Face surgical choices re cervical spine (Artificial Disc Replacement?)

[herniated C6-7]

I have a herniated and severely degenerated C 6-7 which seems to cause all my symptoms. I’ve been toughing the symptoms out for some 9 years but must now think seriously about surgery.

In the past year, the disc immediately below C 6-7 also show up as some 90% degenerated on imaging, but as yet seems asymptomatic.

My surgeon in California recommended replacing both disc with 2 Prodiscs. Prodisc is FDA approved and manufacturer recommended for single-level replacement, so this would be an off label use.

My California surgeon has dome maybe 50 replacements in all, perhaps 20 cervical, at most one or two multi-level cervical.

My insurance co. refused coverage for replacement on the grounds that it is still “investigational”. After I switched insurance cos., the second co. said the same. Appeal to the CA state regulatory board failed to overturn.

Questions I confront are:
1. Should I have surgery?
2. Fusion, with insurance coverage, or pay cash for disc replacement?
3. Do replacement in the US, or Germany where experience is greatest?
4. Which surgeon?
5. Which artificial disc?
6. Might Anthem Blue Cross of California cover surgery in Germany, if I'm over there temporarily, even though it refused coverage for me in California? Anthem has a network of providers in Europe, and my job can take me to Europe.

[KBear]

Welcome to the forums! Those are some tough decisions and require lots of research. I would consult multiple surgeons for opinions. Also see if you can contact surgeons in Germany and find out if your insurance has paid for surgery there before. Also, what about a hybrid surgery (1 fusion & 1 ADR), would insurance pay for that? Good Luck in your decision and keep us updated.
Kathy

[jss]

herniated,

Condolences on the physical and insurance conditions!

Those are all very difficult questions. Most everyone on this board has had to address them and you should soon have the benefit of a wealth of varying experiences. I don't know what you should do, but here's what I did and why ...

In 2000 and 2002 I had fusions at C4/5 and C5/6; and soon started experiencing problems at C6/7. By Fall 2009 the pain was incapacitating, and I was by then also having problems at C3/4. I refused two more fusions, which would have fused my neck into a 2x4, and would have assured (in my thinking) two more future surgeries when C2/3 and C7/T1 succumbed to the stresses of the four adjacent fusions.

After about sixteen months of research I finally chose the Spinal Kinetics M6. It was one of only two ADRs that cushioned axial compression (up and down motion created when we walk, drive in a car, stand, sit, etc...) In my judgment it was the ADR most likely to preserve my two remaining cervical discs.

I wanted to go to Stenum because of their unparalleled experience. Fearing my insurance company would deny coverage, I went to Dr Pablo Clavel at the Barcelona Spine Center in Barcelona, Spain. Dr Clavel had at the time performed 200+ ADRs (far less than Stenum, and far more than any American doctor). His credentials and experience were, in my judgment, eminent; and the cost was two thirds that of Stenum.

Regarding your insurance issue; I have never heard a kind word spoken about Anthem BCBS. I would suggest this book. It is by a woman who was facing a terminal outcome barring a procedure that her insurance company would not cover. The book is her experience navigating the mine field of the appeals process with her carrier. She gives a formula for constructing a winning appeal, and gives her winning appeal. She's since helped dozens of others win appeals with their carriers. I'm engaged in this battle with my insurance company for reimbursement right now. They denied once. I appealed with Laurie's formula. The backed off of their denial reason, agreeing with my appeal, and have now denied for a different reason. !*@&#^$%!

Good luck, and like Kathy said, please keep us updated.

Jeff

[Katie]

Wow, tough call. But first welcome to this forum.

Most of us who post here either have had surgery or are making plans. And most if not all have also gone through the same questions that you are asking, and the pre-op treatments trying to avoid surgery.

I had three level surgery last March, after trying to find a surgeon for almost five years, and years of pain before that. One of those levels was my C5/6, where I had the Nuvasive NeoDisc inserted. Several surgeons before this had recommended that I also have something done with my C4/5 but this surgeon didn't think it was necessary. Such is the world of consults. So far he has been right. All my neurological problems have disappeared, which almost every surgeon had said was unlikely...that surgery would prevent further deterioration but not reverse the damage already done.

I'm pleased to prove them wrong

[wendyayers]

I had a 3 disc replacement (C3-C6), all prodisc in Germany by Dr. Bertagnoli. I could not move my neck or lift my right arm fir a year. Finally, pain free as of last month. Back to playing tennis, working out with a trainer 3x/wk and doing yoga. I never thought that was possible! You could call me if you'd like. 509-710-2321. Good luck,

Wendy

[herniated C6-7]

Much thanks to all of you for your helpful posts. After just a few days on this web site, I am feeling much more positive and hopeful about my surgical prospects. Those of you who set up and maintain this site, and post actively, are providing the best sort of thoughtful and heartfelt public service. I am gratetful and in debt to all of you.

I have noticed that there are other web sites online that provide forums for spine patients. I have run across posts by Justin on some of them. Tracking them all down and keeping up with them, however, seems a bit daunting.

Are there other patient spine forums that I should definitely be reviewing in addition to this one? Can I trust that any pertinent information that shows up on another forum will attract notice and be posted on this one as well?

[herniated C6-7]

I have noted with much interest some posts by individuals who succeeded in getting insurance coverage for ADR surgery in Germany from Anthem Blue Cross.

But my understanding is that the different state affiliates of Anthem Blue Cross can follow different policies.

Does anyone have specific experience with Anthem Blue Cross of California in seeking insurance coverage for ADR in Germany? The CA affiliate refused to cover ADR surgery for me in CA, and I lost my appeal to the state HMO regulatory board. Is it possible that Anthem would cover ADR surgery in Germany even though they refused to cover it in CA?

It occurs to me that ADR is the prevailing standard of care in Germany, and that German hospitals likely bill out lower charges for inssurance reimbursement than US hospitals.

Any thoughts or concrete experiences?

[KBear]

We are all here helping because someone helped us at one point. I remember feeling like I would never understand all of the spine lingo and 'get it'. Thanks to helpful posters on these boards I did get it. I know several of us have belonged to more forums than this at one point. A few still frequent multiple boards. I personally left the other forums due to them not being a true non-profit. I felt that some pushed so hard for their surgeons, hospitals, etc. where if someone didn't use them, they were almost ousted. Some had posts deleted for speaking out against some of the 'preferred doctors' or bringing up another place they preferred more (usually Stenum) because the medical tourism company/ forum owner did not have a financial agreement with them. SPS is a non profit and no one who created it, resides on the board or is in any way involved will profit from it or any spine hardware, surgeons, etc. However, some of the other boards are created and run by medical tourism companies (they get paid to help you get to another country for surgery) or the owners/board members serve to make a profit off of forum members. In my opinion, this is a conflict of interest and biased toward whatever will financially help them. That's why I love SPS, because I can trust what I find on here and know it is in no way padding someone's pockets. I have never once seen someone's posts deleted here, or someone censored because they did not like a particular surgeon, etc. If you read the post "A Grave Mistake" you will see where this lady Job13 says that she was ousted on other boards, deleted posts and kicked off for sharing her story. Here it has been up and for everyone to read her opinion- everyone may not agree; but it is her opinion and she is welcome to it.

With the insurance, if I remember correctly, many of the people who had BCBS pay had government BCBS (they worked for the state or the government). It also is variable on whether a company provides it, or it's an individual plan. Even company to company varies, as the company has say in whether the insurance will pay for something or not. My opinion is that Government insurance in general pays best and has the best chance of getting approval. Then insurance through a company was the next best and had more hope since you can petition your job for coverage. Insurance for individuals was the worst, this is what I have because my husband is self employed (my BCBS of TX individual plan will not even pay for anti-depressants, whereas others with BCBS through work have that benefit). I have seen where people were denied pre-approval for ADR, then had surgery, filed on insurance and did have insurance pay a good portion of it or in some cases all of it. Mine denied me twice, then paid around $10,000 toward my surgery.

[Cindylou]

Herniated, The different forums? Alot of it is a matter of personal preference. Some folks keep up with a handful of forums. I don't know how they do it. I personally keep up with just SPS. And don't assume if you see something posted of interest on another forum, it will end up on here. It could. But don't count on it. And Kathy is right. We are attempting to pay it forward, as others have helped us along the way. Good luck with your research and bear in mind we are not medical doctors offering medical advice, but rather just lay folk attempting to offer educational resources and emotional support. :thumpup:

[Justin]

Welcome to the Spine Patient Society.

1. Should I have surgery?

This is a difficult question for any Spine Patient to answer. For me, it was a quality of life issue and I knew in my gut it was time to move forward with surgery after I exhausted all conservative therapy.

2. Fusion, with insurance coverage, or pay cash for disc replacement?

Fusion and artificial disc replacement are both great procedures and each have "pros" & "cons."

3. Do replacement in the US, or Germany where experience is greatest?

There are many surgeons in the United States with many years of experience with artificial disc replacement. Germany has surgeons with vast experience...it all comes down to a personal decision.

4. Which surgeon?

Again, go with who you feel comfortable with. Easier said than done, right? -- especially with spine surgery.

5. Which artificial disc?

There are many good artificial disc replacement devices on the market. They each have their own "pros" & "cons."

6. Might Anthem Blue Cross of California cover surgery in Germany, if I'm over there temporarily, even though it refused coverage for me in California? Anthem has a network of providers in Europe, and my job can take me to Europe.

I had BCBS when I had my two-level artificial disc replacement surgery. They would only cover my surgery if I was injured in Germany and I needed emergent / urgent spine surgery.

Are you moving to Europe for your job?

I wish you the very best with everything. We are here to help. :thumpup: