Biofilms constitute a protected mode of growth that allows microorganisms to survival in hostile environments, being their physiology and behavior significantly different from their planktonic counterparts.
When performed with chondroitinase ABC or agents other than chymopapain Percutaneous lumbar discectomymanual or automated, is considered medically necessary for treatment of herniated lumbar discs when all of the following are met: Member is otherwise a candidate for open laminectomy; and Member has failed 6 months of conservative treatment; and Diagnostic studies show that the nuclear bulge of the disc is contained within the annulus i.
Percutaneous lumbar diskectomy is considered experimental and investigational for all other indications because its effectiveness for indications other than the one listed above has not been established. Clinical studies have not established any clinically significant benefit of use of a laser over use of a scalpel for percutaneous lumbar diskectomy.
Non-pulsed radiofrequency facet denervation also known as facet neurotomy, facet rhizotomy, or articular rhizolysis is considered medically necessary for treatment of members with intractable cervical or back pain with or without sciatica in the outpatient setting when all of the following are met: Member has experienced severe pain limiting activities of daily living for at least 6 months; and Member has had no prior spinal fusion surgery at the level to be treated; and Neuroradiologic studies are negative or fail to confirm disc herniation; and Member has no significant narrowing of the vertebral canal or spinal instability requiring surgery; and Member has tried and failed conservative treatments such as bed rest, back supports, physiotherapy, correction of postural abnormality, as well as pharmacotherapies e.
Non-pulsed radiofrequency facet denervation is considered experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.
Only 1 treatment procedure per level per side is considered medically necessary in a 6-month period. Pedicle screws for spinal fixation are considered medically necessary for the following indications: Fusion adjacent to prior lumbar fusion Fusion after decompression Revision lumbar disc surgery requiring instrumentation because of instability at the previous level of surgery Scoliosis and kyphosis requiring spinal instrumentation Segmental defects or loss of posterior elements following tumor resection Spinal trauma of all types including fractures and dislocations Spondylolisthesis -- grades I to IV Thoracic fractures Pedicle screw fixation is considered experimental and investigational for all other indications, including the following because its effectiveness for indications other than the ones listed above has not been established: Expandable cages are considered medically necessary for persons who meet criteria for fusion in CPB - Spinal Surgery: Expandable cages are considered experimental and investigational for all other indications.
Percutaneous polymethylmethacrylate vertebroplasty PPV or kyphoplasty is considered medically necessary for members with persistent, debilitating pain in the cervical, thoracic or lumbar vertebral bodies resulting from any of the following: Other causes of pain such as herniated intervertebral disk have been ruled out by computed tomography or magnetic resonance imaging; and Severe debilitating pain or loss of mobility that cannot be relieved by optimal medical therapy e.
Lateral including extreme [XLIF], extra and direct lateral [DLIF] interbody fusion is considered an acceptable method of performing a medically necessary anterior interbody fusion.
Coccygectomy is considered medically necessary for individuals with coccygodynia who have tried and failed to respond to 6 months of conservative management. Vertebral body replacement spacers e. Sacroiliac fusion may be medically necessary for sacroiliac joint infection, tumor involving the sacrum, and sacroiliac pain due to severe traumatic injury where a trial of an external fixator is successful in providing pain relief; Sacroiliac joint fusion e.
Clinical studies have not established a clinically significant benefit of use of a laser over a scalpel in spinal surgery. No additional benefit will be provided for the use of a laser in spinal surgery.
Use of a microscope or endoscope is considered an integral part of the spinal surgery and not separately reimbursable. An epidural steroid injection is used to help reduce radicular spinal pain that may be caused by pressure on a spinal nerve root as a result of a herniated disc, degenerative disc disease or spinal stenosis.
This treatment is most frequently used for low back pain, though it may also be used for cervical neck or thoracic midback pain. A combination of an anesthetic and a steroid medication is injected into the epidural space near the affected spinal nerve root with the assistance of fluoroscopy which allows the physician to view the placement of the needle.
Approaches to the epidural space for the injection include: Caudal — the epidural needle is placed into the tailbone coccyx allowing the treatment of pain which radiates into the lower extremities.
This approach is commonly used to treat lumbar radiculopathy after prior surgery in the low back post-laminectomy pain syndrome. Cervical — the epidural needle is placed in the midline in the back of the neck to treat neck pain which is associated with radiation of pain into an upper extremity cervical radiculopathy.
Interlaminar — the needle is placed between the lamina of two vertebrae directly from the middle of the back. Also called translaminar, this method accesses the large epidural space overlying the spinal cord, and is the most commonly used approach for cervical, thoracic, and lumbar epidural injections.
Medication is delivered to the nerve roots on both the right and left sides of the inflamed area at the same time. Lumbar — the epidural needle is placed in the midline in the low back to treat back pain which is associated with radiation into a lower extremity lumbar radiculopathy.
Thoracic — the epidural needle is placed in the midline in the upper or middle back. Transforaminal — the needle is placed to the side of the vertebra in the neural foramen, just above the opening for the nerve root and outside the epidural space; this method treats one side at a time.Microbial adhesion to surfaces and the consequent biofilm formation has been documented in many different environments.
Biofilms constitute a protected mode of growth that allows microorganisms to survival in hostile environments, being their physiology and behavior significantly different from their planktonic counterparts. MBA Dictionary of Business Management Methods.
This management dictionary contains a description and explanation of terms and methods. It's a management glossary. Diffusion of innovation research was first started in by seminal researcher Gabriel Tarde, who first plotted the S-shaped diffusion barnweddingvt.com defined the innovation-decision process as a series of steps that includes: First knowledge.
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