Fighting for the approval of minimally invasive alternatives to spinal fusion; non-surgeons performing certain spine procedures; and insurers too often dictating care decisions are some of the biggest threats to spine surgeons today, three specialists told Becker’s.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.

Question: What is the biggest threat to spine surgeons today?

Todd Lanman, MD. Lanman Spinal Neurosurgery and the Advanced Disc Replacement Spinal Restoration Center (Beverly Hills, Calif.): The biggest threats to spinal surgeons who perform motion-preservation surgery are the insurance companies themselves. They routinely use third-party administrators to review authorization, and predictably, artificial disc replacement procedures are frequently denied reimbursement. Our practice finds it difficult to get approvals for even simple disc replacement surgeries that should be authorized without question.

My hope is that insurers will soon come to realize that ADR is actually better for their customers — my patients — and will be less expensive for them in the long run. Despite overwhelming evidence demonstrating disc replacement is superior to spinal fusion in the cervical spine and lumbar spine, ADR procedures are often denied. Data gathered on ADR are one of the largest datasets on any type of operation in history — more than hip or knee replacement.

Disc replacement is as good as or better than fusion in terms of pain relief and maintaining motion. When you consider the risk of adjacent-level surgery after ADR is 20 percent to 30 percent lower than fusion, the cost savings in avoided spine surgeries is enormous. Nevertheless, we continually fight with insurers and get denials for ADR surgeries. If spine surgeons don’t win this battle, patients are going to end up resorting to motion-limiting spinal fusion when they could have enjoyed the benefits of motion-preserving disc replacement.


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