SUBJECT: NASS Draft Model Coverage Policy on Interspinous Fixation with Fusion
Dear Dr. Wang:
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
(DSPN), we appreciate the opportunity to comment on the North American Spine Society’s (NASS’) draft
model coverage policy recommendation for Interspinous Fixation with Fusion.
We agree that interspinous process fixation to achieve an arthrodesis is a relatively new way to
supplement a lumbar fusion construct, and has not been widely adopted by neurosurgeons at this time.
While we concur with the statement in the NASS draft that, “There is still limited evidence published
about outcomes of such devices,” we would offer the following comments on the draft policy:
- Indications for Use. At the end of page 3, there is a statement that is confusing and seemingly contradictory. First, it stated that “The literature supports the use … with any of the following … 3.Interbody fusion of the same motion segment.” Then the next paragraph stated “No literature supports the use … without performing an open decortication and fusion of the posterior bony elements.” These two sentences are confusing as written. We recommend that the NASS authors consider changing the second sentence to read “No literature supports the use … without performing an open decortication and fusion of the posterior bony elements or interbody fusion.”
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