Cervical disk replacement surgery: What helps with the pain?

Posted by grandmaR @grandmar, Jun 4 12:50pm

Hi All!
About 4 years ago, I have disk replacement surgery.
C5/6 was replaced and the recovery was very easy (certainly easier than L3/4 X-Lift Fusion).
I've been having pain issues over the last year (or so).
MRI has shown that other disks are not in great shape, I have arthritis and bone spurs.
To top it off, I am growing bones that are fusing by the replacements, something it shouldn't be doing.
Sadly, the 'representative' from the insurance company is NOT approving surgery to remove the artificial disks.
Only 1% of the people who have this surgery has issues, and I am one of them.
Anyway, just wondering if there is another 1% patient who has gone through the same thing.
Right now, I take injections and I'm in PT (something the insurance company insisted upon).
If anything, it hurts more, but what do I know??? lol
Here's to a pain-free weekend, all!
Ronnie
GRANDMAr

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@grandmar I am sorry you are going through more troubles. Bone growth around an artificial disc is a known risk factor of these implants. I have read literature about that. Bone growth happens because of uneven pressure. It is your body trying to stabilize it by growing bone around it. Have you tried to appeal to the insurance company about their denial? They may be putting you into a bad situation if this is left untreated. The bone growth will continue and may get to a point where the spine is fused solidly around the implant and it may not be operable at that point. That is my guess, and the real answer must come from a spine surgeon.

Your state also has an Insurance Board that is the governing body for insurance companies and you can make a complaint there. The exception to that is when the insurance is provided by an employer and is self funded meaning the employer is paying the bills. Usually these are managed by an insurance company, but because they are employers, that is regulated by the Board of Labor in the state. If this is a Medicare situation, there is also an appeals process for Medicare.

Have you talked to your medical team about appealing the case? They may have dealt with this all before. Have you asked to speak to a supervisor at your insurance company about how to officially make an appeal? Insurance companies have been known to reverse a decision when challenged. It doesn't matter that this only happens to 1% of patients with artificial discs. I am a spine surgery patient (cervical fusion at C5/C6), but I also broke my ankle, and the metal plates on my ankle were causing problems. I had those surgically removed after my bones had healed and the insurance company paid for that surgery no questions asked. You need to make some noise about it with those who are holding decision power over you. What does your surgeon recommend should be done in your case?

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I have a friend who needed a complicated hip surgery that her insurance refused to cover at first. She appealled the decision and won and had the surgery. I would suggest that you get a complete copy of your medical record, including CDs of and X-rays, MRIs and/or CT scans. Take the records to a different doctor for another opinion about what can be done. If both doctors think you need surgical intervention, file an appeal. The insurance companies usually have a chain-of-command structure for approving claims. The lowest level person's job, in a sense, is to approve the easy stuff and discourage anything he can't find on the approved list. In a sense, the rule of thumb for us is to "get the first 'no' out of the way and move onto the people who have the authority to say yes." It's a process based on hoping people give up easily. So don't give up as a surprisingly high majority of appeals are decided in favor of the insured party. 😏

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@jenniferhunter

@grandmar I am sorry you are going through more troubles. Bone growth around an artificial disc is a known risk factor of these implants. I have read literature about that. Bone growth happens because of uneven pressure. It is your body trying to stabilize it by growing bone around it. Have you tried to appeal to the insurance company about their denial? They may be putting you into a bad situation if this is left untreated. The bone growth will continue and may get to a point where the spine is fused solidly around the implant and it may not be operable at that point. That is my guess, and the real answer must come from a spine surgeon.

Your state also has an Insurance Board that is the governing body for insurance companies and you can make a complaint there. The exception to that is when the insurance is provided by an employer and is self funded meaning the employer is paying the bills. Usually these are managed by an insurance company, but because they are employers, that is regulated by the Board of Labor in the state. If this is a Medicare situation, there is also an appeals process for Medicare.

Have you talked to your medical team about appealing the case? They may have dealt with this all before. Have you asked to speak to a supervisor at your insurance company about how to officially make an appeal? Insurance companies have been known to reverse a decision when challenged. It doesn't matter that this only happens to 1% of patients with artificial discs. I am a spine surgery patient (cervical fusion at C5/C6), but I also broke my ankle, and the metal plates on my ankle were causing problems. I had those surgically removed after my bones had healed and the insurance company paid for that surgery no questions asked. You need to make some noise about it with those who are holding decision power over you. What does your surgeon recommend should be done in your case?

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Hello!
Nice to hear from you!
Sorry about your ankle!
Yes, we have appealed a couple of times.
They say my MRI doesn't look so bad and apparently they don't know anything about the bone-growth and it's possible complications.
They say I need to complete PT before they will consider it.
I tried it once and I had to give up because I was in more pain than when I started. They told me they were doing the least amount they could, already.
But, I'm trying again in a new place.
I really have no expectations, I'm just doing what they say in order to be able to try for the surgery, again.
I am half-way through and it is a waste of time, but I'll do as they say.
I know my surgeon is very upset.
He was going to do a face-to-face, one-on-one appeal, but the insurance company said they did not have a neurosurgeon for the discussion.
So, my surgeon refused to waste his time.
I really don't blame him.
I have 3 more sessions to go with PT, then we'll see what the insurance says this time.
In the scheme of things, my insurance company is not as bad as some.
I've only had one other incident with them.
When it was suspected that I had lung cancer, they insurance company rejected a pet scan, they wanted the doctor to do a biopsy.
Imagine that, they would rather pay for the use of an operating room, an anesthesiologist and have something intrusive done.
The doctor did fight with the insurance company and did get the PET scan approved.
Oh well, and so it goes……
Best wishes!
Ronnie

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