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Old 10-29-2011, 09:05 PM
Slackwater Slackwater is offline
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Quote:
Originally Posted by Slackwater View Post
2010 Congress of Neurological Surgeons
TITLE: Disparities between Insurance Carriers of Criteria for Approval of Lumbar Surgical Procedures: ALIF, PLIF, or Arthroplasty

AUTHORS: Timothy C. Ryken; Meleah Jensen
FINAL #: 65
Same Abstract/Poster, #65, the web page text did not include the adobe flash text which is re-typed below.

Patient Examples
A 39 y/o male dairy farmer presented with discogenic back pain that he had for about 13 years but worsened over the last year. He also had developed bilateral S1 radiculopathy. His MRI demonstrated disk degeneration at L3-4, L4-5, and to a greater degree at L5-S1. A discogram demonstrated a chemically and mechanically sensitive disk at L5-S1. After thorough discussion with the patient, he elected to proceed with arthroplasty at the L5-S1 to preserve motion to prevent further degeneration at the L3-4 and L4-5 levels. This was denied by his insurance carrier. A request for a ALIF was also denied. After eight months of working with physical therapy during the appeal process to the insurance carrier, the patient elected to proceed with a bilateral L5-S1 laminectomy to decompress the S1 nerve roots to alleviate the radicular pain. One month postoperatively he continues to have a right S1 radiculapthy and discogenic back pain.


A 22 y/o male presented with a five month history of low back pain. In addition he had bilateral S1 radiculapthy. His MRI demonstrated a L5-S1 single level disk degeneration. He underwent discography which demonstrated a mechanically sensitve disk at the L5S1 level. After thorough discussion with the patient he requested to prceed with a L5-S1 ALIF procedure. His insurance carrier however denied the request. During the appeal process however it was determined that even though he did not meet the carrier's requirements for an ALIF, he did meet the requirements for for arthroplasty at the L5-S1 level. The patient then underwent an arthroplasty, five months after presenting to the neurosurgery office. One month postoperatively he has significant relief of his back pain but is still bothered by left S1 radiculopathy.
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