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

Broadly defined, lumbar spinal stenosis (LSS) is the progressive narrowing of the spinal canal and neural foramen resulting in pressure upon the nerve(s) leading to pain and/or numbness in the extremities, muscle weakness, bowel and bladder issues, and/or other pain related issues. However, the difficulty arises in that spinal stenosis is a heterogeneous condition with multiple etiologies which may present with disc height loss, facet hypertrophy, spondylolisthesis, retrolisthesis, coronal and/or sagittal plane deformity, and presence of osteophytes and facet cysts. Therefore, there is not a single surgical intervention that addresses all pathological variations of spinal stenosis, rather, there are several methods used to treat LSS. Diagnostic evaluation is needed to determine the correct surgical treatment solution to address anatomical and pathological variation as some patients can be treated by simple decompression while others may require a form of stabilization. This policy statement focuses on one treatment option: decompression with interlaminar stabilization. ISASS does not recommend any particular treatment method; the choice of treatment depends on the patient’s pathology and the expertise of the treating surgeon. ISASS recommends shared decisionmaking between the patient and the surgeon.