Subject: NASS Draft Coverage Policy for Endoscopic Decompression
Dear Dr. Resnick,
The American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS)
and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN) appreciate
the opportunity to provide comments on the North American Spine Society (NASS) coverage policy
recommendations for endoscopic decompression. We appreciate your consideration of the following
comments.
Our chief concern is that while the NASS proposal refers specifically to “endoscopic discectomy,” the
articles cited in the recommendation describe a very heterogeneous array of surgical procedures. These
include one citation describing a uni-portal, full endoscopic system with a 6.9 mm endoscope with
integrated working channel (Ruetten), as well as a technical report describing a multi-portal working
system with two 5 mm ports, one for the endoscope and one for the instruments (Soliman). In addition,
the meta-analysis which was cited refers to the older MetRx system, which is not full-endoscopic but
utilizes an endoscope attached to an 18 mm working channel placed through a muscle-splitting
approach.
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