Shopping for a cervical disk replacement
May 27, 2015 12:05 PM   Subscribe

My girlfriend has a herniated disk in her neck, for which disk replacement seems to be the best option. Her medical insurance isn't cooperating, and so we're starting to look into private options and medical tourism. Any advice on going down that route, particularly the medical tourism route, since it seems important to find a good surgeon (and we're not quite sure how to do that abroad).
posted by sirion to Health & Fitness (7 answers total) 4 users marked this as a favorite
Seems is the operational word here. If you have not seen a Neurological Surgeon, do that first. Find one that has a good rep, and that has no professional relationship with the Ortho that recommended the replacement. If it went that way. Neuro for Neuro, I watched the patients come and go with tiny disc surgeries, done under microscope, who were gone in a half day, very improved.

If a Neuro recommended this then so be it. Someone might say, well, you'll just have to do it again in 5-15 years, then just say OK.
posted by Oyéah at 1:03 PM on May 27, 2015 [1 favorite]

Definitely see a spine specialist where you are first for a consultation. Spine specialists can be either orthopedic surgeons or neurosurgeons.

Spine surgery is an area of controversy in medical therapy, where many who get surgery may either see no change or even have their symptoms worsen afterwards, so doing your due diligence before moving ahead is very important.
posted by treehorn+bunny at 1:14 PM on May 27, 2015 [2 favorites]

Since it sounds like this will take some time anyway, if you're in the US you could also shop around for insurance that would cover it better next year.
posted by teremala at 1:25 PM on May 27, 2015 [1 favorite]

May I ask what the specific issue is with the insurance? Is it too expensive even with insurance? Insurance will cover fusion but you want a disc replacement? Insurance won't cover it at all?

I had a herniated cervical disc last year (although doctor advised fusion instead of replacement, it's a similar situation). I went to see one of the top neurosurgeons in San Francisco. His office couldn't get the procedure approved by insurance. It was awful. I went to see another (also highly-regarded) neurosurgeon, and his office had the exact same surgery approved in 72 hours. Turns out the first office was just a disorganized mess.

So my advice would be to first go see another doctor.
posted by radioamy at 2:29 PM on May 27, 2015 [1 favorite]

I had a herniated cervical disc and had to visit 3 neurosurgeons before finding one who didn't default to a recommending a fusion. It's the easiest option for the surgeon but (in my opinion...and my surgeon's opinion) not a one-size-fits-all fix. I don't know how many opinions you've gotten, but it's worth shopping around more to find someone with the skill to do a discectomy. It's less drastic than the fusion
posted by tace at 2:34 PM on May 27, 2015

Response by poster: @radioamy: When she was insured with private insurance, 2 years ago, the (experienced, good) neurosurgeon suggested disk replacement if she couldn't improve her symptoms with physical therapy. She tried the PE, it helped temporarily, then stopped helping. Then she lost her insurance, switched to the mess that is Medi-Cal, took ~1 year to get the referral, and finally saw a 1st or 2nd year resident who's claiming that "surgery might not help and she should probably try acupuncture instead." He's unwilling to perform the surgery unless/until she loses mobility and strength in her hands. If we try to get a second opinion covered through insurance, it appears that route will take another 6-12 months for each new referral, and her condition is degrading rapidly. It also appears like even if the doctors at the original hospital ultimately agree that she needs a new disk, it'd be the 1st/2nd year residents who would be performing the surgery, which seems unwise with a surgery of this gravity.

We're definitely going to be seeing new neurosurgeons, paying for the consult privately, but advice as to how best to proceed would be much appreciated.
posted by sirion at 2:51 PM on May 27, 2015

Has she tried anything except a short course of PT? There are many other things to try before costly, irreversible, expensive surgery. Some of the simplest changes in posture, movement, even clothing can help. Massage can help. Stretching, exercise, topical pain relievers. Yes, perhaps acupuncture. A different PT (especially one who focuses on what she can do for herself after PT ends). As a massage therapist, I see many people who have had similar surgeries which have left them *worse* off. Don't go there before you have exhausted your other options.
posted by mysterious_stranger at 9:14 PM on May 27, 2015

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