Policy Statements

ISASS Policy Statement – Vertebral Augmentation It is estimated that over 1.4 million people will develop vertebral compression fractures every year (Johnell & Kanis 2006).  Many will be clinically insignificant or heal with non-operative treatment.  A large group will have persistent pain, kypholic deformity, weight loss, depression and a reduced quality of life.  (Old & Calvert 2004; Borgstrom et al. 2006; Suzuki et al. 2008). Open surgical intervention is used when there is severe deformity, instability, or neurologic compromise. Vertebral augmentation such as Vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive techniques used to treat painful vertebral compression fractures.  There is good evidence that these techniques can provide immediate and lasting pain relief (Berlemann et al. 2004; Grafe et […]

ISASS Policy Statement – Cervical Total Disc Arthroplasty Symptomatic cervical disc disease (CDD) refractory to non‐surgical care is currently treated with anterior cervical discectomy and fusion (ACDF) with good clinical results reported1‐3. Fusion does however eliminate natural motion increasing stresses on adjacent levels, and progressive degeneration at the levels around the fusion has been reported. The rate of symptomatic adjacent segment degeneration (ASD) is estimated to occur at 3% per year and to be present in up to 25% of patients at 10 years4. The etiology for ASD is likely a combination of the altered biomechanical environment imposed by fusion and the patients’ underlying disc disease or genetic predisposition4,5. ASD after a prior cervical fusion is not a benign condition […]

ISASS Policy Statement – Lumbar Spinal Fusion Download this Document in PDF Format Contents Introduction Scope Definitions Conditions for which Lumbar Fusion is Medically indicated Conditions for which Lumbar Fusion is Indicated on a Case-by-Case Basis Conditions for which Lumbar Fusion is Not Medically Appropriate Scientific Background Conclusion References Introduction Pain and other symptoms of the lower back are some of the most prevalent health problems experienced by the populations of developed nations. They cause prolonged suffering and diminished quality-of-life to the patients, resulting in enormous losses of productivity and substantial costs for ongoing medical care. Many patients can (and should) be treated adequately by medical management, but a small portion of patients will not respond sufficiently, and some spinal […]