[Spinal Fusion / Cervical] Anterior cervical discectomy and fusion (ACDF) at C5-6 and C6-7 with anterior plating

[TSH]

NOTE: Tom's post-operative posts start on Page 3 of this thread -- click here for a quick link (Edited by Justin so that others can easily find Tom's post-operative posts)
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Hi all SPS members

so after 53 yrs of a healthy lifestyle, bad genes and age are going to make me slow down for a few months. i've had pretty severe symptoms in my left side, the majority being turning my head to the left, left shoulderblade pain, muscle spasms in the left lat, pec and upper arm, left arm tingling/sleeping from the elbow to finger tips, the list goes on. when the tingling and shoulder blade came on strong last august/september i got in to see my primary doc. we did the PT, exercises, massages, medications and it just kept getting worse, i blamed it on all the crap that hit the fan at my job but my february follow up the doc said the answers might be found in an MRI, we did 2 because my symptoms are irratic, he did the cervical and the left bracial plexus, but as i had guessed because of the neck stiffness that that is where we'd find the answer. well it was but it was worse than i thought, my doc had me an appt with the local NS the following day!

here is the report:

FINDINGS: Vertebrae body alignment is anatomic. Signal at the cervical cord is normal. All discs are desiccated. Marrow signal is heterogeneous but within normal limits.
C2-3: Normal
C3-4: There is severe left neural foraminal stenosis secondary to uncinate and facet hypertrophy. Right neural foramen and spinal canal patent .
C4-5: Moderate bilateral neural foraminal stenosis secondary to uncinate and facet hypertrophy. Borderline spinal canal stenosis noted at 9 mm.
C5-6: Severe bilateral neural foraminal stenosis secondary to uncinate and facet hypertrophy with broad-based disc bulge. Focal spinal canal stenosis of 9 mm with fluid persisting posterior to the cord.
C6-7: Severe bilateral neural foraminal stenosis again secondary to uncinate and facet hypertrophy. No true spinal canal stenosis.
C7-T1: Normal
IMPRESSION: Multi-level degenerative changes producing borderline spinal canal stenosis and left predominant neural foraminal stenosis at multiple levels. Findings may account for the patient’s symptoms. No acute findings. Specifically, no acute annular tear, or evidence for trauma.
So the NS gave me 4 options and then said i've already used up 3 so the only thing left was surgery. He recommends ACDF at C5-6 and C6-7 with a ti plate at the 3 verts involved.
i'm ok with the surgery really but after 50 + yrs i'd think we'd have some more advanced options which is what brought me to the SPS. i'm seeing a lot of publications regarding ADR, i know that the FDA hasn't approved multi level ADR but how about the fusion and ADR hybrid surgery availability in the southeast pa, northern md area? being a very active person (with no intentions of stopping until i'm ready for the glue factory) i don't want to lose my mobility, but more i don't want to accelerate the ASD that i am bound to have due to the already degenerated C3-4 and C4-5.
thanks for reading
tom hunt

[bigdogchief76]

Welcome!

There is a plethora of info here for you. Many folks have walked your road.

I do want to mention that the FDA does not approve medical procedures; they are responsible for the equipment/safety of devices and drugs used for procedures. The medical community has to show in research that new procedures with new equipment is a safe or equally proven procedure to known surgical outcomes. ADR had to show that it was not WORSE then fusion during the initial trials.

What drives whether or not you have to pay for it, is the insurance company. They hold all the power over dr's and patients in the US. When they use terms like "experimental" or "not medically necessary" that equals "we don't want to pay for it"

Again, welcome and don't be afraid to ask questions. I know of a couple of folks on here that were in your same spot.

[KBear]

Welcome to the forum! Did the surgeon mention how bad your facets are? If they are degenerated too much, then you would not be an ADR candidate as that is a contradiction. Just how bad they can be is debatable and different surgeons will say different things. I personally would err on the side of caution. My MRI report said mine were moderate damage, whereas all 3 surgeons I saw said they were mild to moderate and I was still a great ADR candidate.
A hybrid surgery is an option if you are a good candidate and there are several on here who have hybrids. I think it's a great solution in many cases. I also wouldn't rule out fusion based on all the bad said about it. It's been the gold standard for years and there is a reason for that. My best advice is to research like crazy, get multiple opinions and then make the best decision you can with the information you have.
Good Luck,
Kathy

[TSH]

thank you kbear and bigdog, this type of help is exactly why i joined, i'm not discounting anything right now, i would have scheduled the ACDF already but taking action on this was put on temporary hold, i got this diag thurs 2/3 and my wife was diagnosed with cancer fri 2/4 again so i've put my effort into her issues first.

here is a question for you both, my doc and the NS that i've already seen basically said i'm pre authorized for the ACDF, probably because i've exhausted the conservative treatments and the ACDF is the gold standard. looking at ADR Hybrid as an option should i first talk to my insurance company or find a surgeon/doc that thinks i'm a candidate? i asked about it at my local NS and they said they don't do very many because insurance usually won't pay for it. the are the most highly recommended practice in my area but i am easy driving distance to johns hopkins or anything in philly.

thanks again for the already valuable information...

[bigdogchief76]

Well, first off my heart goes out to you and your wife; when it rains it pours. Hang in there!

I highly encourage getting your hands on your summary plan description (SPD) for the insurance you carry. Secondly, do a google search for the procedure you want plus add in the name of your insurance company and policy. So for instance: disc replacement aetna policy or blue cross blue shield Texas disc replacement surgery.

Understanding what you can expect from insurance is very important, regardless of what a NS or orthopedic will say. Drs are somewhat oblivious to policies, as are their staff people.

I just got full benefit coverage from aetna on ADR; I knew the policy (after many long hard life-lessons) stated ADR was a covered benefit for my condition. The doctor office was clueless. I printed off the policy and took it with me to my appointment.

Being smart on insurance is going to get you angry at the BS that insurance can pull, but its going to help you with potential appeals you might have to do for both your wife and you.

[KBear]

Tom, So sorry about your wife's cancer diagnosis. I agree with bigdog, when it rains it pours. It's hard when you are in it to see the out, but it's there. We had a few years like that, both hubby and I developed back problems, had a child with major ear issues and my brother was diagnosed with cancer right before he turned 30. For a long time it didn't seem like any of it would end, but I can say now that hubby and I are both pain free, daughter is all better and brother is in remission!

Before I started the insurance battle, I would find out if you are even a candidate for ADR. I would hate to see you spend tons of time and energy and then find out that it's not for you. As far as coverage, more and more insurers are covering it. There are a few on here (bigdog is one), who's insurance denied fusion but is willing to cover ADR. In the last year things have really been changing and we are hearing of more and more people getting ADR covered. So, I would go ahead and get those 2nd and 3rd opinions, if they say hybrid surgery, then have them submit to insurance and see what insurance says..... you never know, it may be a yes right off the bat. I'm not in the Philly area, but I have heard several of the members speak highly of a Dr. Balderston (I think that's how you spell it). Justin, who started this forum, I believe consulted him before his surgery. I'm sure others will pipe in soon with more information.

[TSH]

thank you kbear and bigdog - if there is any good news with a cancer diag, it's that this is a new cancer and not a recurance, she had been in remission for 11 yrs and this is a new cancer and it was caught very early so although its pretty crappy the outcome looks good so far.

so on to my own issues...

first should i repost to somewhere other than the new member area?

second, congrats bigdog, i am very happy for you.

i've made a decision my my second opinion, i'm going to call my PCP for a work order to get me in to see todd albert at the rothman institute, i've read a pile of his publications and feel confident that he can tell me if i'm and ADR candidate, if i'm not then i'm going for the ACDF.

thanks again

[Justin]

Hi Tom,

Welcome to the Spine Patient Society.

You've received great advice from both Kathy and Matt above. I just wanted to wish you and your wife the very best. Please let me know if there is anything we can do here at SPS to help with your situation.

I wish you nothing short of the very best.

[TSH]

Thank you Justin, just these few emails have helped me make confident choices already, which in turn has helped me mentally. We are both going to be fine, thank you all for your support.

[Cindylou]

Thank you Justin, just these few emails have helped me make confident choices already, which in turn has helped me mentally. We are both going to be fine, thank you all for your support.

So glad to hear it Tom. Let us know if you find out you are a candidate for ADR. I hope the appointment goes well. Be well, Cindylou