Diagnosis: Back pain
treatment: Intracept system
The insurer denied the Intracept system.
The health plan's determination is overturned.

This is a female who has back pain for over 20 years. Most of her pain is in the back right greater left without significant leg symptoms. She has more pain with prolonged sitting, physical activities and lumbar extension. Pain level 6-8/10. ODI (Oswestry Disability Index) 46%(percent). She had tried physical therapy (PT), traction and injections without improvement. Magnetic resonance imaging (MRI) showed Modic 2 changes at L (lumbar) 5/S (sacral)1 and moderate central canal stenosis at L3/4.

The Intracept System is likely to be more beneficial than any standard treatment or treatments for the insured's life threatening or disabling condition or disease.
The Intraosseous nerve ablation procedure (INTRACEPT) 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. Her pain is increased by physical activities and severe enough to have a negative impact on her activities of daily living (ADL) and quality of life. Her ODI is 45%, which indicates severe disability. She had tried physical therapy (PT), traction and injections without improvement. Further interventions are medically necessary to improve her pain and functional level. Other potential treatment options are long-term use of medications (opioids) and lumbar decompression fusion surgery. However, none of these options has a high success rate, and all of them carries significant risks and complications. Given this clinical scenario, the Intracept procedure is likely to be more beneficial than standard treatment for this patent.