Federal AHRQ to Review Comparative Effectiveness for Spinal Fusion

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Note: The public comment period for this has passed. Thank you for your input.

Member Input Needed

The US Agency for Healthcare Quality and Research (AHRQ) has taken up a comparative effectiveness review of “Spinal Fusion for Treating Painful Lumbar Degenerated Discs or Joints.” They recently released a draft report and have provided a public comment period with a deadline of December 18, 2012.

A draft report and report appendix can be found here: Comment on Draft Reports and White Papers

ISASS is encouraging our members to provide comments to AHRQ.

AHRQ reports are not definitive policy for either Medicare/Medicaid or commercial insurers. However, commercial insurers oftentimes cite AHRQ reports to support their policies. AHRQ states that “The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services.”

Here is a summary of their draft Conclusion:

“Overall, limited evidence suggests that spinal fusion compared with physical therapy improves pain and function for adults undergoing fusion for low back pain due to disc degeneration. Because of insufficient reporting and variation in surgical methods used in the different studies, the incidence of adverse events (serious and minor) associated with fusion could not be determined conclusively. The evidence was insufficient to draw evidence-based conclusions for the benefits and harms of spinal fusion for patients with degenerative stenosis or degenerative spondylolisthesis of the lumbar spine. The evidence was also largely insufficient to draw conclusions about the benefits and harms of fusion compared with other invasive treatments or different fusion approaches or techniques. Thus, future research is needed in these areas. However, many of the studies reviewed in full for this review were ultimately excluded for lack of relevance to modern treatment practices in the United States. Because implantable devices are frequently replaced by new products and generations of products, either by product line updates or withdrawal of previous implants and instrumentation from the market because of adverse events, ongoing clinical studies of new devices and materials are needed.”

ISASS will be formulating comments based on our existing Policy Statement on Lumbar Fusions. We welcome member input into our comment document, in addition to comments you may send directly to AHRQ. If you have specific comments or ideas, please contact David Porter, Director of Public Policy, at david@isass.org.