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Accura Scope
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jolene1881 posted:
I have been contacted by Northeast Spine about this procedure which is minimally invasive and they can treat multiple disc levels at one time and was told by them that they have a high success rate and most insurance plans will cover it and the Dr's are in are in Dayton OH and Dallas, TX. I live in Allentown, PA so I would have to make the trip to OH and was wondering if anyone out there has either heard of this or tried it? Trying to gather all the info I can before I make a huge decision to make that trip instead of possibly having traditional fusion surgery?
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cweinbl responded:
I live in Ohio, research pain management and I have not heard of Accura Scope. There appears to be very little information available. A quick look at research reveals the possibility for concern. See:

www.asipp.org/news_alerts.html www.painphysicianjournal.com/2009/december/2009;12;929-963.pdf

What is Accura Scope? Is it produced by Accura Pharmaceuticals? How long has it been available? What does it do? Is it invasive? Do you know anyone who has used it? Will it be covered by insurance? If not, how much does it cost? Is it administered by a physician, osteopath or chiropractor? What is the success rate? Where can you obtain solid research on this (control group, double-blind studies)?

I would want the answers to each of the above questions before traveling to have this done. The fact that almost no research is available on this process would bother me.
 
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jolene1881 responded:
Hi Charles, You have been soo helpful here is the info I have got from them. The AccuraScope? Discectomyand Neural Decompression (?D.N.D.?) Procedure: The AccuraScope?D.N.D. is a Minimally Invasive, Natural Opening procedure used to both diagnose and treat Inter-vertebral discs and Spinal Stenosis. Using live x-ray for guidance, the doctor inserts an endoscopic fiber optic scope, like a small tube, through a small incision in the skin, into a natural opening at the base of the spine. The doctor examines the inside of the spine and the discs of the lower back, from both sides of the spinal canal, to identify any tears, ruptures, herniations, bulges, or other abnormalities. The doctor actually finds inflammation and actually diagnoses the source of pain. The doctor then uses a number of instruments to shrink the damaged disc(s), or spinal stenosis, and relieve pressure on the spinal nerve(s). The procedure is usually completed in 30-45 minutes. Many patients experience immediate relief with this procedure. Patients are returned to a recovery area and are usually discharged approximately one hour after surgery. Patients can walk the same day as their procedure, and can start gentle physical therapy exercises the next day. Many patients can return to work and resume normal activities the following day, and most can return within one week. North American Spine is the world?s sole provider of the AccuraScope? procedure. Its performed by MD's who specialize in pain management and anesthesia. From the info i could find the 1st procedure was performed in June 2009 and has been done on 4,000 patients with a very high success rate. But like you said the info info I can find is the info on their site northamericanspine.com which alarms me.
 
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annette030 responded:
If the only info available is on their website, I would decline.

There is no "natural opening" into the spinal canal or to the discs. That is why they have to make an incision to place this instrument. It sounds like the same old minimally invasive disc surgery that they have been doing for awhile. I am not sure what makes this different.

Any procedure that has only been done for 6-7 months is too new for me. How do they define success? Is that for lower pain levels, pain free, better functional levels? Are their patients off of all opiate meds, just lower doses of meds, how much lower?

If they have done 4,000 patients in six months at two places, my math brings us to around three hundred plus patients per facility per month. That would be ten plus patients per day, seven days a week. I would ask them what their complication rate is? How many patients do not get a successful outcome? Ask for specific numbers, not words like "many" or "most".

I wouldn't do this personally, but that is just my opinion.

Take care, Annette
 
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cweinbl responded:
I would add, Annette, that whenever extruded disc material is removed, the shape of the vertebra is changed at that joint. This can place added pressure on the disc above or below the surgically altered disc.

As far as I can tell, this "Accura Scope" is just another endoscopic surgical procedure to relieve stenosis and decompress a nerve root. The incision might be about as damaging as traditional discectomy. Plus, the smaller the incision, the greater the chance that the surgeon will miss a piece of extruded disc, be unable to reach it or remove only part of it. That leaves the remaining piece of extruded disc free to recompress a nerve root in the future, resulting in repeated stenosis. Having had microsurgery twice and a laminectomy twice, I'd say that the laminectomy is a much better procedure. Micro-discectomy is less invasive, but always runs the risk of leaving extruded disc material inside, only to recompress a nerve root later. Laminectomy is the only way to be certain that all offending disc material is removed.

We also have no viable research reports for "Accura Scope," no vetted insurance coverage (that we're aware of), it is not ubiquitous and there is a dearth of information.

From my perspective, it sounds risky. I agree that if the physician cannot produce a wealth of research data, it is experimental and potentially dangerous. Perhaps we'll learn more about this "Accura Scope" in the future.
 
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annette030 responded:
I do not think the size of the scar is that big a deal. I had an old fashioned discectomy using an anterior approach for my C5-6 disc back in the early 90s. My scar was only about 2 inches long and the doctor did it in the natural fold of my neck. It has been virtually invisible for many years. I have to stretch my neck out and point to it for anyone to notice.

I showered the day after the surgery and would have been discharged the next day, except I had one of the possible complications of any surgery, I developed a blood clot. My surgeon did a sonogram at my request, and had already written discharge orders, kind of laughing at me insisting that I had a clot. Had I been at home, or less educated about these things, I probably would have not been diagnosed early on.

My surgeon was well ahead of his associates in those days as he was the only one in our town who would do a discectomy without doing a fusion on carefully selected patients. Fortunately, I did do well except for the clot, which took some extra care to deal with. I was back to full time ER nursing in six weeks, without any restrictions other than not lifting above my shoulder level, an acceptable restriction for most nurses.

A good friend of mine back on the East Coast went to an orthopedic surgeon complaining of back pain that her own pcp had attributed to FMS, and this guy convinced her to have a microdiscectomy the next day, she did, developed sciatica which she had never had before, he gave her one injection after not returning her calls until she mentioned a lawyer, then he told her he had done all he could and to go back to her pcp. He said the surgery was "successful" and did not cause her sciatica. It took her several months to get rid of the sciatica, and her same old back pain was still there.

It is my friend's doctor that leads me to always say get independent medical studies that show a surgery is successful and be sure you know what they define as "successful", it may be different from what you think. She just wanted the pain to go away and was willing to listen to whatever a doctor told her.

I would rather have a slightly longer recovery time with a slightly more invasive procedure until they can prove success with a minimally invasive procedure. The medical people are doing amazing things through scopes that they could not do when I started nursing, but I am not willing to be a guinea pig myself.

Cheers to people who are, but they should know before they have the surgery that they are part of the whole experimental process that enables medicine to progress.

Take care, Annette
 
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brugette1 replied to annette030's response:
Hi folks, I've read you posts and wanted to put my two cents in because I am a future patient to have this procedure done, in about a month. I have 9 herniated discs, some in each section of the spine, one from a home accident 20 years ago, one from a work accident 6 years ago and the last 1 year ago and we don't know why it happened. I'm allergic to pain meds so it's been tough. I have tried epi's, nerve blocks, rhizotomy and nothing has helped, some did more damage/caused more pain. I did have an anterior cervical disectomy at C5-6 in late '05 and no one will ever cut into my spine unless I'm on an autoposy table, end of discussion, never again.

My husband saw a doc from North American Spine on an early morning tv show and so I looked into it. I called, got basic info, sent my MRI report in and found out they don't accept any type of medicare insurance. $29,500 to do all three sections of my spine. RIght now there's only one doctor who does the thoracic spine and he's in Dallas, TX.

I'm not the usual patien who just needs the lumbar procedure so making this decision took 3 months of phone calls back and forth and the staff, rep, PA, doctor, have been nothing but wonderful. Yes, when it got down to details of the actual surgery and success rate, mainly on the t-spine, Dr. Bulger called me on a Sunday night at 8:30pm, est, and spent 45 minutes talking and listening to me. He explained that he's been in pain mgmt. for 20 years and does the sports teams down there, but he was honest (which I truly respect) and said that he's only been performing the t-spine procedure for just over a year and hasn't done that many, but it's not much different (in getting in there) then doing discograms and such on the t-spine.

So here's what I know. They've been in business 10-13 years and with technology the last 5 years has allowed them to "perfect" the procedure visually. They cut a 3mm incision at the bottom of the tailbone where there are two nature openings going up into the spine. They can to in with a scope a see, find scar tissue, herniated discs and zap them with a lazer that removes a little larger then rice size area at a time. An alarm will go off if they get to close to areas they don't want to touch, my phrase. They can go up the entire lumbar spine, but the t and c are entered into on the side with a 3mm cut. Fot the t-spine they goes alone the ribs to the spine and zap about 3 times and that should get rid of it, they enter the neck on the side also. Yes, anytime you take away you alter the structure of the spine.
There is alot of medical and personal history forms that you fill out, a nurse contacts you, tells you what pre-admission testing they require and then your sent to scheduling, then billing then you have the procedure. I'm at the just had pre-adm. testing done and am waiting on and OK and then to scheduling.

You do have a consult with the doc the day before your procedure and the day after. You can fly home 24 hrs. after the last procedure, if you're having multiple.

Since I would rather live/die in this pain then have the "standard" spinal surgery, this is the best option we have found and we have been researching for a few years. The lumbar is their "calling card", that's the one that has over 80% success rate at totally relieving pain and 100% at mild relief (40-50%).

Most docs I've deal with, and I've gone to many docs, two of the best in the Philadelphia area and they cut want to cut and fuse.

Yes, they do legitimately accept some insurances, I'm sure some companies will decline it, but you can get it appealed favorably.

I'm running out of "characters" and this causes me more pain. I'll gladly tell you what I know, but I'm in the middle of the process now to get it down. I kind of am a guine pig in the thoracic area, but to do surgery on that is major compared to the neck and there's no way. I'm going with this, hopefully it will turn out well.

Ask anything you'd like.
 
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brugette1 replied to annette030's response:
Hi folks, I found you while looking for their home page. Believe it or not but I am in the process of scheduling to have their procedures done on my cervical, thoracic and lumbar spine. I hope maybe I can answer some of your questions.

First I honestly am a person with nerve damage from my head to my hips. I was injured at work in '04 and in '05 had an anteroid cervical disectomy with fursion at C5-6. For three months I had no pain and I thought my life was back, but no it wasn't. My neck continued to hurt and I developed trigger points in my upper back area and excessive scar tissue took over the left side of my neck and then I developed occipital neuralgia (you can google it). My lumbar spine starting hurting from an old household accident because I was squating down instead of bending which caused more neck pain. Then last year I somehow herniated 3 discs in my thoracic (bra strap area) spine, and 2 of these are pushing into my spinal cord and the other has bone spurs. I'm allergic to pain meds and my life has been horrific.

My husband saw them on a morning show and looked them up. He told me about them, I called and was excited to hear what they did but they don't take any type of medicare insurance so I would have to pay $29,500 for the procedures. I've tried nerve blocks, temp fix, after the nb in my thoracic spine my muscles and lung went into spasm and I ended up in the ER. I will never let anyone cut into my spine until I'm on the autoposy table,

I'm in the middle of the procedure to get the procedure done. I have to do all three sections of my spine and had many, many questions. After my anterior cervical disectomy at C5-6 was a trainwreck, l've learned to ask, ask ask. They answered, I spoke with a physican's asst and when he couldn't help I got a call on a Sunday night (2 or 3 weeks ago) at 8:30pm from Dr. Bulger(he's the only one who does the thoracic spinal procdure). He LISTENED to make, asked me questions and was shockingly honest when he said that he hasn't done alot of t-spine procedures, one reason is because it's not an area that has problems compared to neck and lumbar. I was blown away by his call and I respected him for his honesty. They are mainly known for the lumbar procedure because it's the easiest, I think. I've seen many docs over the past 5 years and 2 were supposedly the best in the Phila. area, nothing. Once they realized the fusion took in my neck and they couldn't do surgery to make money, they sent me to phy.therapy, which I didn't do.

My lumbar starting hurting more and more after the neck surgery because I was squatting/kneeling down as opposed to bending over and that caused an old injury to become a new painful area. Last year, out of the blue, my t-spine started adding more pain to a body that is allergic to pain meds.

I have spent countless hours on the phone with them, there's no guarantee I'll be pain free, but my pain will decrease significantly (80%) in my lumbar spine, 50% in cervical and thoracic areas at the least. I'll take it. Some people have gotten total relief on the lumbar area, some 50%, I'll take anything.

They are becoming more popular for their successful lumbar procedure and were initially in OH, just moved to TX and put corporate there and within the next couple of years they are planning on opening a few more centers in the US.

I'm not expecting a mircale, but for me this is the way to go. Since my last t-spine nerve block landed me in the ER and my lumbar is worse since injections, I've had it. I'm also allergic to all injectable steroids and have to take a bunch of meds prior to and after epis and nb, tired of this game so I'm going to roll the dice and see what they can do.

Ask me anything you want, I'll tell you what I know so far and keep you up to date on how my journey progresses. This is truly my last hope and technology is improving all the time.

Hope I can/have/will helped.
 
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TDXSP08 replied to brugette1's response:
I would not have such an important medical procedure done as same day day surgery in a doctors office for 30,000$ especially in Ohio, Cleveland Clinic is a World Class Medical Facility and they would take whatever insurance you have. but hey we all have opinions and its not my body, I wish you all the luck with Your surgery and hope you will come back and give us updates on your progress.
 
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brugette1 replied to TDXSP08's response:
First, I'll be in a hospital having this done, not a min-surgery center. I'll be at Forest Hill Medical Center, beautiful expanding hospital in northern Dallas. The Cleveland clinic is a great place, but it's not always the answer for everyone, especially their headache center. I've heard some bad things about them, as I'm sure is true for most large medical hosptials/facilities. I know some of the best docs are at the large hospitals, but in Philly they treat you like a number, don't want to really hear what you have to say and dismiss if you ask questions. Not my kind of doc. Does the CC do spinal treatments with minimally invasive equipment of any kind?

The home office was in Ohio but has moved to Dallas, TX where a group of Pain management/neuro/ortho docs are finding that this is a better way to treat patients, the least minimally invasive treatment available to date.

I either live with the pain because I've been through all the standard and holistic treatments and nothings helped or try something new. I've tried the standard fusion/disc replacement and it didn't work for me, only does for about 50% or patients.

So I got a call from the nurse today, she contacted my GP to get a copy of my pre-admission testing. Waiting for the EKG, which was done yesterday, to come in, then the scheduler will call me.

Just wondering, has anyone here had their doc call them back and spend 45 minutes talking to you, actually listening to you. He's been doing spinal pain management for decades and he works with the a few major sports teams, guys got credentials and experience, more than any doc I've seen.

I truly only have two problems doing this and one is that he works with the Dallas Cowboys and two, I have to be in Dallas.
 
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annette030 replied to brugette1's response:
Brugette1,

I called a neurologist on Montana once, got his name from a journal article and Googled his phone number. He happened to answer the phone and spent nearly an hour on the phone with me. I was in NV. I had migraines and he had treated them and written an article about it. I was curious about some issues in the article. I never spoke to him again. He knew at the get go that he was not going to get $30,000 from me.

Medicare is pretty much the forerunner for approval, once someone get Medicare approval, the other insurance companies dive in. I would not go for anything that Medicare has not approved, and has no double blind studies to support it as being effective and safe. It is great that the doctors claim such high success rates. I hope it all works out well for you.

Take care, Annette
 
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bestannie replied to brugette1's response:
Dear Brugette,
I have read the negative comments regarding your post and I want you to know that I fully understand your need to go through with this. I have been suffering for three years with major lumbar pain and it is beginning to affect my entire spine. My pain is a product of a tri fusion in the lumbar area in 2004 and then an added injury in 2007. I have had pain management and seen several "qualified" Orthopedic surgeons and Neurosurgeons and been admitted to at least three "major" hospitals. So, I am of the opinion that they don't know as much as they would like you to think. I am tired of being misdiagnosed and yes, I feel that many of the pain procedures they have performed on me have been expirimental. It is quite evident that they are just trying to figure it out themselves. We pay (or our insurance pays) for these physicians because they are supposed to know what they are doing. So far nothing has relieved my pain and I am getting worse and worse to the point that I am now on a walker 24/7.

I have also looked into the accurascope, and if I had the money, I wouldn't hesitate to try it. Unfortunately my injury has prevented me from working and I am living on my social security. I simply cannot afford to try it.

I have said all that just to let you know I am pulling for you and I hope that this is a huge success for you. I cannot wait to hear your results. Please be sure to post periodic updates I will be waiting and hoping all will go well and you will soon be pain free, or at least almost pain free. I also hope that all of these so called experts with their negative comments do not affect your positive state of mind. Good luck. AnneR
 
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An_223064 replied to bestannie's response:
Dear Brugette,

DITTO what AnnR said.
My thoughts are with you for a safe and well journey, B
 
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lindainind replied to bestannie's response:
I had a 3 level problem in my low back. Badly herniated disc and bulging disks and a very unstable back that back therapy no longer helped. I had a Dynesys Stabilization (Zimmer) in May of 2005. One of the really good things about Dynesys is that if it does not help, the entire apparatus can be taken out. The FDA required the S1/L5 be fused but that level has very little movement anyway. I am thankful for the Dynesys. I had it done with Fort Wayne Orthopedic surgeons. The Dynesys is made up of two flexible hollow tubes at each level and a poly? cord running through the tubes which stabilizes the back and yet gives flexibility.


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