Familiar with "TOPS" spine surgery?

@ou14mejc
I always get the osteoporosis numbers confused so it's the higher numbers that are bad, like over 2.5 is bad. What were your numbers that they said you could have TOPS?

@annie1 My neurosurgeon told me you needed a T-score less than -2.0. Mine is -1.3 and I was approved yesterday. Those numbers are standard deviations....The greater the negative number, the more severe the osteoporosis....so anything -2.0 or greater is a disqualifier, according to my surgeon. So to answer your question, positive numbers are good....it's the big negative numbers that are bad. Hope this helps.

@annie1 I was told that due to having 2 previous fusions I am not a candidate for TOPS.

I had the TOPS procedure last year to resolve severe bilateral leg pain due to stenosis AND spondilolithesis at the L4-5 level. I opted for the TOPS procedure, since in theory, it allows a little motion at the vertebra and would thus hopefully reduce the risk of developing spine issues at either end of a fusion where the spinal segment is locked up. Your surgeon is the one to determine if you qualify for the procedure.
My surgery went extremely well. The SEVERE pain issues were resolved immediately, and I was very happy with the outcome. However, I did develop some significant burning pain in both buttocks and upper thighs 2 months after the surgery with the new MRI showing a severe stenosis at the L3-4 level (which had only showed a moderate stenosis on the previous MRI before the surgery). This burning pain is only experienced when sitting on soft surfaces such as the bed, recliner, and car seat. I could walk, and sit on hard surfaces without any discomfort. That is slowly resolving after 12 months, but still is an issue.
*The recovery time with the TOPS is much shorter (slightly less than 3 months to complete recovery in my case, and resumption of all activities; vs. a fusion which might take up to a year to fully heal (as I was told by two surgeons).

One issue to consider is that Medicare (and therefore most insurances) did deny the cost of the spine prosthesis put in, due to still being considered experimental. The denial was appealed twice, with the denial being upheld. However, after going through an ALJ (administrative law judge hearing); the denial was overturned and I was refunded the money I had paid to the surgeon's office).

Last thing to consider is that at the time of the surgery, I was told by the surgeon that the long term studies/outcomes of the TOPS procedure were still ongoing. So who knows what the future might bring. But overall, I am very happy with the results.

@annie1 You are correct....one level, grade 1 spondy, and a T-score greater than -2.0 on a DXA

@johnfm It's frustrating that this surgery has been approved by Medicare and they will even tell you it's approved if you call them. However, the surgeon's office told me I might have an out-of-pocket cost of $11,500. They also told me if you have Medicare, it's required to have the surgery in a hospital, not a surgery center. I am having a hard time understanding why it's approved, yet patients are still charged this enormous fee.

@ou14mejc Doctors are not Medicare insurance specialists . Traditional Medicare will cover it if they state so. If you have one of those managed care type Medicare policies they may not. Check with the insurance billing department or billing service he uses and speak to a Medicare biller.

@marietter I have talked to both Medicare and my supplemental insurance, which will pay everything Medicare doesn't cover. The problem is that many of the TOPS surgeons will not accept what Medicare pays because it doesn't pay well. I actually talked with the person in billing and she is the one who told me I may have an 11,500 out of pocket expense, despite Medicare telling me they will pay. The problem is that going into the surgery, they cannot tell you whether or not Medicare is going to pay....they only know AFTER if it's going to be covered. I'm hopeful that it will be covered!

@ou14mejc - This is not a healthcare system - this is a crap shoot where the victim too often is left holding the bag!

@ou14mejc If your surgeon is a participating physician with Medicare , he cannot bill more than the Medicare APPROVED AMOUNT.
If he is NOT a participating provider, there is still a limit he can charge you beyond the Medicare approved amount. Perhaps that’s what he’s referring to. Sometimes there are additional procedures they cannot foresee which may add to the cost.
In the end, you must do what will help you feel better. Most physicians will work with you to pay monthly on the balance due. They don’t want your balance sent to a collection agency where they only receive a third of your balance because the agency keeps their part. By law as long as you’re paying a reasonable monthly amount, doctors will work with you.
You may also look into Care Credit to pay off the doctor’s bill, you then pay this company monthly. No interest for the first year too. Best regards.