Do failed MILD, Vertiflex, and Minuteman count as FBSS in SCS Algorithm?

Do failed MIS procedures count as FBSS?

  • Yes, hell yeah.

    Votes: 7 38.9%
  • No, no way.

    Votes: 11 61.1%

  • Total voters
    18
About the Ads

Agast

Full Member
10+ Year Member
Sep 14, 2009
1,963
2,048
the river lethe
  1. Attending Physician
    Do you think stim is over-utilized?
    When I do it? No.

    Is there a guy across the road who puts his stim in you on the first date? Yes. And then gets all creepy on you to get the permanent when the stim didn't help? Yes yes. I've gotten a couple of older patients who let their batteries die because "it never helped in the first place." It's not a stretch to imagine someone inappropriately calling interspinous spacer placement FBSS because it benefits their interests.
     
    • Like
    Reactions: 2 users

    drusso

    Full Member
    Moderator Emeritus
    Lifetime Donor
    Verified Expert
    Nov 21, 1998
    11,072
    5,117
    Over the rainbow
    1. Attending Physician
      When I do it? No.

      Is there a guy across the road who puts his stim in you on the first date? Yes. And then gets all creepy on you to get the permanent when the stim didn't help? Yes yes. I've gotten a couple of older patients who let their batteries die because "it never helped in the first place." It's not a stretch to imagine someone inappropriately calling interspinous spacer placement FBSS because it benefits their interests.

      "Over-utilizer" = "Anyone who does more ________ than me?"
       
      • Like
      Reactions: 1 user

      Taus

      .
      Staff member
      Administrator
      Volunteer Staff
      Verified Expert
      15+ Year Member
      Feb 1, 2005
      4,204
      958
      Philly
      1. Attending Physician
        Drusso, are you trying to play devils advocate here or are you asking for permission? If someone puts a spacer in a virgin spine and then tells them they failed surgery, that’s shady.
        Seen it. Several times. Usually combo of Vertiflex or some other variant, then SI fusions by pain dr. Failed? Fbss. Scs. Then come to me for 2nd opinion. Typically 50-70 with severe stenosis. Off to surgeon you go.
         

        drusso

        Full Member
        Moderator Emeritus
        Lifetime Donor
        Verified Expert
        Nov 21, 1998
        11,072
        5,117
        Over the rainbow
        1. Attending Physician
          Drusso, are you trying to play devils advocate here or are you asking for permission? If someone puts a spacer in a virgin spine and then tells them they failed surgery, that’s shady.

          I'm just trying to stoke some grown-up conversation around here...who decides who fails what? The patient, the treating doctor, or a second opinion?

          Should the stim come first or second in "the algorithm?"

          We can go back to talking about meth-head fish?


          1625700604647.png
           
          Last edited:
          About the Ads

          BobBarker

          Member
          15+ Year Member
          Dec 13, 2005
          4,016
          1,924
          1. Attending Physician
            We all know Lou is ready to put a Wavewriter Alpha in that Vflex patient, but looks like he did a very good job on the vflex. There are nice neuroforamenal openings at the treated levels and the levels above and below. I would expect
            that patient to do very well. There is nothing to criticize there.
             

            RoloTomassi

            Full Member
            10+ Year Member
            Apr 28, 2010
            254
            228
              Approval guidelines usually require that there is no corrective surgery or that patient is not a good candidate for it, which is subjective.

              Many older stenotic patients are not good candidates for lami/fusion so I think SCS after failure of mild or Vflex is appropriate in this population. There was a thread on here about this before.
               
              • Like
              Reactions: 1 user

              Ducttape

              Full Member
              Lifetime Donor
              10+ Year Member
              Oct 7, 2011
              11,125
              3,824
              1. Attending Physician
                Can you elaborate what you mean?
                the guiding principle of some of our thought leaders is that procedures that generate significant financial reward are the treatments we need to be advocating and performing.

                I rarely see these leaderss advocating for treatments that, for example, your wife provides. maybe a passing "oh they get a referral for CBT in our office"...



                there are at least 3 separate "pain" programs in this area that are run as block shops. id guestimate almost all of my private pay referrals are from patients who have gone to these other practices where the first and only time they see the pain doctor is in Pre An.

                yes, these are the successful (financially) programs in town. 1 of the 3 is private.
                 
                • Like
                Reactions: 1 user

                drusso

                Full Member
                Moderator Emeritus
                Lifetime Donor
                Verified Expert
                Nov 21, 1998
                11,072
                5,117
                Over the rainbow
                1. Attending Physician
                  the guiding principle of some of our thought leaders is that procedures that generate significant financial reward are the treatments we need to be advocating and performing.

                  I rarely see these leaderss advocating for treatments that, for example, your wife provides. maybe a passing "oh they get a referral for CBT in our office"...



                  there are at least 3 separate "pain" programs in this area that are run as block shops. id guestimate almost all of my private pay referrals are from patients who have gone to these other practices where the first and only time they see the pain doctor is in Pre An.

                  yes, these are the successful (financially) programs in town. 1 of the 3 is private.

                  How does CBT fix stenosis?
                   

                  DOctorJay

                  Full Member
                  15+ Year Member
                  May 8, 2004
                  3,614
                  1,157
                  1. Attending Physician
                    We all know Lou is ready to put a Wavewriter Alpha in that Vflex patient, but looks like he did a very good job on the vflex. There are nice neuroforamenal openings at the treated levels and the levels above and below. I would expect
                    that patient to do very well. There is nothing to criticize there.
                    aside from the continuous lack of any collimation
                     
                    • Haha
                    Reactions: 1 user
                    About the Ads

                    lobelsteve

                    Full Member
                    Staff member
                    Volunteer Staff
                    Lifetime Donor
                    Verified Expert
                    15+ Year Member
                    May 30, 2005
                    17,242
                    7,478
                    Canton GA
                    www.stevenlobel.com
                    1. Attending Physician
                      I think in the future SCS will be more available to surgically naive patients, I’m sure Medtronic and others are working on the study.
                      DPN. Nevro. Excited to tear apart the study SIS.
                       
                      • Like
                      Reactions: 1 user

                      dipriMAN

                      Full Member
                      2+ Year Member
                      Sep 4, 2017
                      1,513
                      1,523
                        DPN. Nevro. Excited to tear apart the study SIS.
                        I don’t think SCS should be used for every neuropathic pain condition like it’s a holy grail.

                        but if we put in stims for FBSS, who’s to say a lot of the chronic radic and back pain that is surgically naive wouldn’t benefit, just can’t predict who is going to have persistent pain after surgery.
                         
                        • Like
                        Reactions: 1 user

                        drusso

                        Full Member
                        Moderator Emeritus
                        Lifetime Donor
                        Verified Expert
                        Nov 21, 1998
                        11,072
                        5,117
                        Over the rainbow
                        1. Attending Physician
                          yes the truth hurts sometimes.

                          or most of the time.



                          so lets just hide behind a veneer of big arse procedures or mind altering substances.

                          If there is one lesson physicians should have learned in the 20th century is that the misattribution of neurological symptoms to psychiatric disease is almost always wrong: See MS, schizophrenia, depression, anxiety, autism, etc for examples.

                          Treat all pain and pain treatment failures as biological problems until proven otherwise.
                           

                          lobelsteve

                          Full Member
                          Staff member
                          Volunteer Staff
                          Lifetime Donor
                          Verified Expert
                          15+ Year Member
                          May 30, 2005
                          17,242
                          7,478
                          Canton GA
                          www.stevenlobel.com
                          1. Attending Physician
                            If there is one lesson physicians should have learned in the 20th century is that the misattribution of neurological symptoms to psychiatric disease is almost always wrong: See MS, schizophrenia, depression, anxiety, autism, etc for examples.

                            Treat all pain and pain treatment failures as biological problems until proven otherwise.
                            That’s a terrible idea. Pain is a symptom and not a disease.
                             
                            • Like
                            Reactions: 2 users

                            drusso

                            Full Member
                            Moderator Emeritus
                            Lifetime Donor
                            Verified Expert
                            Nov 21, 1998
                            11,072
                            5,117
                            Over the rainbow
                            1. Attending Physician

                              Ducttape

                              Full Member
                              Lifetime Donor
                              10+ Year Member
                              Oct 7, 2011
                              11,125
                              3,824
                              1. Attending Physician
                                If there is one lesson physicians should have learned in the 20th century is that the misattribution of neurological symptoms to psychiatric disease is almost always wrong: See MS, schizophrenia, depression, anxiety, autism, etc for examples.

                                Treat all pain and pain treatment failures as biological problems until proven otherwise.
                                so every patient gets opioids, because from most patients standpoint that is the treatment for a biological problem.


                                can you rightly say that scrambling central nervous system pathways benefits any of those conditions? is frontal lobotomy the treatment of choice for MS, schizophrenia, depression, anxiety, autism?
                                 
                                • Like
                                Reactions: 1 users

                                Ducttape

                                Full Member
                                Lifetime Donor
                                10+ Year Member
                                Oct 7, 2011
                                11,125
                                3,824
                                1. Attending Physician

                                  not sure how that makes your point that pain as a separate specific disease. essentially, this working group wants fibromyalgia and nonspecific low back pain to be classified as a separate disease called "chronic primary pain" and other pain syndromes that are associated with a disease to be called "chronic secondary pain", each with its own ICD. the purpose is to facilitate epidemiologic studies and change health policies and I'm not seeing anything about a true biological basis for making this classification.
                                   

                                  lobelsteve

                                  Full Member
                                  Staff member
                                  Volunteer Staff
                                  Lifetime Donor
                                  Verified Expert
                                  15+ Year Member
                                  May 30, 2005
                                  17,242
                                  7,478
                                  Canton GA
                                  www.stevenlobel.com
                                  1. Attending Physician
                                    What duct said. They aren’t arguing it is a disease. Just a title to draw attention and try and score research $$$$
                                     

                                    Ducttape

                                    Full Member
                                    Lifetime Donor
                                    10+ Year Member
                                    Oct 7, 2011
                                    11,125
                                    3,824
                                    1. Attending Physician
                                      @Ducttape and @lobelsteve ganging up on @drusso...there is a disturbance in The Force...
                                      not ganging up.... but you are man enough to take it.
                                      I also agree, financials aside, that people should have the option of SCS without needing someone cutting their spine first.
                                      we already have enough inappropriate use of advanced procedures. if we were to give the option to do SCS without prior surgery, there need to be some appropriate indications that are fairly strict. otherwise the success rate will continue to plummet...

                                      (some of the outstanding inappropriate uses I have personally seen in past - ITP for atypical facial pain; ITP for healed compression fx that failed tramadol; lumbar SCS for cervical postlaminectomy; SCS in nonsurgical normal spine and no neuropathy sx; cervical SCS for total body CRPS)
                                       

                                      lobelsteve

                                      Full Member
                                      Staff member
                                      Volunteer Staff
                                      Lifetime Donor
                                      Verified Expert
                                      15+ Year Member
                                      May 30, 2005
                                      17,242
                                      7,478
                                      Canton GA
                                      www.stevenlobel.com
                                      1. Attending Physician

                                        Ferrismonk

                                        Full Member
                                        10+ Year Member
                                        15+ Year Member
                                        Dec 12, 2006
                                        1,882
                                        1,867
                                        1. Attending Physician
                                          not ganging up.... but you are man enough to take it.

                                          we already have enough inappropriate use of advanced procedures. if we were to give the option to do SCS without prior surgery, there need to be some appropriate indications that are fairly strict. otherwise the success rate will continue to plummet...

                                          (some of the outstanding inappropriate uses I have personally seen in past - ITP for atypical facial pain; ITP for healed compression fx that failed tramadol; lumbar SCS for cervical postlaminectomy; SCS in nonsurgical normal spine and no neuropathy sx; cervical SCS for total body CRPS)
                                          Just make the reimbursement $500, inappropriate use would stop.
                                           
                                          • Like
                                          Reactions: 2 users
                                          About the Ads

                                          Your message may be considered spam for the following reasons:

                                          1. Your new thread title is very short, and likely is unhelpful.
                                          2. Your reply is very short and likely does not add anything to the thread.
                                          3. Your reply is very long and likely does not add anything to the thread.
                                          4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
                                          5. Your message is mostly quotes or spoilers.
                                          6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
                                          7. This thread is locked.