Today I examined a patient who was planning an L5-S1 low back fusion, but received a back fusion denial from his insurance company. This may have saved his back! As a result of the back fusion denial he was forced to do some more homework on the internet, ultimately finding out that there were serious problems with low back fusion including male sterility caused by the BMP drugs now used to promote fusion, serious low back fusion complications, and overload and advanced degeneration of the levels above and below the low back fusion levels. The patient has pain in the left low back and his MRI and CT-Myeogram were essentially normal. What was interesting was that instead of investigating the other causes of low back pain like the SI joint, facet joints, ligaments, or muscles the last clinic jumped directly to a discogram. While a discogram can be helpful, it’s putting a hole in the disc to see if there’s a hole in the disc. Based on his exam and history (despite his “positive discogram”) this patient likely has an SI joint problem that was causing pain. A simple injection under x-ray guidance that’s much less invasive than a discogram and should be able to confirm that the SI joint is causing his pain and not the degenerated low back disc. So what started out as life changing back fusion surgery, ended up as a simple SI joint injection. In this case, a back fusion denial by the man’s insurance company may be the best thing that ever happened to him!
