A key directive to the NASS coverage task force was to apply the principles of evidence-based medicine. "For most things that we do, fair coverage will be based on published data," Bono says.
In the past, when the evidence was not available or not clear, the task force followed the "reasonable man theory" of the US justice system as its guide. "We tried to strike that balance on those procedures where data was absent," he said. "We tried to present what a reasonable spine surgeon would think is appropriate."
For example, the NASS recommendations portray cervical artificial disk replacement as an "emerging/emerged technology" that appears capable of achieving results similar to cervical fusion procedures.
"Though not currently to be considered the standard of care for treatment of degenerative cervical disorders, [CADR] has shown promising results in the available data, indicating at least equivalence to cervical fusion following adequate decompression," The NASS guidelines say.
Bono said it will take time for the NASS recommendations to have an impact in the marketplace. "I would anticipate this is a five- to ten-year project," he said. "It's going to take multiple patients and multiple years to see if this makes a difference."