New treatments for the back cut costs

The ability to go home within 23 hours, the reduced need for anesthesia, and fewer potential complications all add up to less expensive procedures for treatment back pain when you evaluate hydrodiscectomy, X Stop, and balloon kyphoplasty.

The cost of hydrodiscectomy is about $1,100 per tool, but the tool can be used two or three times on the same patient if more than one disc is herniated, says Didier Demesmin, MD, a pain management specialist in Milltown, NJ. "This procedure is very attractive to insurance companies, and reimbursement is not a problem if you select the patients carefully and perform a post-procedure MRI to prove the disc reduction," he says.

Local anesthesia with oral sedation to reduce anxiety is used because he does not want the patient asleep during the procedure. "Patients can give me feedback to let me know what sensations they feel so that I can make sure I am addressing the problem," Demesmin explains. "I do recommend that an anesthesiologist be available in case the patient needs deeper analgesia."

At this time, the majority of Demesmin's patients do require intravenous sedation that requires monitoring. "When the tool pierces the muscle, patients who are anxious tend to move, which makes it difficult to get a clear picture of where the tool is heading," he explains. The deeper analgesia relaxes the patient so that movement is limited but allows the patient to remain conscious, he adds.

The X Stop procedure enables patients to go home the day of surgery or to be held in a 23-hour stay unit, says Arya Shamie, MD, a spine surgeon at Santa Monica-University of California at Los Angeles Medical Center. The Centers for Medicare and Medicaid services recently approved a $4,400 add-on to reimburse hospitals the extra cost of new technology, he says. "Not only is this procedure one-third to one-half the cost of a laminectomy, but there is also no lengthy stay, and the patient does not have to be exposed to the risks of general anesthesia."

Balloon kyphoplasty can be performed under local or general anesthesia, and B. Christoph Meyer, MD, an orthopedic surgeon in Houston, uses conscious sedation for 25%-30% of his patients. "In general, the procedure lasts 30 minutes for each level you are treating," he says.

"Right now, I would do almost every balloon kyphoplasty on an outpatient basis, but Medicare reimbursement of this procedure as an outpatient procedure does not cover the hospital's costs," Meyer points out. Although about 20% of his patients do go home on the same day of the procedure, he does book it as an inpatient procedure, he adds.

Meyer does expect Medicare reimbursement policies to include balloon kyphoplasty as an outpatient procedure as more procedures are performed and the financial benefit of performing the procedure as an outpatient procedure are more thoroughly documented. Private insurance companies are more likely to cover the procedure as outpatient, he adds.


For more information about back procedures, contact:

  • Didier Demesmin, MD, Accucare Pain Medicine, 440 S. Main St., Milltown, NJ 08850. Telephone: (866) 322-6500 or (732) 967-1001. Web:
  • B. Christoph Meyer, MD, 8200 Wednesbury Lane, Suite 360, Houston, TX 77074. Telephone: (713) 484-6200. Fax: (713) 773-0905. Web:
  • James Zucherman, MD, One Shrader St., No. 450, San Francisco, CA 94117. Telephone: (415) 750-4877. E-mail:

For more information on back pain products and techniques, contact:

  • Hydrodiscectomy: HydroCision, 22 Linnell Circle, Suite 102, Billerica, MA 01821. Telephone: (888) 747-7470 or (978) 474-9300. Fax: (978) 600-5037. E-mail: Web: To find information on hydrodiscectomy, choose "products" on the top navigational bar, then scroll down to "hydrodiscectomy system."
  • X Stop: St. Francis Medical Technologies, 960 Atlantic Ave, Suite 102, Alameda, CA 94501. Telephone: (510) 337-2600. E-mail: Web: To find information about X Stop, choose "LSS Fact Sheet" on left navigational bar. You also can choose "patient information" on top bar, then choose "The X Stop System" on the left navigational bar.
  • Balloon Kyphoplasty: Kyphon, 1221 Crossman Ave., Sunnyvale, CA 94089. Telephone: (408) 548-6500. Fax: (408) 548-6501. Web: To find information on balloon kyphoplasty, choose "Healthcare Professionals" on top navigational bar, then select "Balloon Kyphoplasty" on left navigational bar.