Peer reviewed scientific publications regarding the clinical outcomes of these procedures looks very promising ranging from 79% to 94% overall improvement in back, neck, leg, and arm pain and symptoms. In contrast, patient selection is the key to success. Surgeons have become very quick to quote the overall clinical outcomes of these studies to every patient 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 stringent inclusion and exclusion criteria applied when these studies were generated. Patients diagnosed with severe multilevel spinal stenosis (narrowing of the neuro foramen and spinal canal) caused by spondylosis (disc dehydration resulting in loss of disc height) resulting in bone on bone grinding or patients diagnosed with an unstable spondylolisthiesis (slippage, movement, or misalignment of vertebral body in relation to the one above or below) will not have a favorable outcome from these endoscopic or minimally invasive treatments.
Physicians and facilities that advertise these endoscopic and minimally invasive surgeries state that they are the fusion replacement in most cases. Patients are encouraged to travel from one end of the country to the other to seek these procedures. Unfortunately, a significant amount of spinal surgery patients have multiple structural abnormalities relating to their spinal column. The origin of this novel technology was created to treat herniated discs, that is it. The technology has evolved to include minimally invasive fusions, this is not the patient population involved with this discussion.
In conclusion, the direction of novel technology relating to spinal surgery in the form of endoscopic and minimally invasive techniques is good. The attractiveness 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 relating to spinal implants such as pseudarthrosis (failure to fuse), hardware failure, and adjacent segment disease (disc above or below the fusion wears out) are very realistic when appropriate patient selection is applied. If your client has paid cash for an endoscopic or minimally invasive spine surgery (non fusion) to treat back, neck, leg, or, arm pain and symptoms and has been diagnosed with multilevel spinal stenosis with severe spondylosis and or spondylolisthesis causing subluxation (unstable movement) then you have a very strong case for reimbursement if an undesirable outcome was the result. There is no peer reviewed scientific data to support that these procedures are an effective cure for patients with these diagnoses.