Neurosurgeons performing disc replacement surgery @MAYO, Jacksonville

@mjmember Hello and welcome to Connect. I see you are looking for a good surgeon and have questions about what direction is right for you. While we wait for others to answer, it's important to realize that as patients, our experience is limited to the surgeons we have consulted and what questions we asked. The question of how many surgeries of a specific procedure is good to ask, but the surgeon is the only one who can answer that and tell you what their personal success rate is. They know this and it is a percentage number. That is different than a success rate for this procedure among all spine surgeons. It's a very good question to ask. That being said, there is sometimes data you can find online for outcomes of Medicare patients and success rates for a particular surgeon and specific procedure, but that depends on if they have had Medicare patients in the last year. Also understand that older patients on Medicare may have other health conditions that affects the outcome of spine surgery. It isn't data that specifically would relate to you.

Insurance questions must be answered by the billing department of the medical facility. For Mayo, that information is available on the website, and please note, the various Mayo campuses do not all accept the same insurance. Some "Medicare Advantage " plans are not accepted for example. Mayo must answer which they accept. It is best to call the billing department and ask to be sure before requesting an appointment. Spine surgery is very expensive. You may also want to call your insurance yourself to ask if your choice of surgeon and facility is covered, and if it is "in network" with your insurance. There may be coverage "out of network" but at a lesser rate. Insurance companies also know which surgeons are on their preferred lists or their lists of better surgeons.

Here is a link to Mayo Clinic Insurance & Billing
https://www.mayoclinic.org/patient-visitor-guide/billing-insurance
If you do request an appointment, the next step is likely a discussion with an intake person and they wouldn't know what surgeon uses which devices, implants or artificial discs. Neurosurgeons and Orthopedic spine surgeons both do spine surgery. If you are talking to a department such as Neurosurgery, you could inquire about which surgeons there do both fusion and disc replacement. You can also just ask this when applying to Mayo to be assigned to a surgeon who is practiced in both these technologies. Have you been researching the manufacturers of these implants? Sometimes they have referrals as to which surgeons use their devices. Also understand, surgeons are trained on specific hardware, and they don't all select the same devices. They have their preferred procedures, so you can't ask them to use a device you selected by reading about it. It must be their recommendation based on their opinion of what is right for you.

Personally, I saw 6 different surgeons when I was seeking care for cervical stenosis. Most surgeons in my area only did fusions that I saw 6 years ago. I had a fusion at Mayo in Rochester with Dr. Jeremy Fogelson, and he does both artificial disc replacement (if appropriate) and fusions, and spine deformity surgery.

I chose a fusion over disc replacement. I had 2 mm of movement and slipping which isn't great for an artificial disc, but my surgeon could have done this. 4mm of slipping disqualifies patients in clinical trials for artificial discs. I also had concerns about compatibility of implant materials in my body. I have had reactions to metals in earrings and was concerned about immune responses to metals and plastics inside my body. Bone quality is also an issue for anything secured to bone with screws. Sometimes artificial disks cause excess bone growth around them as the body tries to stabilize the spine. I chose a single level fusion without hardware, and only a bone disc spacer was used. I wore a neck brace for 3 months. My surgeon agreed to this and I agreed to follow his instructions. Not all surgeons would give a patient that choice, and if I needed more than one level done, it may not have been available to me. It was the right choice for me and I have had no further spine issues.

Lastly, I would say that getting the best surgeon you can for what you need is worth traveling. I tried to stay local, and I just couldn't find help. Mayo in MN was a couple states away and a 5 hour drive. It was worth the cost to pay for hotels for the time I needed to be there. You can travel to any Mayo campus. If Jacksonville is your preferred location, give it a try. Read the profiles of the surgeons on the Mayo website and look at their areas of interest. Read their publications. You can also keep Rochester in the back of your mind because that is where Mayo has the most spine surgeons and different sub-specialties. It all depends on what you need as a patient.

When you are ready to request an appointment at any of the Mayo campuses, you may use this link to get started. http://mayocl.in/1mtmR63

Thank You @jenniferhunter
I had C4-C6 fusion and I decided to go from Miami to HSS in NY. For one the Miami surgeon was going to use cadaver bone whereas at HSS my surgeon used a titanium basket and used my own bone graft. I only wore the neck brace for a couple of weeks and I never felt much pain.

I am 73 and fusion is fine as I’m not living a very active life like sports etc. I’m looking for my son who is 50 and if there is an alternative to fusion that may be more suitable to him as he is young.

The two-level disc replacement is to preserve motion with two moving mechanical devices. Over a long period with fusion, other discs have to accommodate for the motion lost at the fused level. Secondly, over time, the increased mechanical demand on the surrounding vertebrae can make the discs in the region more vulnerable to additional degeneration.

When I contacted a patient advocate at Johns Hopkins, they forwarded my questions to the assistant to the Neurosurgeon I referred. It was easy to get all the information I needed like the manufacturers of the device etc. At Mayo all they have is an appointment desk and there is no patient advocate to help the patients to get basic information before making the appointment. Even when I contacted the neurosurgery department with great difficulty – the answer was “We don’t give out that information”. It is a simple basic question as to what devices they use as I can get myself more knowledgeable as there are many devices in the market. If it was HIPPA protected I would not have gotten that information from Johns Hopkins.

MAYO seems less friendly toward prospective patients. Patients should be able to get device information and which neurosurgeons perform disc replacement during their initial phase of research without having to take an appointment.

It is very important to be able to get the necessary information with ease when you choose an institution. My prior experience at Johns Hopkins was great. This time being in Florida and Florida insurance I wanted to go to MAYO as it may be equally as good as Johns Hopkins. Jennifer, as you said sometimes we may have to travel and go elsewhere like Baltimore, Maryland even though I would have preferred MAYO in Jacksonville, FL.
Thank You
@mjmember

@mjmember, I wanted to give you some context to the answer you got from Mayo Clinic's Neurosurgery Department about the devices used. A list of devices isn't shared to avoid being misleading and unhelpful. The recommendation on the best device is highly customized based on each patient and their case and condition. No single go-to device is used every time, so a consultation is required to give the best and most customized recommendation on how to proceed.

I am 65 and saw somewhere I am to old for getting a artificial disc regardless of the number effusions I already had fusion from the S1 to T first level and now T12 has a disc bugle with a tear.

Thank You, Amanda
There are more than a dozen devices available in the market. For example, Johns Hopkins uses two types of devices and they decide which one is best suited for the patient. Every doctor uses only a subset of devices available in the market. I'm just asking what devices they use. I'm not asking which device is best suited for my son.
Consultation is not required to give the information on what devices they use. I'm doing initial research as to which facility uses which devices. It is possible they may not be using the same devices that johns hopkins uses. I'm not a doctor but as an engineer, I would like to be knowledgeable about the devices.

Do you know if there is an age limit?

I can't answer that question for the USA but I just had five artifical cervical discs replaced in Germany four months ago and I am 74. I also have severe osteoporosis. Germany is at the forefront of artificial discs and have been doing them for over 15 years.

Hello, I am from Norway, but have been several times to Germany for surgery. As I have instability in my neck, a specialist in Heidelberg recommended fusion. I do trust him, but now I am very curious to hear where you had the artificial cervical discs replaced? I would like to consider that option, too.
Thank you in advance.
Kari

My C4-7 ACDF used laser printed titanium "cages" as new disks/spacers. The cages are perforated to permit natural bone growth and fusion. I also had a "typical" fusion. performed. 3+ months post-surgery and I'm quite happy. This work was done at Mayo Jacksonville.

I wish Medicare would cover ACDF.