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Two-level cervical ADR

Aaron_BostonAAaron_Boston Posts: 2
edited 10/26/2015 - 5:13 AM in Back Surgery and Neck Surgery
Hi all,

My name is Aaron and I am new to this forum. I have cervical DDD with severe foraminal stenosis and central canal stenosis with myelopathy. I am 40 years old and very active. I work a desk job during the day and run a Korean karate studio at night. I am an avid gym-goer as well. Luckily I don't have a lot of pain but I have had a few changes in baseline and odd neurological sensations which have started talk of surgical intervention so I am gathering as much info as possible. So far, the only procedure mentioned has been ACDF and I am really uncomfortable with that considering the fact that my range of motion is key. I would need a two-level procedure done but I am so afraid about adjacent segment deterioration turning that into a three or four level fusion down the road. I feel strongly that ADR is a better option for me but I'm having some trouble with that here in Boston. Everyone acts like this procedure is brand new and I'm finding that there is a lot of misinformation! I know many of you have had two-level cervical ADR done in the states and am wondering where I would look for a reputable surgeon and what I should be prepared for insurance-wise. Open enrollment is coming up at work during which time I will be able to choose between Tufts, Harvard Pilgrim and BCBS (I currently have BCBS). Trying to figure out who covers what is very difficult but I'm hoping that I can get some good information and make an informed decision during the open enrollment period.

Thanks so much in advance!

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  • Hello Aaron.

    I just had a 1- level (C4) Mobi-C ADR that took place exactly 4 months ago. I had Dr. Falicov in Seattle to do my operation. But I'm sure that there are surgeons in your area that have also done many. Also, definitely ask exactly how many they've done. Get someone who's done at least 30. Even though this is new in the states keep in mind that it's been done successfully overseas for years. The one I got has been around since 2004 and over 17,000 patients have got a Mobi-C. I read a lot of research and saw the FDA studies on it before agreeing.. I have had problems with my C5 as well and so this one was used also since it will allow for another one to be done, if need be.

    My insurance agreed to it since I'd run out of options with PT, massage, acupuncture, etc. Essentially you have to have tried everything and then they'll agree. That with a scary MRI does the trick. The total price of the surgery (JUST the surgery) was $100,000. and was paid in full. I had to make sure and call them (both the Dr's office and Premera) a couple of times to make sure all the paper cleared. Get it in writing!

    First couple of weeks. Not comfy at all. Get lots of movies and audio books. Take short walks around your neighborhood (~2-3miles/day) Drink lots of water and rest your head when it starts to get sore. I couldn't take pain meds but survived with a shot of cognac a day and plenty of distractions. They will say you can go back to work within a week but listen to your body. I started back at two weeks on half days then went to FT at a month.

    All is going wonderfully now. Just building back muscle mass and my scar is barely noticeable (I can barely use it for Halloween..). No pre-surgery pain or numbness left (and it was pretty much at a 10!) Just a little gun-shy about driving too fast, etc. One feels a bit vulnerable after this.

    Good luck and feel free to ask anymore questions..

  • SavageSavage United StatesPosts: 5,476
    Welcome to Spine-Health
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  • Aaron - I had a 2-level Mobi-C ADR in Austin that was covered by BCBS TX. I had it done in February and couldn't be happier with the outcome. Feel free to look up my story (and a few others) here under the "recovering from surgery" topic (you could search for mobi-c?).
    L4/5/S1 scar tissue removal surgery, plus unexpected L4/5 microdiscectomy #2 October 2015
    L4/5 microdiscectomy May 2015
    2-level ADR C4-6 (Mobi-C) February 2015
  • Hi Brandis,
    Thanks so much for your response. I read your story and found it very helpful. I'm still confused about the insurance piece since I called BCBS here in MA and they said it would not be covered :( I have the option of Harvard Pilgrim who says they will cover so maybe it;s time to make a change. It's tough not knowing who the surgeon will be... Can I ask who did you surgery? I like the fact that this individual has done so many of them. I have called dozens of places here in Boston and no one is doing ADR here on two levels. It's very rare to even find a surgeon who will do one level. I may not need the surgery right away as the symptoms I am having at this point are a bit off and they would like to do a lumbar MRI so see if there is also disc disease there as well. In the end, I do have severe issues with my cervical spine and will eventually need this procedure so I feel like I need a plan. Any advice I can get on this site is so greatly appreciated.
    Thanks again
  • Insurance can be so confusing and frustrating!! My surgeon's office has a lot of experience with insurance and 2-level ADRs, maybe they know something about getting procedures covered that other people don't? If you were willing to travel to Texas, there are several doctors here with a lot of 2-level experience. I will PM you this information since I am not allowed to post it here.
    L4/5/S1 scar tissue removal surgery, plus unexpected L4/5 microdiscectomy #2 October 2015
    L4/5 microdiscectomy May 2015
    2-level ADR C4-6 (Mobi-C) February 2015
  • rshawnkrrshawnk Posts: 1
    edited 11/13/2015 - 11:16 AM
    My spouse has C4-5 / C5-6 problems. We've been collecting as much data as possible over the last year or so. From what we understand, Mobi-C is the only 2-level C-ADR. Unless that has changed. But they only received FDA approval for the 2 levels - probably in the last year or so. You can locate Mobi-C surgeons on their website. Just do a google search of Mobi-C and it will come right up. We live in Western Mass, [edit]. He received approval from MA BCBS for the 2-level mobi-c surgery - but my spouse backed out hoping he could just manage for a little longer. [edit]
    We also have a friend that runs an ambulatory surgery center in South Florida. She works with several neurosurgeons, one of which was very gracious to review my spouse's MRI, and call me to discuss what he though. This FL surgeon thought that for a 2-level surgery, the ADR was only milderly better than the ACDF; especially in our case for a 55 yo who is only moderately active (just regular no sports). I don't know if because of the stenosis, the ACDF is better? Part of our problem is not necessarily having a surgeon who does ALL of the options. So we feel like their suggestions lead into what they can do - not necessarily what is available.

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  • BeachgirllBBeachgirll Posts: 12
    edited 11/17/2015 - 3:12 AM
    Hi Aaron,

    I'm 6 days post-op 2-level Mobi-C at C4-6 and I feel great! My insurance carrier is United HealthCare and they cover both 1-level and 2-level cervical ADR. I got lucky as many insurance companies still consider the 2-level ADR investigational. In time, this will change. I did elect to travel out of state to Texas for my surgery and do not regret my decision for one second. My original in state surgeon had never performed the 2-level procedure and I was not comfortable being the 1st patient.

    I feel your frustration on hearing the common phrase about the procedure being so new and staff members unfamiliar with the procedure. I encountered the same problem which also prompted me to look elsewhere. [edit] There are many online services that can rate various doctors and surgeons. If your insurance denies your request, you can appeal it. Also, get a few opinions.

    Regarding my surgical experience, I had significant pain in the shoulders and back/shoulder blade regions for the first 24 hours post-op which is common and likely due to positioning on the OR table during surgery. Also, a terrible sore throat that lasted a few days. I did a lot of walking which significantly helped with my muscular symptoms. Only wear a soft collar when I sleep or leave the house. I'm an active 41 year old female who used to exercise regularly until my injury. I actually felt better during the flight home than I did traveling to the surgeons office. Looking forward to starting PT in a week and getting back to all the activities that I love & miss. Chronic pain is debilitating and I found myself becoming socially isolated because it was too painful to step out of my home and participate in social events. I wish you the best of luck!
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    edited 11/17/2015 - 4:23 AM
    To not wind up looking like me!!! Range of motion?? What's That ???

    I love hearing about new ADR stories .... the good and some eh.....
    Good luck and keep us posted.


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  • SavageSavage United StatesPosts: 5,476
    edited 11/18/2015 - 3:06 AM
    Welcome to Spine-Health
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    Spine-Health Moderator
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  • Brenda_ChandlerBBrenda_Chandler Posts: 1
    edited 11/18/2015 - 2:05 PM
    I just had C3-4 done on 11/12/15. I have C5-6 and C67 bulging. I chose Mobic C disc replacement because they can do two levels with that. But they will not do them at the same time. Only a hospital would do that and its hard to find one that will do it. I had mine done at [edit]o but they have them everywhere. Hope this may help you some.
    Brenda Chandler
  • ciaobarbaracciaobarbara Posts: 5
    edited 11/18/2015 - 2:57 PM
    Not everyone is a candidate for disc replacement. Be very very careful on this. If you have alignment issues with a herniated disc the chances of the replacement disc being successful decrease. Complications with this are dreadful. I was not a candidate due to the alignment of my neck. Also knowing that fusions have a very high success rate and for me it was a 5% decrease in mobility. Nearly nothing. I could not be happier. I know the disc replacements sound so sexy but they are still very new and only certain people qualify for them and long term studies are still being done.
  • SavageSavage United StatesPosts: 5,476
    edited 11/18/2015 - 11:38 PM
    Welcome to Spine-Health
    Please click on link for helpful information!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • Ciaobarbara -

    Did you have a 1-level or 2-level fusion? With regards to 2-level cervical ADR, the 5 year data is "statistically superior to ADCF for overall trial success". I'm grateful for medical advances to offer those of us whom are eligible, a healthy option to preserve range of motion amongst the many other benefits.

    Best wishes.
  • KP2015KKP2015 Posts: 3
    edited 11/29/2015 - 5:27 AM
    Hi Aaron,
    I had two different level disc replacement with the Mobi-c device in September 2014. The way my surgeon got around my insurance (BCBS fed) was to make it a same day procedure with a 23hr59min stay. In layman's term; it was an outpatient procedure which does not require BCBS approval. As a matter fact; my disc replacement surgery is counted as FDA off-label use, but it was covered.

    I would get several opinions for both an artificial disc and the traditional surgery before undertaking the procedure. Unfortunately; my story does not end well as I have come full circle with the recurrence of symptoms.
    Best of Luck,
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