Think my 2 best options are.... Any Advice?

longroadahead · #1 (**permalink**) 04-13-2011, 02:17 PM

Appreciate the very good explanation of the SED procedure and was ready to send my $250 for the SED but contacted DISC and they sent me Unitied Healthcare's policy on the procedure. Yeap, it is not covered.

On another note, finally got ahold of Dr. Scott Blumenthal's office and he thought my bone denisty scan was too low for a Prodisc. I am 37 and Bone Denisty is (1.7) - (2.4) range in L1 - L4. Could this be my underlying problem?

Say Dr. Andrew Dossett a few days ago and he said I should just have a microdisctemy and if that didn't fix the back pain he would leave it alone.

Maria · #2 (**permalink**) 04-13-2011, 02:25 PM

Mark,
thanks so much for explaining that and in terms one can easily read/understand. What would the inclusion criteria be for this procedure or exclusion? Does it depend on grade of tear/type of tear/location of tear/tear of many years vs. more recent tear/ tear unaccompanied by signficant loss of disc height??

cp7959 · #3 (**permalink**) 04-13-2011, 07:41 PM

SED sounds interesting, especially since I have an Annular tear. I have a few questions if anyone has the experience to answer.

With the SED procedure, does the Dr. enter the disk from the back going thru soft tissue only or does he create a path thru bone?

With the endoscope entering the disk thru an access point other than the tear, does this create another week spot in the disk in which another tear can form?

How long does the SED last, is it a short term fix, what are the long term results?

And the $$$$ question, how much? I'm sure my BCBS insurance isn't on board with this.

Thanks in advance.

mmglobal · #4 (**permalink**) 04-14-2011, 02:28 AM

I think that most insurance providers will not fund SED. Having said that, I still think it's odd that a spine center will go out of it's way to tell a patient that another center's procedure is not covered. I would check with the SED provider. As I said it may not be covered, but I would not depend on the info received from a competitor.

Anyone considering SED should contact the SED doctors for inclusion criteria. From my memory (which cannot be trusted), discs with grade V tears are not good candidates. Discs with severe collapse and loss of disc height are not good candidates. Classic discectomy candidates are good candidates for SED. This leads me to the conclusion that if you are a good candidate for one, you stand a good chance for all of the procedures, whatever the 'twist' they add in addition to the traditional discectomy. Having said that, I believe that the thermal annuloplasty as the twist, gives SED a chance to deal with discogenic LBP that most other discectomy techniques don't. If I could go back and redo my 2000 and 2001 discectomies, I would do SED.

How long will it last... depends on how lucky you are. IMHO, if you get a few years out of it, you win. More and you win big. Like all discectomies, there is a substantial chance that success will last only a few months. The recurrant herniation story is very common. Even so, the alternatives (adr and fusion) are to be avoided if possible... so IMHO, good candidates for discecomy should try it first instead of opting for the bigger surgery first. If you fail that (like my wife did... her endoscopic discectomy was a great success, but only for 3 months) you are unlucky and lose the bet.

Mark

mmglobal · #5 (**permalink**) 04-14-2011, 02:34 AM

Access for SED is like most endo discectomies... it is through the soft tissue and follows the path of the discogram needle. They use expanding canulas... increasing diameter tubes to convert the needle stick into an opening large enough to accomodate the scope.

Even though they use the needle path for the scope, the may still have to remove a small amount of bone to clear the scope. THIS IS WHERE ALL MISS PROCEDURES ARE NOT CREATED EQUAL. I have several clients who thought they were getting MISS procedures that would preserve their later ADR option, but the surgeon removed too much bone, basically removing a facet, and destabilized the system so that ADR was no longer an option.

You must discuss this with the surgeon in advance and be certain that he understands and is experienced enought not to just do it the easy way... but to get it done the right way. In one of these cases, it was a complete surprise when the patient discovered 6 months later that a facet had been removed. So much for MISS for him.

Mark

cherylstewart67 · #6 (**permalink**) 07-24-2011, 07:32 PM

there are surgeon that only know one thing fusion and they won't tell you what the other options are. think about why for yourself...but me personally if they can't give me more than one i dont trust them anymore. if i had had a computor at the time i would have done more reserach, but i trusted my doctor. he failed to tell me what all was out there!

Maria · #7 (**permalink**) 07-25-2011, 12:03 AM

I really dislike hearing only one option is available to me. It might be true at this point (my age and how long I've let things go however if someone can give me a good reason physiologically/structurally/or medically why I'd not be a good candidate for other options that carries more weight but I dislike when surgeons discount one thing over another just because they don't or can't perform a certain surgery. That's not being considerate of the patient's true needs and I too say walk away and think about this while looking to get more opinions from surgeons that might perform fusion and ADR or at least be open to the idea and or suggest other options.

cherylstewart67 · #8 (**permalink**) 07-25-2011, 01:30 PM

Quote:

Originally Posted by Maria

I really dislike hearing only one option is available to me. It might be true at this point (my age and how long I've let things go however if someone can give me a good reason physiologically/structurally/or medically why I'd not be a good candidate for other options that carries more weight but I dislike when surgeons discount one thing over another just because they don't or can't perform a certain surgery. That's not being considerate of the patient's true needs and I too say walk away and think about this while looking to get more opinions from surgeons that might perform fusion and ADR or at least be open to the idea and or suggest other options.

i do not understand how in good concience a doctor would not tell you what else is out there, but mine didn't. keeping information from someone is the same as lying to me. i cant go back now though. but moving forward i pray there are other options...

dshobbies · #9 (**permalink**) 07-25-2011, 05:43 PM

My first disco/lami was an emergency and I don't think there were many other options in 1994 anyway. However, I trusted that same doctor in 2002 to do another great service to me when the next level went south. He performed another disco/lami knowing it would probably fail and involve yet another level. He knew the odds and the other remedies out there, whether he believed in them or not. He was not 'legally' obligated to tell me about them because ADRs were not yet FDA approved. Second surgery failed within the year.

This doctor was highly respected in his field and considered a top surgeon. My anger has subsided over the years but had I realized some doctors serve themselves first, I would have done my own research or at least, get a second opinion.

Currently, a good friend, whose back has been getting worse over the years, was ready to go for her doctor recommended 4 level lumbar fusion. Blue Cross denied the four level but approved a 2 level. She didn't call me because she knew she'd get an earful- but then why would she just follow her surgeon blindly? Her husband had a successful dicso/lami 15+ years ago and is pushing her toward surgery. But a 4 level fusion?????? What kind of doctor is he, a sadist? I gave her the names of Dr. Regan and Delamarter for second opinions. Stay tuned.