After three systematic reviews of evidence-based guidelines for the assessment and treatment of chronic low back pain, researchers found the guidelines consistent with recommendations for evaluating low back pain but inconsistent with treatment guidance, according to a study published in Spine.
Researchers gathered reviews of the general guidelines from PubMed, which produced 94 citations. A sample of five guidelines with recommendations on fusion was extracted from 182 citations in the National Guideline Clearinghouse and the International Network of Agencies for Health Technology Assessment. Two guidelines were developed in the United States and three in Europe.
According to the report, all guidelines and nearly all payor policies on the subject included a set of primary randomized controlled trials comparing fusion to other treatment options. There were variations in the recommendations from specialty societies. The researchers identified five evidence-based guidelines with recommendations on fusion for LBP to evaluate, and found some consistency across the government sponsored guidelines and policies with overall recommendations. Payor policies showed heterogeneity, which could be due to variations in cited literature and transparency.
The group rated three of the medical payor policies reviewed as poor and one as good based on the modified Appraisal Guidelines Research and Evaluation tool. The study authors call for more transparency in payor policy and treatment guidelines as well as updated high-quality treatment guidelines from specialty societies and groups.
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According to the report, all guidelines and nearly all payor policies on the subject included a set of primary randomized controlled trials comparing fusion to other treatment options. There were variations in the recommendations from specialty societies. The researchers identified five evidence-based guidelines with recommendations on fusion for LBP to evaluate, and found some consistency across the government sponsored guidelines and policies with overall recommendations. Payor policies showed heterogeneity, which could be due to variations in cited literature and transparency.
The group rated three of the medical payor policies reviewed as poor and one as good based on the modified Appraisal Guidelines Research and Evaluation tool. The study authors call for more transparency in payor policy and treatment guidelines as well as updated high-quality treatment guidelines from specialty societies and groups.
Related Articles on Spinal Fusion:
5 Points on Lowering the Cost of Spinal Fusion Care
Spinal Fusion's Place in the Future: 9 Points on Fusion Efficacy and Coverage
Spinal Fusion Reimbursement: Q&A With NASS President Dr. Greg Przybylski