Having problems choosing Surgeons

jbcool35 · #1 (**permalink**) 04-17-2011, 08:36 PM

Hey everyone,
I'm new here. I had a 360 lumbar fusion at L5/S1 in May 2008. It didn't fuse and I have a loose screw in the back part of the hardware. I got a second opinion months ago from an orthopedic surgeon and he wants to go in through the front, remove the metal plate, take out all the bone graft and put in a new bone material since the BMP didn't fuse me. He syas the screw is loose cause the plastic containing the BMP is crushed. He will also give me another bone growth stimulator and a big belt to wear. He has confirmed I'm not fused with x-rays and a CT scan. I also have a loose screw in the back part of the hardware.

Didn't feel comfortable with that, so I went to Cedars Sinai and got a third opinion from a supposedly "really" good neurosurgeon Dr. Frank Acosta. He said he would never go back in through the front because of all the problems that can happen. He said he would go in through the back, add more BMP, put bigger screws in the hardware. He would also give me a bone growth stimulator and a huge belt to wear. He did digital x-rays and an MRI a few weeks ago but I haven't heard about that yet. He also has the CT scan from the second opinion surgeon and agrees I'm not fused. What do you guys think? Also I have workers comp. I don't know who else to get an opinion from.

Maria · #2 (**permalink**) 04-17-2011, 11:53 PM

Hi Cool,
My low back stuff has been WC for many years now (have future medical thru WC). I've seen a few orthopedic surgeons in the LA area and one Neurosurgeon in La Jolla that I'd recommend for "another opinion." Dr. Coufal is his name (Robert?)?

I'd definately want to see him if I was considering a fusion even tho he was my "2nd surgical opinion" that agreed on recommending a hybrid surgery w/fusion at L 5S1 and ADR at L4 back about 2006. Basically it was this surgeon's recommendation that got WC to agree to authorize a hybrid surgery for me back in 2005.

The ortho's I saw in the LA area were Dr. Delamarter and Dr. Regan.

Long story short all surgeons agreed on same surgery for me and then I decided not to have the surgery at that time. Still have not had more surgery to date.

jbcool35 · #3 (**permalink**) 04-18-2011, 05:30 AM

Thanks for the info. I will check out Dr. Coufal and see what he says. I also have future medical with workers comp. I sometimes wonder how that's gonna work out once obamacare go full force.

Maria · #4 (**permalink**) 04-18-2011, 08:50 AM

My OSS of the last 12 years has told me that WC is hardly authorizing anythng anymore. He said in 2 years Medicare will be the same (not authorizing surgeries). Then he said something to the effect of "wait until we have Obamacare".. so I think if you can get surgery auth'd now and need it that'd be good. I didn't do it when I could and I'm no longer even a candidate for same surgery tho thankfully getting along Ok.

ESIs helped me tremendously re pain but they're not being auth'd any longer either. WC adjustor calls me every so often to see if I want to settle out my future med/go medicare set aside. This last time she was too nice so it made me think something's up that isn't going to bode well in my favor.

** wanted to edit to add that Mark (this is his forum and he's a spine patient advocate as I mentioned on the other forum) accompanied me to the Coufal visit and while I think he would have given the same opinion re the 2nd surgical opinion I believe it greatly helped to have Mark there with me. When I was too tired to accurately state my situation Mark could word it in a way that the surgeon identified w/better (the original appt. was for a certain time and it got delayed a few hours because of an emergency surgery for Dr.Coufal and my spine wasn't too good at sitting/waiting). Mark also accompanied me to the Delamarter visit and got me into see Dr.Regan as WC didn't authorize that visit and I wanted his opinion as well. Again he asked questions or stated things I didn't think of tho pertinent to my spine situation. Long story short..worthwhile to contact Mark and talk at the very least. Check out the website below:
GPN Artificial Disc Replacement ADR

dshobbies · #5 (**permalink**) 04-18-2011, 06:24 PM

Hi jb and welcome to the forum,

I'm sorry your fusing didn't take. I'd be curious to know what your original doctor has to say about it but agree with Maria that Mark is a good source of helpful knowledge for other doctors.

I know workers comp can be difficult to maneuver through but in your case, very necessary.

I also realize that we have become a sue happy society but if you can't get them to authorize what needs to get done, including second opinions, perhaps it's time to get a legal opinion too. WC is not a people created nightmare, it is a political nightmare designed to avoid fraud but the result is most medical care, whether needed or not, whether work related or not, is not authorized. Let me just tell you this - you have only 1 back and usually only 1 chance to get it right. You know have a rare second chance. Don't let WC bully you into making a wrong decision.

Good luck, Dale

jbcool35 · #6 (**permalink**) 04-18-2011, 08:31 PM

Oh I learned long ago about workers comp and have had an attorney since then. I wouldn't get anything done any other way. They give me trouble and my attorney has always taken care of it. I just have a hard time trusting doctors. My original surgeon said I was fused solid!!! He outright lied to me and strung me along for a year. Then he said I can't do anything else for you.

jbcool35 · #7 (**permalink**) 04-18-2011, 08:48 PM

Does anyone have any information on Dr. Frank Acosta out of Cedars Sinai in Beverly Hills, CA? He is the one I'm scheduled to have surgery with next month. Would like to know if there is anything good to say about him.

joejoe · #8 (**permalink**) 04-19-2011, 05:12 PM

I dont have any experience with Dr Acosta. Im with Maria on Dr Delamarter. I recently had a fusion at L1-2, and 2-3, and a Disc replacement at L3-4, and L4-5. He was a great doctor. I feel after a lot of research ,and talking to others that he was one of the best . I am 7 months out of surgery and am very happy with the outcome.

jbcool35 · #9 (**permalink**) 04-19-2011, 08:42 PM

Well I'm gonna go over my current MRI and digital x-rays with the Doctor and I'll go from there. I'm leaning toward no more surgery. It just doesn't feel right in my gut.

Maria · #10 (**permalink**) 04-19-2011, 09:32 PM

I followed this too in latter years and haven't been displeased. Who knows maybe I woulda been better w/more surgery, maybe not. All I know is I wasn't psychologically prepared to be worse at all and felt Ok w/where I was at compared to where I had been post 2nd surgery and quite a number of years.

Then again.. who knows. Some people would say you're going to feel some "gut" reaction anyway and being nervous/scared is normal though I'm trusting my own instincts more and more after some bad trial and error. Again all is subject to change at any time re more surgery~ just felt that the time surgery was auth'd I wasn't really ready or had been more ready at an earlier time when WC was taking their time w/the auth (gave it, took it back, had to go another 2 more years to get it again and by then I felt differently spine wise).

Good luck either way. I'm sure you'll make a well researched thought out decision whatever you do.

dshobbies · #11 (**permalink**) 04-19-2011, 09:38 PM

While no one should tell you to have surgery or not, you are right in not going forward if it doesn't feel right.

Only you will experience any benefit with a positive outcome or suffer with a negative one. We've all second guessed ourselves into oblivion so if you're not sure but 'give in', you could very well spend the rest of your life playing the what if game.

Dr. Delamarter and Dr. Regan are both excellent surgeons with great reputations and egos that match. However, you're not shopping for a friend, you want the best.

Good luck, Dale