out of country ADR's...who has done it? confused re whether 2 get fusion or go out of country for 2 adr's

[larae]

Hello everyone-

I have posted before but my situation has changed slightly and I am looking for some insight. I just got back from seeing my surgeon (for a second consultation). He probably thinks I am OCD.
Before he reccommended the hybrid. I thought this was in lieu of L5-L6 w/ a black disc and start of arthritis...which I was prepared to deal with. Now, after speaking w/ him today...he made it sound like, the reason he suggested a fusion was partially because of insurance not covering a double ADR...and now they are not covering he hybrid (they were last yr.). So, If i went out of the country to get the two level ADR done...who has done this.
he said that both the hybrid or 2 level ADR wld produce the same benefits with the same risks, etc.
I thought that if you had the choice...go w/ the ADRs! He just kept mentioning the money aspect.
I keep thinking....you have one spine...and all money aside...what wld be most beneficial and successful.
again, he said, they wld be about the same. hmmmmm
I am sure there are threads out there pertaining to the matter. All my pain is very localized FYI, with no sciatic radiculopathy pain.

Thank you, thank you, thank you,
barb

[Justin]

Hello everyone-

I have posted before but my situation has changed slightly and I am looking for some insight. I just got back from seeing my surgeon (for a second consultation). He probably thinks I am OCD.
Before he reccommended the hybrid. I thought this was in lieu of L5-L6 w/ a black disc and start of arthritis...which I was prepared to deal with. Now, after speaking w/ him today...he made it sound like, the reason he suggested a fusion was partially because of insurance not covering a double ADR...and now they are not covering he hybrid (they were last yr.). So, If i went out of the country to get the two level ADR done...who has done this.

I traveled to Germany in November 2003 for a 2-level lumbar artificial disc replacement (ProDisc).

he said that both the hybrid or 2 level ADR wld produce the same benefits with the same risks, etc.

The approach through the abdomen would be the same. This inherently holds the risk of damaging one of the "great vessels" in that area (inferior vena cava and the abdominal aorta). The outcomes for lumbar fusion and artificial disc replacement are quite similar based on peer-reviewed medical literature.

I thought that if you had the choice...go w/ the ADRs! He just kept mentioning the money aspect.

This is not necessarily true; especially if the Spine Patient has advanced facet degeneration (think of facets as knuckles in your spine).

I keep thinking....you have one spine...and all money aside...what wld be most beneficial and successful.
again, he said, they wld be about the same. hmmmmm
I am sure there are threads out there pertaining to the matter. All my pain is very localized FYI, with no sciatic radiculopathy pain.

At the end of the day, it comes down to a personal decision. The best thing you can do is try and educate yourself as to why you would pick one operation over another. Artificial disc replacement has somewhat of a quicker recovery time. However, outcomes at 2 years post-op are very similar.

Make sure to read as much as you can. Good luck!

[Hooch]

Different horse for different courses Barb. There is a school of thought that a hybrid procedure produces a more consistent outcome due to less torque produced through adjacent unconstrained adr's and therefore more stability and less facet degeneration etc, and there is a achool of thought that adr's generally have a slightly better outcome than fusion so it's best to avoid the fusion.

I went through all the lit before I had mine done.. you can't get a totally clear statistical picture even without bias when analysing surgery.. the consensus when I looked at it was that outcomes for a hybrid or a 2 level were similar.

Most important thing is confidence in your surgeon and confidence that the procedure is the best one for your condition. Overseas isn't necessarily better by any means.. in fact there are some significant dangers in medical tourism.

Just make sure you get a few opinions, and be aware that some surgeons are more gung-ho than others when it comes to interpretations of contra-indications like facet degeneration.

[Jack-of-all-trades]

Is the L6 an aberrant bone? That upset the apply cart , depending on its condition.

From what I've read L1,2,3 do most of the twisting/bending and the lower disks less. I would suspect, it it is a surgeon who know his shinola you would be fine with either. Procedure. There was
a post up at one time that helped to determine odds of success and how the patient and surgeon defined success for any given procedure. I can't find it now.

[larae]

Thank you all-

I have two sides now from a few people: get the 2 ADR (and you dont need to go out to go out of the country)...Justin where did you go and for what reason? Was it cost related? how much was it (u can PM me if you want on that one! ) recovery good?
But, Dave just had two ADR's in Cali and is loving life (thanks Dave for all your info!!)

And I had someone tell me the fusion wld be a better option...their ADR @ the low level did not maintain. All my pain is localized...no radiculopathy.
I know I will get different schools of thought, not worried there (well, amongst the forum...& docs). My concern was that my surgeon said at one time that because I had OA starting, fusion wld be a better option. then, the second consult, he said it wasnt that bad and either or wld work just fine and the same. hmmm Not quite likin the switch. He kept mentioning again, the authorization part of it. that's why he picked the fusion.

I am thinking all about recovery! who wants to recover from a fusion vs. ADR? I was under the impression that if you cld have either or...go w/ the ADR.

I might get one more opinion down in Cali. They really don't know what will happen 10 yrs from now w/ a low level ADR. But are pretty firm on the outcome of the fusion. yrs....down the road.

You guys are all groovy. Thanks a bunch. I have been doing so much research & surviving with lyme that reaserching the back is the least...if you can believe that! Although, Chris, I have read all your sent articles. thanks

[Cindylou]

It can be overwhelming, to say the least. So many considerations to take into account, and I believe it was Justin who replied earlier about bottom line, going with your best gut decision after all of your research. If you are feeling somewhat unsettled about the doctor who has done some "switcharoo" with you on "his best advice," then definitely get some 2nd, 3rd, even 4th opinions from other doctors. You should do that anyway, because all of that interviewing will also help mold your decision about what is the best treatment option for you and your body. Hang in there. Cindylou

[KBear]

It can be overwhelming, to say the least. So many considerations to take into account, and I believe it was Justin who replied earlier about bottom line, going with your best gut decision after all of your research. If you are feeling somewhat unsettled about the doctor who has done some "switcharoo" with you on "his best advice," then definitely get some 2nd, 3rd, even 4th opinions from other doctors. You should do that anyway, because all of that interviewing will also help mold your decision about what is the best treatment option for you and your body. Hang in there. Cindylou

Agreed

[trkdoc714]

After a lot of research, I made a choice to travel to Europe for ADR surgery. There was a huge amount of confusing data being thrown at me prior to that decision. Most surgeons are going to offer their opinion toward the surgery they or an associate can perform. As fusion has been the gold standard for over 50 years, most suggested fusion. ADR surgery was infrequent enough at one level and extremely rare at two.

I researched all aspects of what I was being told before making my choice. My employer sped the process up by hinting that since I wasn't able to perform my job, the company would let me go at some point during the ensuing year.

The bottom line was the choice I made was the best choice for me, my pathologies and the best chance of recovery to pre-injury levels.

Nobody on this forum can tell you what you need to have done. All we can do is share our choices and outcomes as openly as possible in the hopes that some portion of the motives for our decisions can fit into your situation.

I wish you all the luck in the world. This is a tough decision to make.

Bob

[larae]

perfect answer. Wish you went to Europe to have a fun time though
whatever will be will be.
barb
p.s. i am still curious if people go out of the country for financial purposes as a primary reason.

[rhatzy]

If you are dead set to get the ADR, then it is cheaper out of country. Unless, your insurance will pay for it here in the US which is very very rare. I had a two level lumbar ADR and the total cost was $39,000 that included 5 to 7 days in a hospital, 7 days in a motel, the discs, the surgeon, anesthesilogist, meds, nurses, pt, massages, everything. Plus your choice of discs are many and the surgeons are more experienced with the number of disc surgeries they have done.

You will pay double that in the states which will include one night in the hospital, maybe 2. I went because of the experience, the discs and the costs.

Mark