S1 + ADR L4/L5 or two ADR's at L4-S1. And of course there is also option of waiting and living with Neurotin since I don't have so much of the back pain - my mine problem is burning in the legs with some occasional spasms.

[Maria]

I had much burning bilat in legs altho with back pain when my back would go out (or I would think the disc was leaking goop on nerves because of onset of pain, type of pain, duration of painful episode and bedrest required to relieve pain).

Currently my back is bothering me very much and I'm having bilat burning again in thighs/quads. It rather sucks.

I have been taking Neurontin since '98 for the residual burning pain left from my failed discectomy in '92. Maybe you could give it a try and see how that goes if all else seems to be status quo and you're not much affected by your spinal situation.

My disc bulges were small as well before both of my discectomies however the pain they caused was BIGGGGGG and BAD!!!! I think I have a bigger disc bulge now in one of the same discs that was surgerized way back in '92.

[B13s]

I was on Lyrica for couple of months after my op, after that switched to Neurontin since Lyrica made me extremely sleepy all the time. Together with Neurontin I was also taking Cymbalta + Novalgin + Katadolon (not sure if it's known outside Germany) - and all this cocktail still couldn't kill burning... Doctor was pushing for opioids but I was against it and in the end burning disappeared within two weeks 9 months later - and it took so long without any herniation.
With new herniation I'm not sure how long it will take and if it will go away at all. I prefer to have 'normal' pain - and even happy when I get it because it makes all the burning to stop at least for a few hours. Burning really drives me crazy - well, you have the same thing - so you know what I'm talking about...
On the other note - today arranged appointment yet with another doctor for consultation, so far have 3 lined-up. Also on my way back from work stopped at the Alphaklinik, but was already too late - got only some advertisement material

[dshobbies]

Upon awakening from my 3 level Prodisc, both my legs were completely numb. I immediately started on Neurontin and a course of steroids. Within days, my right leg began to come back but... both legs became extremely hypersensative. The touch of the blanket or even a breeze on my legs was excrutiating. This pain lasted for about 6 months, during which time I was on Dilaudid, a narcotic. I couldn't drive but this pain was so severe, I welcomed however relief came.

Take what you need for your comfort and when you capable, decide how to best deal with your pain. I hate pills but am grateful they're there for me if I need them.

[B13s]

Went today to the same hospital that did initial operation, spent 2 hours - met surgeon as well, got x-rays - no instability, however facet joins aren't too perfect and they advised against ADR, advised against fusion as well since they think that new herniation is too far from nerve roots and new operation won't improve neuropatic pain. They think that it could be caused by scar tissue - I have it a lot on the left side, but it cannot explain pain on the right side. Have appointment with Dr. Zeegers next Thursday, but probably will cancel it and see Dr. Baumbach instead.
Also went to another hospital - again - do not recommend ADR, say scar tissue cannot be a problem 1.5 year later after operation, can remove new herniation, but no guarantee that it would improve anything.
Overall it looks like I'm back to pain management without anybody knowing what's really going on...

[B13s]

Went to see dr.Zeegers to Alphaklinik today - spent five hours - and the result - well - dr. Zeeger probably is good surgeon, but not so sure about diagnostics. Or maybe my case is really a puzzle. Got my flexibility measured - almost excellent, back muscle strength - quite bad - and this is despite all the exercises I was doing... After looking into my MRI and X-ray unfortunately he didn't say anything new - I can wait, can have only herniation removed, can get STALIF or STALIF at L5/S1 + ADR at L4/L5 - and it's up to me to decide. During our conversation I mentioned dr.Baumbach and dr.Zeegers was a bit surprised that I know that name, however he agreed that it would be good idea to see dr.Baumbach as well - and 10 minutes latter I was already in dr.Baumbach's office.
Now regarding dr.Baumbach I can say that his examination is really pretty good. However result was that it's not clear at all what's causing my burning pain. Herniation I have shouldn't be causing my current symptoms. Fortunately he had few more ideas - I need to get MRI of my neck - there is possibility that something is pressing on my spinal cord in that area and it could fit to my symptoms since he also found that I have some muscle strength deficit in my fingers, I also need to check if I don't have Lyme disease and also need to check if I don't have spinal cord infection by doing lumbar puncture.
After dr.Baumbach I went to see dr.Zeegers again - he called dr.Baumbach, they argued a bit about my diagnosis - didn't really agree on it and well - wished me a good luck
Cost (from my own pocket): for dr.Baumbach - 200 Euro (worth every cent), for dr.Zeegers - 300 Euro (feels a bit of waste and as payment for really nice office ).

Another interesting thing - I was looking at all ADR's at dr.Zeegers office - according to him they are made from exactly the same material as original ADR's including cores - but for me plastic of the cores (both Charite and Active L) looked really soft - I pressed on it with a nail and my nail left a mark on the core - keeps me wondering how this plastic supposed to last years ? I also asked about Charite and he said that they are not good - bit surprising comment from the surgeon who implanted lots of them...

[fuzzy]

Thank you, B13s, for keeping us updated on your quest for an answer to your spinal problems which is specially interesting as you are in Munich and can walk in of the street for these consults.

I have also visited Dr. Baumbach (6 hours, 800 euro's, in my case) and he was definitely trying to make sure not to rule out any posiblillity even those seeminly rare cases of cervical myleopathy in which the neck does not hurt but something is pushing on the spinal chord and causing exactly what you describe which btw is very similar to the problems that I have had, in my case burning feet that are very uncomfortable to stand on. Baumbach, based on his tests, found reason to believe that *possibly* my neck was involved. So neck MRI which showed nothing clear as daylight but a hint on possible problems. But I had severe lumbar problems and the leg and foot problems often coincided with the events in my back, i.e. sitting certain ways made it a lot worse. So all surgeons said if any surgery then lumbar should be worked on first as I surely need that. Zeegers got the job and found issues in my spine that were not clearly visible on the MRI (reminds me of slot machines, you never know what you'll get). But even though I still have problems 8 weeks out it is obvious that my foot problems were caused by my lumbar spine, knew it the next day when I tested my feet, I now could walk with little of the original problems, only to be replaced with a lot of irritation which I believe to be nerve damage that will take a long time to heal. I wonder if I waited too long. But no one had a clear answer for my problems and Baumbach/Zeegers got a lot closer then anyone else.

[B13s]

A bit of update - got MRI of the neck - no problems whatsoever (at least the one that could be seen on MRI) - so at least one good news.
However during my exercises yesterday managed to do something to my back again Was doing sit-ups (not the normal ones, but the ones for people with back problems - like trying to sit on the toilet - learned them during my rehabilitation) - and got pain on the right side of the back, however instead of stopping - I continued to exercise (call me stupid...) - now I have hell of the pain on both sides of the back, can barely stand straight - hope that it's just muscles since pain does not go to the legs and I can raise legs also without any issues. Then again - maybe my herniation got even bigger, but since its central - it doesn't affect legs. If pain persist - I guess I'll start with opioids - cannot afford to be out of work until my probation ends in 2.5 months... On the positive side - because of the pain in the back have no burning in the legs

[B13s]

Got cost estimates from Alphaklinik today - L5/S1 STALIF only - 26K Euro, L4/L5 ADR + L5/S1 STALIF - 32K Euro. Seems to be really on the high side...