Steven Garfin, MD, president of the International Society for the Advancement of Spine Surgery, has issued a letter in response to The Health Care Service Corporation on its draft policy for lumbar spinal fusions. HCSC is the parent corporation for Blue Cross/Blue Shield plans for Illinois, New Mexico, Oklahoma and Texas. The new draft policy states, "Due to lack of evidence of improved outcomes, spinal fusion is considered not medically necessary when the sole indication is disc herniation, DDD, facet syndrome or initial discectomy and/or laminectomy for neural structure decompression."
In his response letter, Dr. Garfin mentions: "There are six randomized controlled trials of fusion surgery versus nonsurgical therapy of which HCSC/BCBSIL reviews. In addition there are at least 15 publications comparing prospectively in randomized trials fusion surgery versus a different fusion technique or lumbar arthroplasty. There are also retrospective controlled trials, prospective non-comparative cohort studies and studies of surgery only cohorts.
"Except for one retrospective cohort study, these other studies are not considered. Instead HCSC/BCBSIL quotes a study from 1992 which states that there were no randomized trials of fusion which is correct and another study from 1999 which also did not find any randomized controlled trial which is also correct."
HCSC/BCBSIL also quotes from the American Association of Neurological Surgeons and Congress of Neurological Surgeons 2005 guideline concluding that evidence was weak at that time for spinal fusion. "What they did not quote was the recommendation from the guideline that fusion surgery be considered as treatment options for carefully selected patients with disabling low back pain due to degenerative disease at one or two levels," Dr. Garfin wrote in his letter.
The deadline for providing responses to the policy is May 31.
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In his response letter, Dr. Garfin mentions: "There are six randomized controlled trials of fusion surgery versus nonsurgical therapy of which HCSC/BCBSIL reviews. In addition there are at least 15 publications comparing prospectively in randomized trials fusion surgery versus a different fusion technique or lumbar arthroplasty. There are also retrospective controlled trials, prospective non-comparative cohort studies and studies of surgery only cohorts.
"Except for one retrospective cohort study, these other studies are not considered. Instead HCSC/BCBSIL quotes a study from 1992 which states that there were no randomized trials of fusion which is correct and another study from 1999 which also did not find any randomized controlled trial which is also correct."
HCSC/BCBSIL also quotes from the American Association of Neurological Surgeons and Congress of Neurological Surgeons 2005 guideline concluding that evidence was weak at that time for spinal fusion. "What they did not quote was the recommendation from the guideline that fusion surgery be considered as treatment options for carefully selected patients with disabling low back pain due to degenerative disease at one or two levels," Dr. Garfin wrote in his letter.
The deadline for providing responses to the policy is May 31.
More Articles on Spinal Surgery:
Dr. Anthony Asher Named Director of American Board of Neurological Surgery
Cervical Spine Research Society Names Dr. Michael Fehlins President
How Often Should Spine Surgeons Renegotiate Vendor Contracts?