I found Dr Deyo's comments to be most troublesome... It's troublesome because

(1) he makes it sound like fusion is acceptable just because we've used it for so long and it's less expensive than ADR. He ignores the reasons and motivations for why ADR is being developed in the first place...to provide a BETTER solution to disc problems that preserves motion! What a joke! There are serious drawbacks to fusion and that's why we are trying to find something better. Now, that we have an option, what...did we forget why we didn't love fusion before?????

Folks we need to find and submit data to CMS to back up the common knowledge that fusion SUCKS! Data to illustrate the numbers of failed fusions that require additional surgeries and how much that costs! Data that details how many fusion patients need a second or third fusion surgery down the road due to stress on adjacent levels. We need medical studies detailing and reminding us of the risks associated with different fusion approaches. Doesn't AILF approach have the same vascular risks as ADR? Isn't PILF less desireable for lumbar fusion because large muscle groups and major nerve roots are in the way, plus less access to disc space? Why aren't our surgeon's reminding CMS of all the downsides to various fusion techniques so that the only critical data being looked at is about ADR? What surgey is perfect??? NONE! Every surgey has risks...I don't believe that for an ideal ADR patient, the risks of ADR is worse than fusion!

Someone with clout needs to remind these people there is a reason why so many surgeons do NOT recommend fusion to younger patients... because of the lack of movement and stress on spines for decades is too much!!!! But now that ADR is an option, younger disabled patients can be fixed! So for some people, including some medicare recipients, the more effective treatment may be withheld!

(2) This is just a political sham...CMS cannot be allowed to ignore disabled young people...if it's illegal to use monetary reasons as a justification to ban ADR, then CMS MUST be forced to acknowledge the younger medicare population.

Isn't it suspicious that Dr. Deyo claims that CMS shouldn't concern itself with how it's decision might influence private insurance coverage. Major insurance companies administer medicare healthcare...there is a very real relationship there! And, if insurance companies look to CMS for leadership (more so than the FDA...as crazy as it sounds, it seems to be the case), then CMS, as a government entity, must consider the ramifications it's decision will have on the general population.

There must be another way for CMS to "protect" certain people in the medicare population (with adr contraindications) without a national ban that hurts everyone whether they are over 60 or not!

Besides if the majority of the patients over 60 are not good canidates due to bone density or other issues...then what's the big deal...surgeons, CMS, the FDA and manufacturers should be working together to make sure these patients are not offered ADR with or with out a CMS ban. But why ban it for everyone...why ban it for those in the medicare population that are not part of Dr. Deyo's "concern?" It's very simple for the manufacuturer to issue a warning listing all contraindications. We also see manufacuturers producing commercials for consumers all the time, why cant the solution be for the FDA to force the manufacturer to educate the public and surgeons about who is and who is not a good candidate for ADR. Wouldn't that slow down the demand for ADR from the older population and those who maybe aren't the best candidates?


Here's the section of Dr. Deyo's comments that inflames me:

Deyo: In this case I�m not sure you�re rationing anything. We have a new technology that is fully equivalent to something we had before at a lower price. What are we rationing? It�s not like we�re rationing something that is highly effective that�s being withheld from people. [YES THAT IS EXACTLY WHAT THEY ARE DOING!] We�re withholding something that is equally effective to what we already have[FUSION IS NOT EQUALLY EFFECTIVE FOR THOSE PATIENTS WHO ARE IDEAL CANDIDATES FOR ADR], often at a lower cost [NO WAY, FUSION WAS NOT RECOMMENDED FOR ME BECAUSE I AM TOO YOUNG, WHICH MEANS I CANNOT BE A PRODUCTIVE SELF SUPPORTING INCOME PRODUCING CITIZEN...OR I CAN TAKE FUSION AND WILL NEED MORE EXPENSIVE SURGIES DOWN THE ROAD!). And there are still important questions about safety in the clinical trials that the rate of serious complications was slightly higher for the disc[ISN'T THIS DATA RELATED TO THE EXPERIENCE LEVEL OF THE SURGEON AND THE NECESSARY EVILS OF THEIR LEARNING CURVE ON THE PROCEDURE?], and certainly in the elderly population its safety is simply untested. It has not been evaluated in people over age 60. Medicare has to consider that [SO BAN IT JUST FOR PEOPLE WITH CERTAIN MEDICAL CONDITIONS LIKE OSTEOPENIA AND OSTEOPOROSIS???]Everybody gets upset because Medicare is seen as the key to other insurance coverage but that�s not their concern. Their concern is for the population they serve. [THAT INCLUDES PATIENTS UNDER 60 WHO CAN NO LONGER WORK DUE TO DISABLING PAIN...WHY AREN'T THEY ACKNOWLEDGING THIS PART OF THE POPULATION THEY ARE SUPPOSED TO BE SERVING?????]