Orthopedic
Pain management

Diagnosis; back pain
treatment: nerve treatment to the spine
The insurer denied nerve treatment to the spine. The health plan's determination is overturned.

This is a male with chronic low back pain and neck pain. For his low back pain, he had a LESI (lumbar epidural spinal injection), and Bilateral L (lumbar) 4 - S (sacral) 1 radiofrequency ablation (RFA). His back pain is across his waistline, worse with walking and standing. Pain is disabling with a significant impact on activities of daily living (ADL) and quality of life. A follow up visit indicated that after the RFA the patient continues to have low back pain. On physical exam (PE), there was pain with extension and facet loading. An magnetic resonance imaging (MRI) scan showed multilevel degenerative spondylosis without high-grade spinal canal stenosis and Modic type 1 and 2 at L4-L5-S1 level.

The nerve treatment to the spine is medically necessary for this patient.
The Intraosseous nerve ablation procedure was designed to treat low back pain from vertebral body by ablating intraosseous nerves. There are multiple clinical trials demonstrated the efficacy of this intervention. This patient's persistent back symptomatology is consistent with vertebrogenic pain. He had tried extensive treatments including epidural injection, lumbar medial branch blocks, RFA and pain medications without adequate improvement. His pain is severe with a negative impact of activities of daily living (ADL). Given this patient's clinical scenario, the nerve treatment to the spine is medically necessary.