Mikec

I guess I’m not surprised with the full removal of my facet. During my second office visit the surgeon had a intern with him and he was explaining that he had to be careful not to remove more than 50% of my facet as that could potentially leave me unstable. And I am certain this is what was said as I recorded the office visit and went back and reviewed the recording. During this same office visit his initial recommendation was a ALIF but that BCBS would not approve this procedure unless I had a prior failed back surgery. During my one month follow up he repeated this same thing but stated they would not approve an ALIF unless I had one, two or possibly even three failed back surgeries. Which I now know is not true.

Unfortunately this appears to be nothing short of an unethical money grab buy the surgeon. So why would the full removal of my facet be a surprise? And by the way I also have a recording of him stating I would need 1 to 3 failed surgeries before being approved by my insurance company for the surgery I truly needed.

At this point I am left with the feeling that this has turned out to be nothing short of a cash grab by the surgeon. And by the way who in their right mind would stay with the same surgeon after two failed surgeries??? Guess there is not enough money in office visits when you can do multiple surgeries on your patients.

Since the MRI and X-rays don’t address the percent or amount of facet removed would you recommend returning to the imaging center and asking them to ammend their report to specifically address the amount of facet removed. Also, I am going to contact the surgeon’s office and request an order for a CAT scan.

I have found a orthopedic spine Dr that is a specialist in revision surgeries and I’m in the process of gathering all the prior MRI’s, office and surgical notes to take to my first office visit.

The most recent MRI barely mentioned DDD and stenosis which have been on all my prior MRI’s. After one MRI my interventional pain Dr reviewed mt films on disc and was shocked at the report. The report listed minimal DDD, arthritis and stenosis and he stated my condition is far from minimal. He even had the anesthesia Dr to come in the exam room and review the films to confirm what he was seeing and they both can to the same conclusion that my condition to be moderate to severe.

I understand that some conditions are open to interpretation but it seems like they want to go with the less severe conditions or they just minimally read the films and have a predetermined conclusion prior to reviewing the films. It seems they are scared to list a condition as severe and want to leave that determination to the surgeon. But what about the people who have MRI’s ordered by their family physician who is only going to read the report and not review the films? These people continue to suffer and not forwarded to a spine specialist as the report alone does not warrant a referral. I find this behavior to be highly unethical as a lot of insurances now require a referral from the family Dr to a specialist???

Seems like the pain and suffering from my first surgery was all in vain.

Discussed in Alabama, I am;

Sincerely,

Mike Couch

All I can find in my area is a Toshiba 1.5 Short Bore Vantage MRI system. This is a a free standing imaging facility. I don’t want to go to he radiology department at my local hospital as they have a local radiologist that I don’t trust.

Do you feel this 1.5 MRI machine would provide me with the quality images I need?

Thank you,

Mike

Per our last conversation you suggested I get the operative report from my Micro-D surgery on June 7, 2017. The notes are as follows:

Physician Quality Reporting Incentives Indicators:
ASA Score: ASA 3 – Patient with moderate systemic disease with functional limitations. Prepping antibiotics discussed. 1 gram IV Ancef given at 0935 hours and ordered for an automatic stop after 24 hours. Skin incision was made at 0957 hours. Skin closure accomplished at 1051 hours. TED hose and SCD hose were placed on the patient’s legs prior to intubation.

Operative findings:
Patient had a combination of a protruding disc, this was a subcapsular herniation impinging the traversing L5 nerve root and combined with large facet compromising the exiting L4 nerve root. Essentially after facetectomy was performed on the left side. The herniated disc material was impacting the L5 nerve root as it was traversing and far laterally was putting pressure on the exiting L4 nerve root. The facet was drilled away with a high speed drill underlying disc was then incised and removed. Murphy ball hook passed freely with both L5 and L4 nerve roots at the end of the procedure. Micro dissection techniques were utilized using operating microscope. Patient had neuro monitoring and there was diminished sensory over the L5 nerve root at the beginning of the case and this did not seem to improve with surgery, weasel same as baseline.

Procedure in detail:
Patient was taken to the operating room, satisfactory general endotracheal anesthesia obtained. Patient was carefully turned and positioned prone on an operating table. Back was shaved and prepped in usual fashion with Betadine solution. Sterile towels, drapes, and Steri-Drape created a sterile field. Time out between surgeon, anesthesia and circulating nurse was then performed to verify patient, levels and laterality of proposed surgery. Sharp incision was made two fingerbreadths from the midline on the side of the level of pathology.
Subperiosteal dissection to the level of the lamina and facets on the side of the patients pain. Midas Rex drill and Kerrison rongeurs were then used to perform a partial hemi-laminectomy on the affected side. Micro-Dissection techniques were utilized to expose the nerve roots. C-arm fluoroscopy was utilized to confirm level and location of the disc space. The nerve root was held medically with a nerve root retractor, the ruptured disc identified and removed with a variety of disc rongeurs and scraping instruments within the disc space. Murphy ball hook passed freely with the nerve root at the end of the procedure. Hemostasis was achieved using bipolar and thrombin. Copious quantities of bacitracin irrigation were utilized. Deep fascia was then approximated with 0 Vicryl, subcu with 2-0 Vicryl, skin with staples. Patient tolerated the surgery well, went to recovery room in satisfactory condition. Patient is not yet awake at the time of this dictation.

I have a question about the following: Patient had neuro monitoring and there was diminished sensory over the L5 nerve root at the beginning of the case and this did not seem to improve with surgery, was same as baseline……. what exactly does this mean.

I asked the surgeon if he planned to perform any type of physical exam to help determine the cause of the new and extremely pain condition affecting my left buttock check, the back of my left thigh, back of my left calf and the numbness on the top of my left foot…. he stated there was no need for a physical exam as these symptoms were to be expected and “IF” they were going to go away it would take 6-12 months.

I inquired about why he didn’t consider a TLIF procedure and he again stated BC/BS would not pay for a fusion unless I had one, two and possibly even three failed back surgeries. I have discussed this with several other surgeons over the past few weeks and they all find this to be non-factual. Why would a person have endure multiple failed surgeries in order to get the surgery they truly need unless this is a ploy being used to enrich the surgeon. I find this to be extremely unethical and might even border on malpractice. I recorded my 2 follow ups after surgery where he stated BC/BS would not approve an anterior lumbar inner body fusion and then when he stated I would require up to 3 failed back surgeries before insurance would appprove fusion.

Initially he refused to order post surgical imaging but after a heated exchange he agreed to order code V67.4/Z09 72158 MRI LUMBAR SPINE W/O & W/DYE and code V67.4/Z09. 72114 X-RAY EXAM OF LOWER SPINE – COMPLETE ap/lat flex ext obliques.

Also based on your advise I have found a Orthopedic Spine Specialist who is actually a revision specialist that I will try to schedule an appointment with once I have my MRI and X-RAYS.

If you would advise about the diminished sensory over the L5 nerve root I would greatly appreciate it. I don’t understand what this means and has me concerned. My surgeon did not have time to go over this report with me.

Also, I will not be returning to the Neurosurgeon that performed my Micro-D. I only went to today’s follow up because it was already scheduled and I wanted to pick up a copy of my operative report. I still have severe motor weakness in my left leg and have to use a walked due to my leg “going out” on a regular basis and I don’t want to fall and further complicate my injuries.

Thank you for your time and the dedication it takes to maintain this forum. You are truly an exceptional person and Dr to put the time in to answer all the questions you get.

Michael