WOW! It seems Im perhaps the first patient on these message boards to have gotten the new Prodisc -Nova model. As posted my Mark at I spine, below is a brief description of the new Nova prodisc
"They changed the keel configuration to minimize the risk of adjacent keels in multi-level procedures becoming 'stress risers'. Instead of central keels on both the upper and lower plates, the new Nova version has a central keel on the upper plate and 2 smaller keels on the lower plate.
Most importantly, the new Nova is MRI compatible because instead of the metal components are primarily titanium instead of cobalt chrome. Titanium does not have the durability of cobalt chrome, so Synthes did it right and retained the cobalt chrome where it's needed. The wear partner in the joint are still UHMW Polyethylene and cobalt chrome, while the major portion of the metal is titanium to make the prosthesis much, much more MRI compatible."
Anyways, I had originally submitted my films to Dr B's team in Germany on Thursday 2/12 and my prognosis/surgical recommendation came back on Sunday 2/15 with a assigned surgery date of 2/26. It all happened very fast!! (thank God! Besides being in severe pain, my Aetna expired 2 days later on a Saturday 2/28!! I made it by 1 day!! I can now appeal for reimbursement of a multi level ADR)
I was originally scheduled for a 2 level but as my discogram done here in the US indicated that the C4/5 had a tear (but produced no pain at the time), Dr B was suspicious that it might be a bad disc also. He said he wanted to take a look at it interoperatively and asked me how I felt about replacing it also it it looks bad. I advised him to replace it if it looked bad as I really didnt want to have to return for another expensive surgery a year or two later. So, he did a discogram while he had me cut open and he witnessed the dye material leaking into the spinal channel and so he replaced it. Apparently the discogram done in the US showed it just had some tears but didnt cause pain. This is why Dr Z was only reccomending a 2 level. The day before, Mike(known as pizza man on this board? ) was supposed to get 4 levels done but Dr B said he only needed 3. So, this is good to know that DR B simply calls it as he sees it. Ive heard he is actually quite conservative about suggesting additional ADR's.
As it turned out, Surgery went well but I was really in alot of pain and discomfort for the first 24 hours. No matter what body/head position I layed in, I could not find a comfortable position to lay in. I was constantly turning and churning every 3 seconds trying to escape the agony. My heart was racing and a sort of panic started taking me over. The german patient I shared my room with spoke some english and he asked me if I was ok. I told him, "No, I think Im in shock". LOL. But I think I really was. Its AGoNY not being able to get comfortable and I started to panic. They gave me more pain killer and some valium and it did the trick. 4 days later I checked out of the hospital and pain level was only about a 4 (on a scale of 1-10). But it seemed to get worse during my week long stay at the hotel in Straumbing, oftentimes the pain level was more like 6 at times. I couldnt hardly go walk anywhere for more than 20 minutes (like going to eat) without having bad pain and having to lay down again. Some days it was agony just sitting at the dinner table with my friend. Even the smallest head movements could send pinched nerve sensations through my neck. I spent a week just laying in bed day and night. I could not sleep for more than an hour or two at a time so I just got whatever sleep I could get in small doses. But overall It wasnt too bad I guess.
The post op pain I have been referring to above and currently having now is only from about the a few inches below shoulder level on up, due to muscle stretching that occurs during surgery. The SEVERE old DULL pain between my shoulder blades and my below the waste symptoms are all gone!! I could feel that from day one after surgery! But one thing that still frustrates me is how badly the US doctors "missed" the call on my below the waste symptoms. In some ways these US doctors dont seem to know squat! I had gotten several second opinions from 2 well known top rated surgeons, one orthopedic and the other a neurologist. One sent me to a urologist for gods sake, I knew it was a waste of time but I did it anyways just to prove to him it wasnt anything related to a seperate urology issue. The US doctors kept telling me that it was "IMPOSSIBLE" that my below the waste symptoms were related to my cervical spine issues. They said so because the spinal cord doesnt go down that far. However, to his credit, my 3rd opinion, from Dr Z, was the only "US" doctor who said it was a possibility". Of course, as I suspsected, Dr B said it was not at all uncommon to have cervical patients have below the waste symptoms and he sees that quite often and that he expected mine to clear up with this surgery. And he was correct as it did resolve after the surgery. IMHO, these US doctors still have a long ways to to go to get to the level of EXPERTISE of the german doctors.
My 3 level surgery should have taken about 3 hours but Dr B says it took 6 hours because in his own exact words, ....my case was "technically complicated and challenging". He further stated "We had to do alot of remodeling and restructuring". He went on to explain that he checks every single nerve at each level to make sure there are no other compressions occuring. In my case it sounds like locating each individual nerve at every level was a bit tough and then he had to further decompress some of those nerves further ,....I guess that besides the bulging discs compressing the nerves, I probably had bone spurs and other structures that were pressuring my nerves that he had to "restructure" , or perhaps shave away some bone spurs to uncompress them. Im not exactly sure of the precise details but this is basically what I understood him to basically say. I do recall reading "stenosis" in my MRI reports, so yea, maybe he cut away some bony out growths or stuff like that? He sure went all the way for me by doing a 6 hour surgery. At our post op consultation, I looked him in the eye and gave him a heart felt "Thank you" for spending all that time on getting me done right, to which he replied "it was my pleasure". Ive heard (though dont know if its true or not) that not all doctors will spend that much time and go quite that far as they have other patients waiting for surgery behind you. Ive heard that many surgeons will just put in the discs and fix any obvious compression issues and not really get too involved in looking at every single nerve and check for any further deconpressions that might need doing. I know that in my case, this is what made my surgery a 6 hour surgery. My surgeon said "steve, I am never in a hurry when I do my surgeries. Some 3 level adr patients take 3 hours while others take up to 6 hours like yours". I wonder if there is any truth to the idea that not all surgeons are equal when it comes to the amount of time they are willing to go into in checking every single nerve and other details etc when doing a ADR?? Just curious.
Anyways, if I had done the 2 level here in the US with Dr Z, I bet we'd have never discovered the 3rd faulty level. Dr Z was just going off the discogram and saw that only 2 levels were causing pain. I really love dr B's approach. He visited at least 3 times in my patient room. It was real nice to be laying in the hospital bed watching TV and to have him just swing on by from time to time discussing things with me. Of course, the final meeting was more formal in his office and we had our picture taken together and he asked me if I was interested in serving as a reference for other patients which I am very happy to do. As we got up to leave, he again restated how much he is worried for patients who are getting multi level fusions here in the US. He seems to think that the risk of fusion gets exceedingly riskier the more levels that get done. The risk, of course, is needing more fusions done in the future due to a cascading effect if a stiffer and stiffer fused spine.
So, bottom line is that I am 100% "Old" pain free!! Just dealing with the post surgical pain. Dr B is an incredible person!! I chose him based on the fact that 99.9% of the patients who posted having surgery with him (and Dr Z also) all came out great.I didnt see quite as high of a success rate with US doctors. But I could be wrong, its simply my own personal observation that affected my decision making. I do know that many US doctors do a fine job also, but as mine is a multi level procedure, I really needed to go with experience in this case. And given that one of the best in the world said I was a technically complicated and challenging case, it sure felt good to know that I didnt go with a much less experienced US doctor, IMHO. Dr B has done more multi level surgeries than any other doctor in the world and that played a part in my decision also. My next step is to prepare for going to war with Aetna.
Please, if anyone can send me proof of their insurance carrier covering 2 or more level ADR's , or if you can direct me to someone who has, please contact me at Or PM me here at this forum. Besides getting copies of insurance approvals, Im willing to take any other info you can email or fax me or refer me to that you believe was helpful in winning your appeal(i.e. such as studies showing how ADR is cheaper or has better outcomes than fusion etc). BUt my most valuable ammunition is proof of other insurance carriers covering these, especially Aetna as I had Aetna coverage at the time of surgery.
Here is my X r ay. Ill post a few more in the next day or two. ">