AANS and CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN)
Comments on NASS Coverage Policy Recommendations on Lumbar Interspinous Device without
Fusion and Decompression
The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons
(CNS) Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN) appreciates the
opportunity to provide comments on the North American Spine Society (NASS) coverage policy
recommendations on Lumbar Interspinous Device without Fusion and Decompression. Below in italic
print are recommendations from the NASS document followed by our comments in bold.
Interspinous devices (ISP) have been used previously for the purpose of indirect decompression without
laminectomy through spinous process distraction. Importantly these coverage recommendations are for
interspinous devices without fusion in conjunction with a direct decompression in the form of a lumbar
laminectomy for patients with neurogenic claudication or radiculopathy secondary to spinal stenosis.
Coflex for example is specifically approved for this indication. Interspinous fusion is importantly excluded.
AANS/CNS Joint Section on DSPN Comment:
The title of the policy may cause confusion. We suggest the title be changed to: “Lumbar
Interspinous Device without Fusion in conjunction with Decompression” or alternatively
“Decompression without Fusion when using Lumbar Interspinous Process Devices”. Either one
of these alternate titles clearly indicates that the surgeon is performing a decompression.
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