Introduction Of A New ‘Minimally Invasive’ Herniated Disc Procedure

A very interesting article from the Detroit Free Press today for sufferers of Herniated or Bulging Discs.

Bradley Scott woke up pain-free last week for the first time in two years.

The stabbing pain in his leg is gone. He now walks more than a mile a day.

But the biggest difference Scott notices is that he finally can sleep through the night. Before, his back pain was so bad he awoke every two hours when he slept.

Scott, 41, of Riverview credits his pain relief to a new minimally invasive procedure he had two weeks ago that heats, shrinks and removes tissue from the bulging discs that caused his severe back and leg pain.

The introduction of the Disc-FX procedure is the latest refinement in techniques for herniated or so-called bulging discs, one of the most common health problems in America. More than 250,000 Americans undergo surgery each year for low back pain.

The procedure uses a small camera inserted into a thin tube that allows a doctor to see how the disc protrudes on nearby nerve endings in the back. Another tool inserts a wand with a heating tip that shrinks the inside of the disc so it doesn’t protrude.

Elliquence LLC of Oceanside, N.Y., received federal approval to market the system in 2006, but only recently has begun to train doctors in the technique. Milford Medical Supplies Inc., a medical device distributor, is working with doctors in Michigan to provide the first round of training and education.

Like many new technologies, it faces hurdles getting insurers to pay for it. It costs about $4,100 for the Disc-FX procedure, compared to as much as $15,000 for back surgery.

While doctors say they are hopeful the procedures will be reimbursed, Blue Cross Blue Shield of Michigan, Michigan’s largest insurer, covering seven of 10 people in the state with health insurance, said it considers the Disc-FX procedure investigational. It will not be covered if physicians bill them for it, spokeswoman Helen Stojic said.

On Sept. 1, Blue Cross Blue Shield of Michigan also stopped paying for a similar procedure called nucleoplasty, after concluding it was not widely successful, Stojic said.

Dr. Louis Bojrab, an Ann Arbor and Brighton interventional anesthesiologist whose center, Michigan Pain Specialists, offers an array of pain treatments, cancelled about a dozen nucleoplasty procedures after he learned that Blue Cross no longer would pay for it. He considers Disc-FX an improvement, despite its newness.

“I tell my patients this is brand new and they should feel free to say no,” said Bojrab, before the one-hour procedure he preformed on Scott on Oct. 27. Any alternative to surgery is welcome, because scar tissue can form where doctors remove disc material or fuse bones.

“It is the bane of neurosurgery,” Bojrab said. “The surgery can do everything exactly right and you still have to heal.”

As many as 30% of people who undergo the Disc-FX procedure still may need surgery, Bojrab and others say.

Dr. Jawad Shah, a neurosurgeon at Flint’s Insight Institute of Neurosurgery and Neuroscience, said that while Disc-FX “is not for everybody, it’s far preferable to full fusion procedures” to remove herniated discs. The treatment alleviates leg pain 95% of the time, and is about 70% successful in relieving all low-back pain, he said.

He has performed nearly 20 of the procedures in the last four months. “I tell people up front there’s a possibility they won’t get better. But it’s definitely safer.” Most patients so far have been helped by the procedure, he said.

Dr. Dennis Dobritt, an interventional anesthesiologist who directs Tri-County Pain Consultants, with offices in Royal Oak, Livonia and Novi, said patients need to know that “there is no convincing data that proves one technology is better than another for this problem, although this device has many advances that make it potentially better.”

That’s what Scott was betting on.

He expects greater relief in the weeks ahead. He attributes his back pain to long hours driving for his job as a sales representative. His Health Alliance Plan insurance turned him down this summer for a nucleoplasty procedure; Bojrab offered the Disc-FX treatment to him for free because Scott was his first patient using the new procedure, which is not an uncommon practice.

Steroid injections helped Scott before he had the procedure, though they felt like “a fireball going into your back” and the pain returned as the drugs wore off a couple months later, he said.

“When I did any activity, I would get pain radiating into my butt like a lighting bolt,” he said. “It felt like someone stabbing you with a knife.”

Scott returned to work Monday and is scheduled to begin physical therapy today.

“It’s getting better every day. As far as energy level and sleep, it’s huge. That’s the biggest difference I notice.”

Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com

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