New to the forum

[strictlyna]

I have been diagnosed with DDD at the L5- S1. I have one doctor who said that I was a prime candidate for a disc replacement and two other surgeons agree that I need a fusion. The problem is my insurance company denied my surgery and I have a huge battle ahead of me. I would like to hear from anyone who has had either procedure to get your feedback. Also, if anyone in the US has the same problem and had a disc replacement, please, please contact me. There is no way I can go to Europe and pay thousands of dollars for this surgery. I am meeting with my surgeon tomorrow because he wants to talk to me about alternatives. I don't see any alternative. I have done PT, Acupuncture, Chiro, Epidurals, Discogram, MRI's and X-Rays. The L5 is also herniated. My worry is if I get a fusion, the L4 has signs of DDD and so I might end up in the same pain down the line. I believe if God made with this spine and this amount of disc's then that's what I need. I am looking for anyone who has information to help me!

Thank you!

[trkdoc714]

Strictlyna,

Was that your first attempt with the insurance company? What were their reasons for denial for both procedures?

Bob

[ajj1001]

hi, sorry can't help on the insurance thing as i am in the uk but i can let you know that the l5/s1 doesn't seem to bend much anyway. i have very little difference in bend with an adr and a fusion on the same area. i'll let you know personal experience on the l4/l5 soon but that disc is meant to have much more motion from it. try not to get hung up on what replicates the natural as what will give you the longest best outcome is what matters. having many spine surgeries is not a good thing. hope you get some good information on how to deal with the insurance soon.

[strictlyna]

Strictlyna,

Was that your first attempt with the insurance company? What were their reasons for denial for both procedures?

Bob

Bob, my neurosurgeon has requested a lumbar fusion but was denied and then did the peer to peer and denied again. After further research, I believe that I need to get a disc replacement so I am going to research UCLA Spine Institute, perhaps Dr. Rick Dalamarter or go up north to SF to see Dr. Serena Ju does the ProDisc-L procedure and I talked with the Insurance Warrior, Laura for over an hour on how to approach the next appeal. I don't think that appealing for a fusion is what I want. The insurance company doctor said that it wasn't medically necessary and then the second letter contradicted itself by stating that if I had done x, y & z - an exception could be made. I sent them a threatening letter with 65 pages of medical records showing that I have done everything they suggested and I am in terrible pain. I had my surgery date scheduled and found out it was denied the day before. I have since been out of work on disability and on a whole lot of pain medication. I am opiate tolarent and need to find a doctor who is willing to help me fight this huge evil insurance company. This is why I am asking if anyone has recently has a disc replacement paid for by their company so I can use the information on my appeal. I want what I deserve and don't think fighting for a fusion is worth it because the L4 has signs of DDD so I will put too much pressure on it and be in the same boat a few years down the line. I have a sample appeal and plan to fight but need recent data!! Thanks!

[strictlyna]

hi, sorry can't help on the insurance thing as i am in the uk but i can let you know that the l5/s1 doesn't seem to bend much anyway. i have very little difference in bend with an adr and a fusion on the same area. i'll let you know personal experience on the l4/l5 soon but that disc is meant to have much more motion from it. try not to get hung up on what replicates the natural as what will give you the longest best outcome is what matters. having many spine surgeries is not a good thing. hope you get some good information on how to deal with the insurance soon.

Thanks for responding. I am so confused because I have been told not to let the doctors do a fusion and that a disc replacement is the only way to get better. Since the insurance company denied a fusion, I am going to ask for a replacement and then once they deny that, I will file an appeal. You are so lucky to be in the UK and not have to deal with an insurance company dictating what type of care you are allowed to have. My doctor has no say so which is terrible!! And I have one of the best health plans available and access to the best hospitals in Los Angeles, yet I cannot get the care that I need. I cannot afford to fly to Europe to pay for this surgery and so you are lucky!! Please keep me posted as your outcome and let me know if you have any relief with the L5- S1 and whether it is from a fusion or disc replacement. Have a great day!

[Justin]

Hello strictlyna,

Welcome to the Spine Patient Society. I'm sorry that you are in the "fighting phase" with your insurance company--it's draining, as I've been through it myself.

Thanks for responding. I am so confused because I have been told not to let the doctors do a fusion and that a disc replacement is the only way to get better.

The bolded statement above is false. Spinal fusion has been the gold standard in spine surgery for the last ~50 years. Spinal fusion is a great procedure in properly selected candidates. I also personally believe that fusion is not a bad option at L5/S1 (a lot of literature supports this notion).

Artificial disc replacement is by no means a "cure all." It's still a man-made device that poorly replicates our physiology. However, I do know that these are the devices we have available to us as Spine Patients. I guess I'm just trying to relate that I've seen/spoken with countless Spine Patients over the years (about the last 10) that think "If I could just have an artificial disc, I would be as good as new." This is seeing things through rose-colored glasses. I'm not trying to be frank, but present an opinion from a Spine Patient that has had 3 spine surgeries myself. I do understand the -- "there is this new operation that can take my pain away and make me better" thought process, especially when you are in chronic pain.

An artificial disc will not fix the "collateral damage" that has occurred to surrounding structures and elements of the spine, especially if this has been a long-standing issue and you are a more mature patient (someone in their 40s - 50s, etc.).

Is artificial disc replacement a good option for many Spine Patients? Yes. Is it any better than spinal fusion? This is debatable. In properly selected patients, spinal fusion and artificial disc replacement are both great procedures.

What does your L4 disc "look like" now?

[Cindylou]

This was such a great response Justin. It should be saved and earmarked for future reference to this/these type of questions. Thank-you for articulating it so beautifully. CL

[Justin]

This was such a great response Justin. It should be saved and earmarked for future reference to this/these type of questions. Thank-you for articulating it so beautifully. CL

Thanks, CL.