ISASS Recommendations/Coverage Criteria for Decompression with Interlaminar Stabilization - Coverage Indications, Limitations, and/or Medical Necessity

Abstract

Surgeon expertise and proper patient selection are critical to determine the correct surgical treatment solution to address anatomical and pathological variation of patients with LSS. Decompression alone and decompression plus fusion are both established treatments for LSS. The choice to perform decompression alone, decompression with interlaminar stabilization, or decompression plus fusion is the discretionary purview of the spine surgeon and his/her patient. Lumbar decompression with interlaminar stabiliza-tion is recommended for coverage in carefully selected lumbar spinal stenosis patients without gross instability or in which the decompression procedure itself may create iatrogenic instability. The procedure should be performed by a qualified and well-trained spine surgeon after completion of a thorough diagnostic evaluation, documented failure of nonsurgical management and taking into consideration appropriate anatomical and pathological considerations. It is important for spine surgeons to be able to provide surgical solutions that have proven net health benefits for clearly defined, precisely diagnosed patient cohorts, which in parallel support fiscal responsibility of reducing overall costs to the healthcare system. Further, in considering the evolutionary healthcare environment, ISASS coverage guidance considers the increasing importance of value-based and bundled payment initiatives which incorporate clinical as well as economic value propositions. In select patients within the LSS continuum, decompression with interlaminar stabilization has proven to provide equivalent outcomes with a reduced cost compared to decompression plus fusion. 14,15 Additionally, for patients with significant back pain and associated advanced degenerative segmental disease, decompression with interlaminar stabilization provides benefits beyond decompression alone and may extend the durability of the decompression procedure (Table 2).