In a letter to Aetna, ISASS expressed concern with Section IX – Intervertebral Body Fusion Devices (Spine Cages) of Aetna Back Pain – Invasive Procedures Policy Number 0016 (“Policy”). Section IX of the Policy allows coverage of cages for cervical fusion under the following indications:

A. Multilevel (three or more vertebral bodies) corpectomy (removal of half or more of vertebral body, not mere removal of osteophytes and minor decompression) in the treatment of one of the following:

1. for tumors involving one or more vertebrae, or
2. greater than 50 percent compression fracture of vertebrae, or
3. retropulsed bone fragments, or
4. central canal stenosis with myelopathy.

B. Multilevel (three or more vertebral bodies) fusion for pseudarthrosis in persons with prior fusion; or

C. For adjacent level diseasethat has developed inpersons with a prior cervical fusion involving a plate, in order to avoid dissection for plate removal; or

D. Multilevel (three or more discs) discectomy in persons meeting criteria for cervical discectomy in CPB 0743 – Spinal Surgery: Laminectomy and Fusion; or

E. Jehovah’s Witnesses with poor bone stock (e.g., due to osteoporosis, osteogenesis imperfecta, ESRD, diabetes, long-term steroid use, immunosuppression after transplant, or parathyroid deficiency).

Section IX of the Policy then states, “spine cages are considered experimental and investigational for all other indications because their effectiveness for indications other than those listed above has not been established.”

ISASS Letter to Aetna