[gdbeckett]

#31732

Dear Dr. Corenman,

You performed a lumbar decompression for me in 2012. If I recall correctly, you discussed the advantages and disadvantages of a non-fusion approach, but that decompression alone could have favorable outcomes. My was that until this year when a new synovial cyst formed and is impinging on the central nerve causing the sciatic symptoms you know so well.

I am looking for some medical references to share with my insurer to confirm the above (again, if recollection serves). The last procedure did well, and my current DPT and back doctor do not believe that fusion is warranted, as there has been minimal changes in the spondylolisthesis since your work in 2012.

Any thoughts or advice will be greatly appreciated. Happy holidays and best wishes for a great New Year!

Park City UT

[Donald Corenman, MD, DC]

#31734

If your spondylolisthesis does not demonstrate instability as found on flexion/extension X-rays and has not advanced in slip (let’s say from 3mm slip in 2012 to 5mm slip now), you could consider another decompression of that level. The caveat is that these cysts tend to be adhesive and stick to the nerve roots and dura making a second decompression more difficult. There are plenty of papers in the literature that discuss this but the insurance company should follow the lead of the surgeon and allow leeway for you and the surgeon to make that decision.

Dr. Corenman

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