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I'd like to have the new surgery for a disc replacement instead of a fusion. My doctor has explained how the fusion will stop all motion at that level but can cause problems at the level above or below. She also told me the new disc replacements are designed to restore full motion. The problem is my insurance company won't pay for it. If the FDA approves these implants, then why won't the insurance company pay?

You've come upon a major dilemma when it comes to health care, technology, and costs. There are many experts who don't advocate the use of treatment just because it's available. The rising costs of health care make it necessary to find out who can benefit most from each type of treatment.

The artificial disc replacements (ADRs) are new enough that we still don't know for sure who can benefit most. There may be some patients who truly would do better with a lumbar fusion instead of an ADR. The opposite may be equally true.

Third party payers (insurance companies, Medicare) want to know that ADRs have been proven superior to other treatments known to be effective. How reliable is the data collected on results if the companies who designed the new ADRs do all the research?

There are many questions that remain to be answered before insurance companies can or will approve the use of ADRs in patients with disc problems. How long will the implant last? Will patients end up having a spinal fusion anyway if the ADR fails?

Will patients gain more function and/or have less pain with an ADR compared with spinal fusion? If the ADRs are approved but a patient still wants a fusion, will it be covered? Many more studies must be done to provide reliable and valid results before these questions will be finally answered.

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