Understanding Artificial Disc Technology In Your Claim

Medical technology is changing medical care and treatment injured workers receive. One of these areas is in the field of back injury care. This includes the use of spinal fusion surgery and artificial disc replacements.

The Changing Landscape of Back Injury Care

The spinal cord is the core of a person’s central nervous system. It is composed of a series of parts that starts at the medulla oblongata near one’s brain and extends to the coccyx, otherwise known as the tailbone. It contains a number of bones, which are called “vertebrae.” Material referred to as “discs, which serves as a cushion between each vertebrae. Injury to one’s spinal cord can result in damage to these discs, which include nerve root impingement and misalignment of the vertebrae.

Traditional surgical procedures involving the spinal cord and discs include fusion surgery. When this procedure is performed, hardware is affixed to adjoining vertebrae to reduce the impingement of nerves. While this procedure is often effective, the downside is it will decrease motion within the spinal column.

To address this downside, medical device manufactures have created artificial disc technology. The use of this procedure, commonly referred to as an “intervertebral disc arthroplasty,” eliminates the need for a fusion surgery by providing the same benefits as a fusion, but without the loss of motion in the spine.

How Does this Affect My Claim?

There are a number of pros and cons associated with the use of artificial disc technology. Claims handlers working on files that involve such procedures require caution.

• Pros related to artificial disc technology:
  • Quicker healing times and possible return to work;
  • Less loss of motion following surgery, which can reduce exposure for claims related to Permanent Partial Disability; and
  • Increased satisfaction with post-surgical results.

• Cons related to artificial disc technology:
  • Evolving technology that sometimes does not have a consistent result;
  • Hardware failure can be catastrophic; and
  • Varied surgical costs that can be more expensive from traditional spinal fusion procedures.

Defending Cases that Involve Artificial Disc Replacements

There is a growing body of case law dealing with the reasonableness and necessity of artificial disc replacement requests across the country. Several years ago, this advance in medical technology was rarely considered and viewed by many as questionable even though it was being used with increasing frequency outside the United States. The FDA has been reviewing these procedures and they are gaining acceptance in domestic medical treatment. The result is more injured workers opting for an artificial disc replacement following a severe back injury.

Important issues to consider when analyzing these cases from a claim management standpoint include:

• The prior medical history of the claimant and their response to surgical requests. The prior use of cigarettes and tobacco products is another important matter to consider. Patients who have used or are currently using these products have a well-documented poor response when recovering;

• The potential medical costs of artificial disc procedures compared to spinal fusions. Medical technology is constantly changing. So are the costs of these medical procedures. As the technology develops and becomes cheaper, it may be more difficult for insurance carriers to argue the standard approach of fusion surgeries is appropriate; and

• Interested stakeholders would also consider the expertise of their independent medical examiner when defending a case where use of an artificial disc replacement could be an issue. It is well documented that a compensation judge may ultimately accept one expert’s opinion over another if they have a background in this area, or at least the proper foundation and scientific knowledge to give a credible opinion.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.