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Help with approval ltrs and finding studies for my appeal
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| iSpine Discuss Help with approval ltrs and finding studies for my appeal in the Main forums forums; Dale: Do you remember any details about why 3-level fusion is contraindicated? Does that apply to both cervical and ... |
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03-17-2009, 02:55 AM
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Dale:
Do you remember any details about why 3-level fusion is contraindicated? Does that apply to both cervical and lumbar? A friend of ours just had 3-level cervical ADR and is planning to appeal, as well. His "choice" for surgery was 4-level fusion or 3-level ADR. 
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03-17-2009, 10:56 AM
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Steve,
You may want to get an "estimate" from Dr. Ziglar and any other ortho/ neurosurgeon that will give a cost estimate for multi-level fusion and use that as a comparison. You may want to offer signing an agreement to not file a claim for revision surgery if needed. I think I've read that your surgeon performs revisions (if needed) as no charge "warranty" except for travel expenses. I haven't gotten there yet, but maybe a workers comp attorney can help you navigate your way through these processes. It's important to not let yourself get discouraged at the rejections, just keep hammering them on a monthly basis. Good luck, Bob
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04/06 L5/S1 Rupture 05/06 MRI shows DDD @ L2-S1 06/06 Diskectomy/ Laminotomy L5/S1 04/07 Recurrent Disc Surgery L5/S1 3 Ortho and 1 Neuro Surgeon, 3 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later: 03/27/09 Maverick ADR at L4/L5 & L5/S1 03/27/09 The Lord and Dr. Ritter-Lang returned my life to me.
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03-17-2009, 05:46 PM
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Sahuaro,
If memory serves, I found this article almost 3 1/2 years ago, it pertained to lumbar fusion and the reason for the contraindication was multi-level fusion actually promoted DDD. I searched my bookmarks in an old computer (shocked I still have it), I googled it and looked for the article which I printed out but so far, nothing. I will soon be putting my 2008 records into storage and will see if I can find the article in a storage box but keep in mind, if this was written 2004/5, it may no longer be relevent. However, I suspect it is. While looking through my bookmarks, I'm pretty sure I found the article in Back Pain: Trusted Information for Pain Relief | Spine-Health. Sorry I can't remember more. Dale
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3 level Prodisc adr S1-L3, Oct 12, 2005 Dr. B in Bogen, Germany Severe nerve damage in left leg, still working on it
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03-17-2009, 06:23 PM
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heres a great site for papers written by doctors just search link is for bertagnoli.
Bertagnoli,R chuck
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ddd 1990 2003 mri,xrays,shots,emg 2004 discogram ouch pos l4 l5 facet block neg lost all appeals BCBS 5 months of that 3 surgeons later surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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03-18-2009, 06:09 PM
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I knew there was a paper that I had seen in the articles section of this forum, that compares cost of fusion with ADR. It is for single level, but I would think it would transfer to multi-level. At least it is a starting place.
Here is the thread. An economic model of one-level lumbar arthroplasty versus fusion But let me know if you can't pull up the paper. I can save it in PDF, and email it to you, if need be.
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Cathy 46 years old. 12-15 years of intermittent pain, 2 years with constant pain. DDD, L4-5 and L5-S1, pain confirmed by discogram. PT, ESI's, Facet injection and block, Acupuncture - all no help. 2-level (Prodisc-L) ADR surgery with Dr. Bertagnoli, May 26, 2009. Currently taking Opana-ER (tapering off) and oxycodone Last edited by treefrog; 03-18-2009 at 06:13 PM.
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03-19-2009, 03:56 PM
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treefrog, that is a very good article. Is there any that give actual cost in dollars and cents? I know that is hard, with the costs being scattered between the hospital departments, etc. It took a long time to find that for up here.
The ironic part is that the report also states, along with almost every other publication I've found, that the reason they are not doing more ADRs is because of costs....even though their other own government department proves that it is instead cheaper, not more expensive. I suspect they mean that they can not afford all the training, etc. Short sightedness again..... Have you had any more luck with this, Steve?
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DDD Herniated discs C4/5 & 5/6, L3/4, L4/5, L5/S1 Severe compression of spinal cord in two levels All conventional therapy exhausted, including spinal injections, PT, massage, etc. In appeal with Gov't Insurance for Out-of-country coverage for ADR hybrid surgery of above discs. Recently discovered that I am severely allergic to all common metals used in surgical hardware except for Titanium.
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