Josiah Morse, MPH
Program Director
Washington State Healthcare Authority
Health Technology Assessment Program
P.O. Box 42712
Olympia, WA 98504-2712
Re: AANS/CNS Comments on Key Questions for Washington State HTA Re-review of
Lumbar Spinal Fusion Coverage Policy
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of
Neurological Surgeons (CNS), the AANS/CNS Joint Section on Disorders of the Spine and
Peripheral Nerves, and the Washington State Association of Neurological Surgeons
(WSANS), we appreciate the opportunity to provide comments regarding Key Questions
published by the Washington State Healthcare Authority (WCA) Health Technology
Assessment (HTA) program for the technical assessment for the re-review of coverage
policy for lumbar spinal fusion scheduled on November 20, 2015. We have provided the
following comments to the Key Questions. We are aware that the draft technology
assessment will be released on or about August 17, 2015, and we look forward to providing
more in-depth comments upon its publication.
Key Question #1
What is the comparative clinical effectiveness of lumbar fusion surgery for patients with chronic
low back pain and uncomplicated DDD relative to that of conservative management, minimallyinvasive treatments, and selected alternative surgical approaches?
Studies on the comparative clinical effectiveness of lumbar spine fusion surgery relative to conservative
management, minimally invasive treatments, and selected alternative approaches is limited. The
existing literature demonstrates that both nonsurgical treatment and lumbar fusion surgery may improve
function and pain for individuals with low back pain attributed to degenerative disc disease, however,
limited evidence suggests that lumbar fusion may result in better outcomes compared to nonoperative
treatment for certain individuals [1-4]. In 2014, the American Association of Neurological Surgeons and
the Congress of Neurological Surgeons published a joint systematic review and reported a Grade B
Recommendation to support lumbar fusion for patients with chronic low back pain that is refractory to
traditional conservative treatment [5].
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