General Guideline Principles for Disc Replacement
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Disc Replacement.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Disc Replacement of of Therapeutic Procedures: Operative

Replacement of artificial discs is not among the pre-authorized treatments. Providers who wish to carry out one of these operations must first submit a preauthorization request to the carrier.

1. Disc Replacement of Therapeutic Procedures: Operative

   Disc Replacement of Therapeutic Procedures: Operative is recommended in select patients as clinically indicated.

   Indications: for radiculopathy associated with lumbar degenerative disc degeneration at one level that is resistant to conservative treatment.

   The following criteria must be met:

   • Patient with mature skeleton who is not suffering from kidney failure, severe diabetes, osteoporosis, severe spondylosis, severe facet pathology, lumbar instability, localised fractures, or systemic or localised infections
2. Imaging tests such a CT or MRI with one of the following diagnosis for L3 to S1 single-level disc degeneration:
   • Herniated disc
   • Osteophyte formation
   • Loss of disc height
3. The patient must exhibit symptoms that are consistent with the level of disc replacement planned.
   • Intractable radiculopathy (nerve root compression) and/or myelopathy (functional disturbance or pathological change in the spinal cord) causing radicular pain in the lower extremity; or
   • Functional and/or neurological deficit.
4. Six weeks of non-operative alternative treatments have failed.

   Physical therapy, drugs, braces, chiropractic care, bed rest, spinal injections, or exercise regimens are all examples of possible therapies. It is necessary to keep track of therapies and failures to improve.

   The U.S. Food and Drug Administration must certify the disc (FDA). All more artificial disc systems are regarded as investigational and experimental.

   The term “experimental” and “investigational” are used to describe all other indications, including multilevel degenerative disc degeneration.

   Not Recommended – since the replacement discs’ security and efficiency for patients with the following disorders are unknown:

   • Prior surgical procedure at the concerned level
   • An earlier or planned fusion at a nearby lumbar level
   • Replacement of artificial discs at many lumbar levels
   • Clinically impaired vertebral bodies at the afflicted level as a result of recent or previous trauma (including, but not limited to, fracture callus, malunion, or nonunion as seen on radiographs).
   • An infection that is present throughout the body or at the site of surgery
   • Remains of polyurethane, titanium, or ethylene oxide allergy
   • A DEXA bone mineral density T score is used to diagnose osteoporosis.
     greater than or equal to -2.5.

What our office can do if you have workers compensation Disc Replacement

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.