Hello has anyone had Alif surgery for a herniated disc and a grade 4 annular disc tear at L5 S1 level ? I would like some good info please. I ask this because my insurance dinied the surgery and my Docter needed to appeal their decision.The insurance recomended i get a Discectomy.I trust my Doc since he is the one that has been treating me.But now i'm confused Dont now why insurance company can have an opinion on what surgery i need???
So i ask is Alif surgery the best way to go? And any info on Discectomy vs Alif surgery will be very helpfull
Has anyone had this kind of problem? I'm now waiting for insurance approval.I was shecduald for surgery April 20 thats tomorow now it got put back for May 4. Any info would be very appreciated.
I cannot respond to your question specifically but I can give you a bit of general information.
Insurance companies have tightened their criteria for a fusion, be it ALIF, PLIF, TLIF, AxiaLIF....beginning about two years ago. I was scheduled to have a 3 level PLIF a year ago...March 2nd was the date. I got within a day of surgery before finding out it was not approved. I will spare you all the details....The appeal was a complex procedure, and it was during this time that I learned about the criteria that many of the big insurance companies are now using to evaluate a need for spine surgery.
During the course of this experience, my surgeon told me that in 22 years of doing spine surgery, he could count the number of his patients who would have met these new criteria. He was so incensed that the insurance company was telling him what he could and couldn't do and what was best for his patient, without ever laying eyes on me or my MRIs!
My guess just from the few words you used to describe your condition is that you meet the criteria for a discectomy, but not for a fusion. They are figuring that the discectomy, which is a less complicated procedure, requiring a shorter hospital stay, etc., will resolve your issues and save them some money. They are betting on that being the case, because if it doesn't work, you will then be needing the larger, more complex surgery.
Your doctor may be able to explain to their satisfaction that there are reasons why you require the fusion, in which case, they will approve the operation.
My appeal was successful and I had a 3 level fusion on June 1st.
Hope this helps you understand what might have happened in your case....
Thank you for your insight.It makes no sense to me like my doc put it.A discetomy can be done but the risk for me is high on needing future surgery again since i work in construction as a carpenter.So i dont see the logic on behalf of the insurance company on wanting to save money on me if in the future i will need to get a fusion.Just get it done and over with.I dont want them to miss around with my back more than once!!! After all it is my back!!
I see I didn't really address some of your questions. A fusion is performed when there is instability at a particular vertebral segment or segments. ALIF is just the approach the surgeon uses to access the segment, in this case going in from the front. There are other techniques as well, and each has its particular good and bad points. The fusion adds bone to a particular area of the spine, causing it to grow together and thereby stops the motion that is causing the pain and instability.
Discectomy is performed to decompress the nerve root that is irritated by the disc herniation. If the only problem at this level is the annular tear, once the material that is compressing the nerve is removed, the pain should eventually go away and the disc will "scab" over.
The Following 2 Users Say Thank You to teteri66 For This Useful Post: dee289 (06-10-2011), quattro70 (04-19-2011)