Scoliosis and Osteoporosis Surgery Options for Seniors

The mother has scoliosis and osteoporosis, and the doctor recommends surgery?

Hello Doctor: My mother has severe scoliosis combined with osteoporosis.
She has visited two hospitals, Tongji Hospital and Taichung Renai Hospital, where doctors have recommended surgery.
However, after agreeing to the surgery, we found out that the application to the National Health Insurance was denied, and we would have to pay out of pocket???? This has left us in a difficult situation.
The nurse only informed us that if surgery is truly necessary, we would need to pay out of pocket (costing around 300,000 to 400,000 NTD), but did not specify the reason for the application denial.
She then referred my mother to a neurologist for treatment of scoliosis and osteoporosis, suggesting that medication and rehabilitation could be options??? What is the normal procedure in this case? What could be the reasons for the surgery application being denied despite the assessment indicating that surgery is needed? My mother is already 56 years old, and if surgery is necessary, we hope to address this as soon as possible to prevent her body from deteriorating further! We sincerely seek clarification on this matter.
Thank you.

Suan Suan, 20~29 year old female. Ask Date: 2011/09/06

Dr. Shi Guozheng reply Orthopedics

The reasons for spinal surgery are typically due to nerve compression or pain that cannot be managed with medication.
In adults with scoliosis, surgery is only necessary if there is compression affecting cardiac or pulmonary function.
As for severe osteoporosis, surgery is required only if there are compression fractures.
It is important to clarify that if the application for health insurance has not been approved, you may need to inquire with the hospital or the local health insurance bureau about the reasons and what additional materials are required for the application.
Compliance with regulations is also relevant.
If the current condition can be managed with medication, surgery is not recommended, or you may need to seek a second opinion from another physician for further evaluation.

Reply Date: 2011/09/06

More Info

Scoliosis and osteoporosis are two conditions that can significantly impact the quality of life, especially in seniors. When considering surgical options for these conditions, it's essential to understand the risks, benefits, and the overall process involved.

Understanding Scoliosis and Osteoporosis
Scoliosis is a condition characterized by an abnormal lateral curvature of the spine. It can lead to discomfort, pain, and in severe cases, respiratory issues due to the compression of the thoracic cavity. Osteoporosis, on the other hand, is a condition where bones become weak and brittle, increasing the risk of fractures. In seniors, these conditions can be particularly concerning as they may lead to significant mobility issues and a decrease in overall health.

Surgical Options
For patients with severe scoliosis and osteoporosis, surgery may be recommended when conservative treatments (like physical therapy, bracing, or medication) fail to provide relief. Surgical options typically include:
1. Spinal Fusion: This procedure involves fusing two or more vertebrae together to stabilize the spine. It can help correct the curvature in some cases, but it may not be suitable for everyone, especially those with severe osteoporosis, as the bone quality can affect the success of the fusion.

2. Vertebroplasty or Kyphoplasty: These minimally invasive procedures involve injecting a cement-like material into fractured vertebrae to stabilize them. They are often used for osteoporotic fractures and can provide immediate pain relief.

3. Deformity Correction Surgery: In cases of severe scoliosis, more extensive surgeries may be necessary to correct the curvature. This often involves the use of rods and screws to realign the spine.

Risks and Considerations
Surgical intervention carries inherent risks, particularly in older adults. These risks include:
- Infection: Any surgical procedure carries the risk of infection, which can be more severe in patients with compromised bone health.

- Blood Loss: Significant blood loss can occur during spinal surgeries, and patients with osteoporosis may have a higher risk of complications.

- Non-union: In spinal fusion surgeries, there is a risk that the bones may not fuse properly, especially in patients with osteoporosis.

- Nerve Damage: There is a risk of nerve damage during surgery, which can lead to numbness, weakness, or pain.

Recovery and Rehabilitation
Post-surgery, recovery can vary widely based on the individual’s health, the extent of the surgery, and adherence to rehabilitation protocols. Generally, patients may need several weeks to months of physical therapy to regain strength and mobility.

Insurance and Financial Considerations
Regarding your concerns about insurance coverage, it is not uncommon for certain surgical procedures to require prior authorization from health insurance providers. The reasons for denial can vary, including:
- Lack of Medical Necessity: Insurance companies may require extensive documentation to prove that surgery is necessary and that conservative treatments have been exhausted.

- Specific Criteria: Each insurance plan has specific criteria that must be met for coverage, which can include age, severity of the condition, and overall health status.

- Cost: If the procedure is deemed experimental or not standard practice, it may not be covered.

Next Steps
1. Consultation: It would be beneficial to have a thorough consultation with a spine specialist who can provide a detailed assessment of your mother's condition and discuss the potential benefits and risks of surgery.

2. Second Opinion: If there are concerns about the recommendations or the insurance process, seeking a second opinion from another specialist may provide additional insights or alternative treatment options.

3. Insurance Appeal: If surgery is deemed necessary, and insurance coverage is denied, you can appeal the decision. This often involves providing additional medical documentation and possibly a letter from the surgeon explaining the necessity of the procedure.

4. Explore Financial Assistance: Some hospitals offer financial assistance programs for patients who are uninsured or underinsured. It may be worth inquiring about these options.

In conclusion, while surgery for scoliosis and osteoporosis can be a viable option, it is crucial to weigh the risks and benefits carefully. Engaging with healthcare providers, understanding the insurance process, and considering all treatment options will help in making an informed decision for your mother's health.

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