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New, need advice

Xray showed Spondylolisthesis, but I do not have that report.
MRI: FINDINGS: Visualized osseous elements intact with no evidence of fracture. Marrow signals within normal
limits. Normal lordotic curvature of lumbar spine. Conus medullaris & cauda equina normal.

IMPRESSION:
1. L3-L4: 3 MM CENTRAL DISC HERNIATION WITH COMPRESSION OF THE ANTERIOR THECAL SAC
AND NO SIGNIFICANT LATERALIZATION BEST APPRECIATED ON AXIAL T2 WEIGHTED IMAGE #9/20.
2. L4-LS: EARLY DESICCATION AND LOSS OF NORMAL WATER CONTENT. 5 MM CENTRAL L4-L5
DISC HERNIATION WITH COMPRESSION OF THE ANTERIOR THECAL SAC AND SLIGHT NARROWING
OF BOTH THE RIGHT AND LEFT L4-LSINTERVERTEBRAL FORAMEN. DEGENERATIVE CHANGES
WITH HYPERTROPHY WITHIN THE RIGHT AND LEFT L4-L5 FACET JOINTS.

Had pain shots for lumbar pain in 2008, but did not put together that my back was causing severe leg weakness and pain.
Fired from my job of 15 years because I could not get to work on time, stiffness and pain horrible in the mornings. Gained 50 lbs. in fluid, and went from dr to dr just to have them tell me I was fat! Finally went to a rheumy, who said it could be my back. Checked reflexes and said I can't help you, you need to go to TX Back Institute.

After xray showing spondy, Surgeon sent me for MRI. Said I was a candidate for surgery, and I said yippee, finally no more pain and edema. Sceduled surgery, got cleared by psychologist and medical exam.

But no, Humana Open Access denied my claim for surgery saying it was not medically necessary. This doc was supposed to appeal and he did, but they still denied. Never heard from his office again, so went to a top doc neuro. he said they won't turn me down, I'll do a 180 (first doc was gonna do a 360), but they denied, daying they had already denied a previous claim with the same codes for this patient.

After I already went to 2nd doc, got letter from OrthoNet, who is doing the denials for Humana, that was sent to first doc denying ther initial claim saying again,

"not medically necessary, no CT scan to confirm the pars defect read by the radiologist that is typically done to show a pars defect. The surgery is not indicated without proven isthmic defect and without a failure of conservative treatment including exercises and activity modification.

So the initial doc dropped me after the 2nd doc asked for the xrays, and the 2nd doc's asst. said they will do everything they can to help me, but nothing is happening (I have since provided them with this letter) and it has been 30 days since I was there. Right now I'll do well to get them to refill pain meds, which I am working on now.

My left leg is horribly painful feeling like a hot poker is stabbing the side of my calf, radiating pain from hip to calf, spasms under buttocks, both calves burn and ache. I have had bowel issues for quite some time, so the MRI did not correctly reflect cauda equina.

I can't work, I can't go visit my grandkids, the summer heat is making me sweat incessantly, and I am living a miserable existence.

Any suggestions?


Janis Haertling
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Comments

  • lulusheartllulusheart Posts: 4,273
    edited 07/19/2012 - 1:29 PM
    hi and welcome to the forum! we are here to offer you support and answer what questions we can.. i am sorry you are having so many problems to getting treatment.. it does not appear that you have gone through any conservative treatments as of yet! some surgeons may find this necessary before they decide to do surgery.. it is all up to the surgeon! please do your best to preservere and carry on!!having bowel issues is something that should be taken care of as soon as possible... please look into this further.. good luck to you!! have a good look around the forum and make yourself at home!! i hope that something changes for you soon!! stop by anytime! Jenny
  • Neither doctor offered conservative therapy. Did get lumbar shots in 2008, Found this: "Whenever there is a significant disc herniation that is pressing against the thecal sac, surgical intervention is really the only recommended treatment option,"
    Basically both docs said I was a candidate for surgery and I said yes. Both were so sure of approval they scheduled my surgery, so I'm thinking Humana handed off to Orthonet to deny cause they simply don't want to pay for it.
    Janis Haertling
  • HankJanisHHankJanis Posts: 3
    edited 08/05/2012 - 5:58 AM
    You don't get edema because of back problems. If you in fact had edema it would be from medication or from laziness and not doing anything. Back injuries don't cause edema which you seem to think does. You gain weight because you are not active. It's fat you're gaining not water. Unless you're on water pills.
  • if the letter from the insurance said there was no CT scan, why didn't one of your docs order the CT scan to prove what is being said? If that's what the insurance wants, it seems like it would be an easy thing to get. Have you asked one of the docs about that?
    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
  • Im sorry but I must disagree with the comment that back problems do not cause edema. I have edema in my left leg only and is much worse when I am having alot of trouble with back. I had thoracic discectomy on May 24 and have had moderate to severe edema in left leg from knee down to foot. I recently seen the NS and he said yes back problems can cause edema.I may have gained weight since having surgery but I know the difference between fat and edema. People who have chronic pain deal with emotional, financial and mental issues and for you to make a comment such as this was uncalled for. Sorry I just could not listen to someone who obviously does not know what he is talking about say something like that.

    kelli
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