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Offshore Insurance Plans

Regarding the effects of captive insurance

Excerpt taken from the Spine Minds discussion: Grade I Degenerative Spondylolisthesis: To Fuse or Not to Fuse? (Part 1)

Watch the video:

http://spineminds.com/2013/05/31/offshore-insurance-plans/

I’ll give you an example of something that happened this week. Not only affecting the individual surgeon who has shown expertise in a particular spinal procedure, it radically affects the patient.

A patient I saw this week works for a large industrial group. His insurance plan has a tiered system of payment that’s reflected in co-pays and deductibles. If he goes to a Center of Excellence in Tennessee, the plan payment/copay is 90%/10%, with 10% being the copay that he will have to pay. If he goes to a non-center of excellence or somewhere else the payment/copay is 80%/20%. Read More

Decision-Makers

Regarding the decision-making process for patients with spondylolisthesis

Excerpt taken from the Spine Minds discussion: Grade I Degenerative Spondylolisthesis: To Fuse or Not to Fuse? (Part 1)

Watch the video:

http://spineminds.com/2013/05/16/decision-makers/

It’s a great topic, Do You Fuse Spondylolisthesis or Not?

If the minimally invasive fusion takes an hour and it works, that’s a far different fusion than one that takes four hours and is open, and far different if the patient is obese and diabetic, than if the patient is slender, 40 years-old, healthy and a non-smoker.

As practitioners in the orthopedic spine field, we all recognize that while we may want to and are expected to abide by the current best evidence on decision-making for the spondylolisthesis patient group, we have just defined how you can’t do that for the individual patient. Read More

Watchful Waiting

Excerpt taken from the Spine Minds discussion: Grade I Degenerative Spondylolisthesis: To Fuse or Not to Fuse? (Part 1)

Watch the video:

http://spineminds.com/2013/05/06/watchful-waiting/

Watchful waiting is an approach to a medical problem that allows time to pass before we advise another form of medical management or surgical intervention. This is a frequent term that we use here at the Spine & Orthopedic Center. It is not ignoring the patient, but generally involves continuous monitoring of the patient’s progress.

It may be asking the patient to ignore their symptoms for a period of time.

Watchful waiting is generally the recommendation for situations with a high probability of self-resolution or advised for conditions where the risks of surgical or therapy intervention may outweigh the benefits. Read More

Healthy Skepticism

Excerpt taken from the Spine Minds discussion: “Devices, Trends and Materials”

Cervical Arthroplasty vs. Cervical Fusion

Watch the video:

http://spineminds.com/2013/04/29/healthy-skepticism-2/

Regarding a patient who had a surgical revision from an arthroplasty to a fusion: After three weeks, I got a text from the surgeon who said: “the patient is a rock star!”

I think that she was going to do well no matter what was done or wasn’t done as long as something was done.

That brings up the healthy skepticism concept which is relevant to the discussion today; we must have a healthy skepticism about new products or new techniques as surgeons, particularly out in the community, as our responsibility is to decide for an individual patient what should be done or what shouldn’t be done. Biases have to be considered. When we’re a private practice, we have to be skeptical about what’s new out there until in my opinion, it’s blatantly obvious that what we’re recommending has stood the test of time. Read More

State of the Art Spine Surgery

“Keep it simple, individualized, customized and safe by intervening only when needed and then with the least damage to uninvolved tissue as possible.” – David R. Campbell, MD

Cervical Spine Myelopathy and Radiculopathy

These terms are commonly used by spine surgeons to explain a medical condition where the spinal cord or the spinal nerves in the neck are not functioning properly. These are Latin derived terms that need some explanation.

The cervical part of the spine is the neck. The spine is comprised of vertebrae, spinal cord, spinal nerves and discs. The vertebrae are composed of bone. The spinal cord is a long bundle of nerve tissue serving as a major conduit for nerve impulses from the brain to the body. The spinal cord represents the word “myelo”. The term “pathy” means messed up, diseased, pathologic and improperly functioning. Combined you get myelopathy. The nerve roots branch out of the spinal cord. When the nerve roots become a problem, it is given the term radiculopathy. If the spinal cord and the spinal nerves are functioning abnormally, it is described as myeloradiculopathy. Read More

Cervical Spinal Stenosis

Cervical spinal stenosis is an abnormal narrowing (stenosis) in the spinal canal of the neck. This narrowing causes a restriction to the spinal canal and may result in neurological deficits which include pain, numbness, paresthesia and loss of motor control. Cervical spinal stenosis can be threatening if the spinal cord becomes compressed. The spinal cord is a column of nerve tissue which is protected by the vertebrae in the spinal canal. The narrowing of this space in the spinal cord places a person at risk of nerve tissue being squeezed. These nerves allow us to feel, move, and control body functions including the bowel and bladder. Read More

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