Legal Law

Endoscopic and Minimally Invasive Spine Surgery: Miracle or Myth for Cash-Paying Patients?

The peer-reviewed scientific literature regarding the clinical results of these procedures looks very promising, with an overall improvement of 79% to 94% in back, neck, leg, and arm pain and symptoms. On the contrary, patient selection is the key to success. Surgeons were quick to cite the overall clinical results of these studies to all patients interested in this open back or neck surgery alternative to fusion with implants (screws, rods, cages, or artificial discs). What the patient does not know is the strict inclusion and exclusion criteria applied when these studies were generated. Patients diagnosed with severe multilevel spinal stenosis (narrowing of the neuroforamen and spinal canal) caused by spondylosis (disc dehydration resulting in loss of disc height) resulting in bone-on-bone grinding or patients diagnosed with unstable spondylolisthesis ( slippage, movement or misalignment of the vertebral body in relation to the superior or inferior) will not have a favorable evolution with these endoscopic or minimally invasive treatments.

Physicians and facilities that advertise these endoscopic and minimally invasive surgeries claim that they are the replacement for fusion in most cases. Patients are encouraged to travel from one end of the country to the other to seek these procedures. Unfortunately, a significant number of spinal surgery patients have multiple spinal-related structural abnormalities. The origin of this new technology was created to treat herniated discs, that’s all. The technology has evolved to include minimally invasive fusions, this is not the patient population involved in this discussion.

In conclusion, the direction of new technology related to spinal surgery in the form of endoscopic and minimally invasive techniques is good. The appeal of these procedures to patients recommended for traditional open back or neck surgery is overwhelming. The benefits involved for the surgery itself, as well as the absence of long-term complications related to spinal implants, such as nonunion (failure to fuse), hardware failure, and adjacent segment disease (the disc above or below the fusion wears away) are very realistic when proper patient selection is applied. If your client has paid cash for endoscopic or minimally invasive (non-fusion) spine surgery to treat pain and symptoms in the back, neck, legs, or arms and has been diagnosed with multilevel spinal stenosis with severe spondylosis or spondylolisthesis causing subluxation (unstable spondylosis). movement), then you have a very strong case for reimbursement if the result was an undesirable result. There is no peer-reviewed scientific data to support that these procedures are an effective cure for patients with these diagnoses.

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