2 min read
Dr. Button Answers Questions from Claims Adjusters:
Question:
What is the appropriate need for a spinal cord stimulator?
Answer:
Spinal cord stimulators are used as a course of last resort when patients have chronic back or leg pain and have failed all other forms of conservative treatment. This frequently includes patients who have failed surgery, as well.
Gavin J. Button, M.D.
Orthopedic Surgeon (Spine)
Outcomes with spinal cord stimulators are hit or miss, but they are a reasonable option when all other forms of treatment have been exhausted. A trial is performed before implanting a permanent stimulator in an effort to see if a permanent stimulator will be beneficial.
Question:
What are the differences between a disc bulge, protrusion, and herniation?
Answer:
A protrusion is synonymous with a bulge which differs from a herniation. Imagine an air-filled balloon. If you pushed on the top of the balloon, it would flatten some. That is a bulge or a protrusion.
If you had your hand inside the balloon and you had pushed your thumb out in a very focal spot, that would be a herniation. A herniation occurs when some of the inner disc or nucleus comes out of the annulus or pushes the annulus out in a very focal location as opposed to a bulge or protrusion where the entire disc flattens.
Question:
When is it appropriate to treat with injections versus surgery?
Answer:
Treatment of surgery in the spine is complicated and it is impossible to provide generalizations for every spinal condition and when surgery is appropriate. Injections are appropriate typically in two situations. The most effective situation is when radiculopathy or pain radiates down the arm or leg due to nerve compression from either a disc herniation or stenosis, which is pressure on the nerves that can also originate from bone spurs.
Symptoms under 3-4 months
When symptoms have been going on for under 3-4 months there is still a reasonable chance that therapy, medicines, and tincture of time can lead to resolution. Still, injections during this period can greatly decrease pain while the body’s natural healing processes take effect. Benefits from injections are greatest when a radiculopathy has been present for less than a few months.
Symptoms 4-6 months or longer
Injections for chronic radiculopathy that has been present for 4-6 months or beyond generally provide only temporary benefits because the body has not been able to heal the underlying pathology. There is limited benefit to repeating those injections. Injections can also be performed into joints for chronic neck or back pain, but the outcome of those injections is much less reliable because it is for a chronic arthritic condition.
Dr. Button is board-certified by the American Board of Orthopedic Surgery and has performed over 1,000 spine procedures ranging from microdisectomies to multilevel fusions. He has completed spine fellowships at Orthopedic Physician Associates at Swedish Hospital and at the University of Washington.
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A Previous "Ask the Doctor" Response
In our previous "Ask the Doctor" blog, Dr. Wicher discusses the probability of a new mental health claim, such as anxiety or depression, arising due to financial stressors.