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47
CMS Won't Cover New Technique for
Lumbar Spinal Stenosis Patients
By Bob Herman
C
MS said Medicare will not reimburse
percutaneous image-guided lumbar
decompression for lumbar spinal stenosis patients, according to a new national coverage determination.
CMS officials said spinal stenosis, which occurs
when the spinal canal narrows and thus causes
lower back pain, is the most common reason for
lumbar spine surgery in adults older than 65. It's
often the result of normal aging. Complex surgical procedures to treat lumbar spinal stenosis
have "increased substantially" over the past several years as well, according to CMS.
Most surgical options to treat lumbar spinal stenosis are laminectomy and spinal fusion. However,
percutaneous image-guided lumbar decompres-
sion, or PILD, is a newer technique for lumbar spinal stenosis patients. PILD is a minimally invasive
procedure conducted via image guidance "without
any direct visualization of the surgical area," according to the analysis. PILD is often performed
commercially with mild, a technology owned by
Vertos Medical.
CMS opened a national coverage analysis of PILD
for lumbar spinal stenosis this past April, and
after several months of combing through studies and reviewing public comments, the agency
concluded the treatment will not be covered by
Medicare. CMS cited several reasons:
• ack of consensus on diagnostic criteria. CMS
L
said since many conditions lead to back
pain, it is hard to peg what exactly defines
spinal stenosis patients.
Disc
Replacement
vs. Spinal Fusion:
4 Findings on
Dysphagia Levels
By Laura Miller
P
hysician researchers conducted a prospective randomized controlled study to determine and explain differences in dysphagia between patients undergoing artificial disc replacement and anterior cervical decompression
and fusion and published the results in Spine.
The study included 136 patients who received disc replacement or
ACDF at one or two surgical levels and completed a questionnaire
at four weeks, three months, one year and two years postoperatively.
The researchers found:
• ysphagia was significantly higher than baseline levels in
D
both groups at four weeks.
• tatistically significant difference between the groups only
S
showed up at two years, when patients in the ACDF group
showed significantly higher dysphagia levels.
• here was a stronger association to implant type than to
T
number of surgical levels for dysphagia.
• he surgery duration was associated to the number of surT
gical levels but did not differ significantly between implant
types. n
• Lack of consensus on the treatment of lumbar
spinal stenosis. Laminectomies already exist as
a minimally invasive option for lumbar spinal
stenosis patients, and CMS said other nonsurgical treatments could be options as well.
• ILD as a treatment. CMS said it is not cerP
tain performing spinal surgery with PILD
tools is "efficacious" and necessary.
• nalysis of evidence for PILD as a treatment.
A
CMS called available studies on PILD "weak,"
making it difficult to determine if Medicare
patients will benefit from the procedure.
Many Blue Cross Blue Shield subsidiaries, including North Carolina and Tennessee, also consider
PILD "investigational" and generally don't provide coverage for it. n
Advertising Index
Note: Ad page number(s) given in parentheses
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Aurora Spine.
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DePuy Synthes.
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Meridian Surgical Partners.
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National Medical Billing Services.
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(636) 273-6711 (p. 19)
Specialty Healthcare Advisors.
www.sha-mcra.com/ / (860) 904-4447 (p. 38, 39, 40, 41, 42)
Spinal Elements.
info@spinalelements.com / www.spinalelements.com /
(877) 774-6255 (p. 18)
Surgical Management Professionals.
info@smpsd.com / www.smpsd.com / (605) 444-8297 (p. 11)
