Orthopaedic spinal procedures

Vitality will fund one initial epidural nerve root block injection in members with lumbosacral radicular pain, if they are unfit for surgical intervention or are unable to tolerate neuropathic medications [4].

We will also fund one further injection if the initial injection resulted in six months of pain relief and functional improvement [5]. However, we will not fund any further epidural injections.

We will not fund claims for epidural injections for neurogenic claudication with central spine stenosis.

Vitality will not fund any claims for facet joint injections.

As an alternative, the GRIFT report recommends that facet joint injections should be replaced with diagnostic medical branch block [4]

Vitality will fund one episode treatment in members with mechanical axial back pain which includes;

Vitality will fund claims for radiofrequency denervation for members who have a positive response to a medical branch block and fulfil the above NICE recommendations.

We will only fund a repeat procedure if there is evidence demonstrating a significant previous improvement in pain and function, 12 months after the initial procedure.

We will not fund imaging as a prerequisite for radiofrequency denervation in members with facet joint focussed lower back pain [5]

Vitality will not fund claims for spinal fusion for lower back pain unless the Spinal Second Opinion Service feels it is appropriate

In terms of alternative, evidence suggests that non-surgical intervention such as physiotherapy results in the same patient outcomes as those who had spinal fusion [10]

We advise to consider spinal decompression where non-surgical treatment has not improved pain or function, and radiological imaging is suggestive of sciatica.

We will fund one claim per area (I.e., cervical, thoracic, lumbar, sacral) for spinal decompression procedures.

We will fund one claim per area (I.e., cervical thoracic, lumbar and sacral) for vertebroplasty or kyphoplasty per member