The North American Spine Society (NASS) has just announced the proposed revisions of coverage recommendations for Epidural Steroid Injections and Diagnostic Spinal Nerve Root Blocks, Interspinous Fixation with Fusion, and Lumbar Discectomy. The 30-day public comment period ends March 30 for anyone wishing to review and provide feedback on the draft coverage recommendations.
NASS: New Coverage Recommendations
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Secondary#diagnosticspinalneckblocks#epiduralsteroidinjections#interspinousfixationwithfusion#lumbardiscectomy
Asked about one particular difficulty/challenge of each coverage recommendation, Gary Ghiselli, M.D., co-chair of the NASS Coverage Committee, told OTW, “The biggest challenge with each topic is to use the highest level of evidence-based literature to support the coverage recommendations.”
“There are many published studies that are biased or are of limited usefulness. Each of our authors and reviewers are specifically trained in evidenced-based medicine and have a unique set of skills that allows them to produce a coverage recommendation supported by the best and most current evidence.
Regarding what was most important to “capture” when deriving the recommendations, co-chair Scott Kreiner, M.D. told OTW, “It is important to be clear and direct when writing the recommendations. There are a lot of gray areas in medicine, but it helps to make the recommendation either for or against the coverage policy.”
“This is helpful for payors, device manufacturers, physicians and most importantly, patients. NASS is committed to preserving patient access to quality spine care and as such, recognizes the necessity of preventing inappropriate procedures that are not proven effective with evidence.”
NASS President Jeffrey Wang, M.D. commented to OTW, “It is very important that everyone understands that these coverage recommendations do not represent the subjective opinions of any one person, or even a group of people from NASS.”
“This is a very important, rigorous, and scientific process, where NASS only uses the highest quality evidence and real data, in order to determine the final recommendations. This group of NASS volunteers who donate their valuable time, are all trained in evidence-based medicine, remain unbiased, and spend countless hours working together to synthesize all of the evidence, in order to determine the final recommendations.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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