The peer-reviewed scientific literature regarding the clinical outcomes of these procedures appears very promising, ranging from 79% to 94% overall improvement in back, neck, leg, and arm pain and symptoms. On the contrary, patient selection is the key to success. Surgeons have been quick to cite the overall clinical results of these studies to all patients interested in this alternative from neck or open back surgery to fusion with implants (screws, rods, cages, or artificial discs). What the patient is unaware of is the strict inclusion and exclusion criteria applied when these studies were generated. Patients diagnosed with severe multilevel spinal stenosis (narrowing of the neuro foramen and spinal canal) caused by spondylosis (disc dehydration resulting in loss of disc height) resulting in bone-on-bone grinding or patients diagnosed with unstable spondylolysis (slipping, moving or misalignment of the vertebral body relative to the top or bottom) will not have a favorable outcome from these endoscopic or minimally invasive treatments.

Doctors and facilities advertising these endoscopic and minimally invasive surgeries claim that they are the replacement for fusion in most cases. Patients are encouraged to travel from one end of the country to another to seek these procedures. Unfortunately, a significant number of spinal surgery patients have multiple structural abnormalities related to their spine. The origin of this novel technology was created to treat herniated discs, that’s all. Technology has evolved to include minimally invasive fusions, this is not the patient population involved in this discussion.

In conclusion, the direction of new technology related to spinal surgery in the form of endoscopic and minimally invasive techniques is good. The appeal of these procedures to patients recommended for traditional neck or open back surgery is overwhelming. The benefits involved for the surgery itself, as well as the absence of long-term complications related to spinal implants, such as nonunion (failure of fusion), hardware failure, and disease of the adjacent segment (the disc above or below the fusion wears down) are very realistic when appropriate patient selection is applied. If your client has paid cash for endoscopic or minimally invasive (non-fusion) spinal surgery to treat back, neck, leg, or arm pain and symptoms and has been diagnosed with multilevel spinal stenosis with severe spondylosis or spondylolisthesis causing subluxation (unstable movement), then you have a very strong case for reimbursement if the result was an unwanted result. There is no peer-reviewed scientific data to support that these procedures are an effective cure for patients with these diagnoses.