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Skip Level Surgical Options

SkipLevelSSkipLevel Posts: 5
edited 07/01/2015 - 9:21 PM in Back Surgery and Neck Surgery
Hello all. I've been taking in everything I can about spine health lately and I am hoping to solicit some feedback from the forum on my condition.

I am 34 years old and had an MRI in May after a few months of numbness in right hand/arm, left foot/leg, some radiating pain down right arm, and occasional weakness. The MRI revealed 2 large herniations at C3-4 and C5-6 that were compressing the spinal cord. C3-4 was the worst with significant edema and the MRI report also used the scary word myelomalacia. C5-6 has thecal sac effacement. C4-5 is the healthy one stuck in between. Overall I have very minor symptoms and pain, but they do seem to be trending worse.

I have now seen 3 surgeons, 2 ortho and 1 neuro. All 3 say I need surgery and all 3 have commented that I am a fairly unique case. Also, all doctors have mentioned 'silent paralysis' and that lack of pain doesn't necessarily mean I don't have a serious condition. Each doctor has given me a different surgical recommendation: 3 level ACDF, a laminoplasty, and skip level ADR.

I'm being told the 3 level ACDF is necessary because skip level ACDFs will almost certainly cause the skipped disc to fail. A 3 level ACDF scares me and also makes no sense to me to take out a healthy disc.

The laminoplasty seemed like a good option at first to decompress the spinal cord, but the other 2 doctors disagreed with this and this approach. I've also read lots of stories of tough recoveries and lots of residual pain given this is an open procedure. Muscle atrophy is also a major concern.

The 3rd Dr recommended the skip level ADR and after reading up on it and lots of recovery stories, this seems to be the most logical for my age and the fact that it only addresses the discs that are problematic. The problem is that the Mobi-C disc is the only one approved for 2 levels and those levels have to be contiguous. The Dr offered this procedure and gave me the impression that he could convince insurance to approve it for my unique case. As you might expect that hasn't been the case. The pre-auth has been denied and it's now been a month and I am now just starting the appeal process. The Dr is impossible to get a hold of and his office staff have been less than proficient at dealing with the insurance company. There is no sense of urgency from anyone and they keep screwing things up. For example, the pre-auth peer to peer (doc to doc) review period expired because the Dr was out of town and apparently no one planned for this.

So I am now strongly considering trying to find a new doctor if appeal is denied (makes me sick to start this process over again), but I will still have the same problem in finding an appropriate treatment for skip level herniations.

- Has anyone heard of a skip level ADR being done?
- Does anyone know of other options to address skip level herniations?




  • LizLiz Posts: 7,832
    Please take the time to read this post and refer to it when you have questions

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    Doug Hell

    Also working with us very closely is Allison Walsh from the Spine-Health company


    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Anyone had to deal with at least 2 non-contiguous herniations?
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