Patient Q & A 
Question: I was prescribed a back brace. Will my insurance benefits cover it?

Answer: Coverage of back braces depends on your medical condition as well as the policies of your insurer. To determine whether a back brace is covered by insurance, contact a customer service representative at your insurer via the number or email address provided on your insurance card. Some insurers also provide coverage help on their individual websites. Your physician may be able to provide assistance as well.

Answer provided by Allison Waxler, Senior Manager of Health Policy & Practice
Reviewed by members of the NASS Patient Education Committee



Question: I have been diagnosed with disc protrusion. My physician recommended surgery to relieve the pain. The surgeon mentioned they make a hole in the lamina to remove the protrusion. Does the lamina heal post-surgery or does the hole remain?

Answer:  The situation: your surgeon has recommended surgery to address your lumbar disc herniation. He has counseled you on the procedure, which entails surgery with you lying prone (on your abdomen) while he approaches your spine from the back. A small incision is made, and he then proceeds to expose the spine. To get to the disc material, a laminotomy - a hole in the bone covering the nerve, is created. The surgeon uses special tools to make this laminotomy, usually a tiny drill or a Kerrison (an instrument specialized to remove bone) is used. Once the hole is made, the surgeon gently moves the nerve safely to the side, and is then able to remove the disc herniation. Once completed, the nerve is free of compression, and the incision is closed in several layers.

What happens to the laminotomy, or hole the surgeon created in the bone? Most commonly, the hole quickly closes in a few weeks with scar tissue. This scar tissue acts like a protective tent covering the hole. Usually scar tissue causes no problems because its production is a natural event in the healing process. In a select population of patients, however, a small amount of bone regrowth does occur. But this rarely causes any significant problems.

Answer provided by Olumide Danisa, MD  
Reviewed by members of the NASS Patient Education Committee



Question: I had a cervical hernia (c5-6) and osteochrondosis. After  I've completed the treatment, can I go back to my normal life? Can I work out, do strength training/bodybuilding?

Answer:  Although it is very likely that you can, this question is hard to accurately answer for many reasons.  There is simply too little information to make recommendations, and an appropriate history and physical examination is critical.  It is important to understand that physicians treat the patients and not their imaging study.  The the goal is to ideally make the patients feel better without significant compromise in quality of life, and not to make the photo look pretty.  For all of these reasons, it is critical you contact your spine physician for an accurate answer to this important question.

Answer provided by Faisel M. Zaman, MD, PC  
Reviewed by members of the NASS Patient Education Committee



Question:
Currently, in the United States, disc replacement is only approved for use at one cervical level and is not approved for use adjacent to a previous cervical fusion. Is this statement accurate? I have a fusion and am looking at a disc replacement at an adjacent level.

Answer:  Total Disc Replacement (TDR) is FDA approved for single level disc only currently. Benefits versus risks of TDR over anterior cervical discectomy and fusion is uncertain adjacent to a two-level fusion at this time. 

Answer provided by Patrick Bolt, MD 
Reviewed by members of the NASS Patient Education Committee




Question: I have seen several ads for laser surgery, and I want to know if this is something I should ask my doctor about?

Answer:  Thank you for your question. Please see this SpineLine article from 2009 about laser surgery. 

Answer provided by Jack Stern, MD, PhD, FACS 
Reviewed by members of the NASS Patient Education Committee




Question: Is there a difference in standing vs. lying imaging for low back and does it matter? The X-ray (standing) looks and reports out much worse, with  significant damage. The MRI (lying down) shows moderate damage for the same back (and pain). Does the weight-bearing nature of the spine show up in the x-ray better than the MRI?

Answer:  Typically, standing (or weight bearing) imaging can let your health care provider see certain problems easier.  For example, a torn ligament, disc bulge or herniation may be stressed and or made worse in an upright position as opposed to when you’re lying down.  Problems with posture can only be seen  on an upright X-ray and cannot be evaluated in an image taken while lying down. 
X-ray and MRI are two separate imaging types and cannot be compared. 

Answer provided by Jordan Gliedt, DC 
Reviewed by members of the NASS Patient Education Committee




Question:
I’ve had multiple back surgeries, including a fusion. My fusion was more than six weeks ago. Will I ever be the same?

Answer: Spinal fusion surgery requires time for recovery.  While the skin can heal over days, the muscles may need weeks to months to stabilize. The healing of bony fusions and nerve compression can take months to years. Recovery may be partial or incomplete. Rarely, early or late complications from surgery may arise.

If you are concerned about issues with your recovery from surgery, you should let your health care provider know promptly. In all aspects of medicine, but particularly in spine treatment, it is important to communicate with your health care provider. It may help to write down your questions prior to your appointment and to write down the answers. It is important to discuss clearly your concerns and expectations and also understand your doctor's concerns and expectations of your recovery. Best of luck in your ongoing recovery.

Answer provided by Patrick Bolt, MD 
Reviewed by members of the NASS Patient Education Committee




Question: 
I am trying to find out if a health insurance company decides not to cover a medical procedure that would significantly improve a patient's life and the patient is willing to consider bearing the costs in order to obtain better health, can the patient still go ahead with the procedure and be entitled to all of the health insurance company's negotiated discount rates for purposes of charges by doctors, hospitals, surgery room, and supplies, etc?

Thank you very much with your assistance.

Answer: I am not aware of any laws or regulations requiring doctors or hospitals to offer negotiated discount rates to individuals paying out of pocket. Many will do so, but they are not required. I would encourage you to discuss this with your doctors and hospital prior to any procedure.

Answer provided by Allison Waxler, Senior Manager of Health Policy & Practice
Reviewed by members of the NASS Patient Education Committee