Re: AANS/CNS Comments on Washington State HTA Re-review of Lumbar Spinal
Fusion
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of Neurological
Surgeons (CNS), and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves, we
appreciate the opportunity to provide comments regarding the Washington State Healthcare Authority
(WCA) Health Technology Assessment (HTA) program decision to review its coverage policy for Lumbar
Spinal Fusion. As such, we would like to share the following remarks.
AANS and CNS Disagree that Cited Literature Warrants a Policy Revision
We strongly agree that safety, quality, and cost are important considerations and understand the
agency’s requirement to balance these considerations. We believe the WCA HTA Healthcare
Technology Clinical Committee weighed these considerations during their review in November 2007
and we do not believe there is adequate data to at this time to change the policy. In 2012, the
Agency for Healthcare Research and Quality (AHRQ) proposed research questions on the topic of
“Spinal Fusion for Painful Lumbar Degenerative Disc or Joint Disease.” The AANS and CNS have
been active in developing clinical guidelines on this topic and we have attached our February 2012
letter to the AHRQ. Based on our experience, we do not believe that a re-review of the WCA HTA
policy on lumbar fusion is useful. Nevertheless, we understand that the agency is going forward
with the review and we are eager to provide you with neurosurgical expertise.
Neurosurgeon Participation in Technical Assessment Review
We urge you to include neurosurgeons in the development of key research questions and in the
review of clinical evidence included in the technical assessment prepared for the issue. AANS and
CNS and the Washington State Association of Neurological Surgeons (WSANS) are able to provide
names of neurosurgeon spine experts both in the state of Washington and nationally who are
trained in evidence based medicine, do not have financial conflicts, and are willing to devote their
volunteer time to assisting the agency. We feel it is essential that treatment offered as an alternative
to surgery be equally as thoroughly vetted for safety, quality, cost, and availability. During the 2007
review, statements were made about lumbar fusion as compared to services which may or may not
be available in Europe, but certainly were not easily accessible in Washington State and had not
undergone a rigorous analysis for safety, cost, and quality.
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Read full letter here
