New member -- Artificial Disc Replacement (Approval after initial insurance denial)

[RCWIII]

Well - here's my story. I injured my back in the spring of 2010 simply by squatting down in front of a piece of telecommunications equipment and standing back up - nothing in my hands and my back made a substantial "pop" noise. I say substantial because in switch rooms all the equipment have fans that run constant and in the area I was in there were enough fans to feel like you were in a wind tunnel, plus it was loud enough that one of the engineers with me heard it and he was about 2' away from me.

So after driving 3 hours back home in pain I make an appointment to my family doctor who refers me to my first D.O. A set of MRI's and some simple tests in his office he shows me the area of my back in concern: L3/L4 disk desiccation, L4/L5 DDD with posterior disk bulge (5mm) in and suggests that I have the Facet injections to alleviate the pain and some rigorous physical therapy to strengthen my core... I have to say those Facet injections were like instant relief - however they didn't last long at all and I was in pain in a matter of weeks. I later figured out that the injections would only offer temporary relief and really did nothing to correct the issue (disks).

So I go for a second opinion - which required another set of MRI's, a Myelogram, and some tests (EMG, ect..). Now, this second doctor, looks at my films and suggests that I have a fusion from L3 to S1. I'm not too keen on fusing my back at 36 - just doesn't set well with me. My father had a fusion in the same location from a vehicle accident and I saw what he went through. So, we go over the films and the additional tests that we didn't have the previous year. I have follow-ups with him to go over the options and gather as much data as I can. He explained two options for me - trim the disk to correct the nerve damage in my right leg and partially fuse the posterior transverse process of the vertebrae (for strength) or a full disk removal/fusion from L3-S1 to correct everything. I still didn't feel comfortable with this.

I felt it necessary to get yet another opinion so I found the third doctor. He looked at my films and test records then looked at me and said - "I bet they told you to have a fusion done from L3-S1, right?". I said yes and that's when he went into great detail telling me that it was not necessary because the L5/S1 disk was perfectly healthy and realistically if we read the radiology reports the DDD is prominent in L4/L5 along with the bulge and how the disk actually sank a few MM's in the vertebral foramen (spinal cord duct), he's the one that showed me the small tear in the L3/L4 disk on the MRI. We spoke in depth about the extend of damage to both disks and what the likely-hood of detrimental damage would be for the L3/L4. Eventually I'll have to address that disk area, but it could be 15 or 20 years down the road. I went through and asked him a series of question regarding options, down time, recovery time, and what I could potentially be looking at 5 years, 10 years, 20 years and so down the road. This is very important to me as I don't want to continue to have surgeries and would like the best option for longevity. We started talking about ARD - I literally spent 2 hours with this doctor on my initial visit and he addressed a gauntlet of questions from me and explained everything to where I clearly understood what I was looking at.

It all was made perfectly apparent to me when he made the comment that I have substantial nerve damage in my right leg/foot. I made an offhand comment about what his definition of "substantial" was and what my definition of "substantial" were two different things and I needed something to show me what "substantial" was from his perspective. He said that's fine - we can do a simple test to show you what "substantial" is. I was getting defensive as I've gone through several tests in the last couple of weeks and didn't want to schedule another one and made that perfectly clear. He said, we can do it right here, right now. Stand up and turn around (immediately my mind races to a bad joke at this point). He instructs me to place my hands on the table and pick my left foot up off the ground (heel to my rear) and stand on my tip toes on my right foot. In my head I'm thinking this is some sort of joke - really tippy toes?? So I go to execute this maneuver - and to my disbelief, I can't. I try and try but can't get my right heel off the ground. He has me change to my left foot and repeat - to which I immediately stand up on my toes. I turn around and he smiles and says, "now we have the same, clear definition of "substantial"!". I left his office thinking, this is the guy that's going to help me get well!!

Then we hit a snag - Insurance.....my insurance provider would not cover the ARD, but would provide coverage for the surgery and/or the fusion and/or the laminectomy. Nice huh? Insurance is telling me that I have to do something that is against my core value. So Dr. #3 went through and wrote an extensive letter of appeal to my insurance provider - Monday 9/26 I received the letter stating that they (insurance) have approved the procedure!

I'm waiting on a call from his office now to see about the scheduling of the ARD surgery and trying to do my due diligence to research as much as possible but from my personal perspective - the ARD appears to be the better solution in my situation.

I know that most of us have lived with the constant issues of back pain over the years and we modify our lifestyles to cope with the pain the best we can, making sacrifices to our lifestyles. Keep hope and faith never sacrifice that.

[KBear]

Welcome to the forum Robert. Sounds like you have half the battle over.... getting a correct diagnosis, knowing what treatment you want, the surgeon who will do it and insurance approval. We all have to come to the point of knowing enough is enough and being ready for surgery, when we realize that we can't keep going on like we are. It's a hard reality to face, but it also is the first step in getting better.
Best of luck,
Kathy

[Justin]

Hi Robert,

Welcome to the Spine Patient Society.

Congratulations on having your artificial disc replacement surgery approved! That's a HUGE step that many Spine Patients here have been fighting for a long time -- some years.

Keep us posted on when you are scheduled for surgery, as we would love to hear about your successful outcome.