Diagnosis: Lumbar Stenosis
Treatment: Lumbar Intraspinous Distraction Device
The insurer denied: Lumbar Intraspinous Distraction Device
The denial is: Overturn

The patient is a male who has low back pain with radiating pain to the bilateral hips and calf region, left greater than right. His pain is aching and burning. Pain level is rated at 6/10. Pain is increased with prolonged standing and walking. He is on Meloxicam 15 milligrams (mg) by mouth (PO) daily. He had tried extensive treatments including physical therapy (PT), lumbar transforaminal injections and radiofrequency ablation without adequate improvement. Physical exam (PE) was unremarkable except positive flip test. Lumbar magnetic resonance imaging (MRI) showed multilevel generative disc disease, moderate to severe on the left and mild to moderate right neuroforaminal stenosis at lumbar (L) 4/5, and severe bilateral L5/sacral (S)1 foraminal stenosis. This patient was recommended for Interspinous distraction device.

The proposed treatment is likely to be more beneficial for this patient than any standard treatment.
The interspinous distraction device can function as an extension blocker to minimize the extent of compression of neural elements, particularly in the lateral recess and foramina. There are clinical trials which demonstrated long-term clinical benefit of interspinous spacer decompression for lumbar spinal stenosis. Nunley's randomized controlled trial showed sustained clinical benefit for patients with intermittent neurogenic claudication associated with moderate lumbar spinal stenosis. (1) This patient has symptoms consistent with neurogenic claudication. MRI revealed foraminal stenosis at L4/5 and L5/S1 level. He is an appropriate candidate for the interspinous distraction device. The interspinous distraction device is a minimally invasive procedure that can be performed under monitored anesthesia with less surgical risks than open surgical decompression.