Guideline Update for March 1, 2023

Guideline title updated to Cervical Diskectomy or Microdiskectomy, Foraminotomy, Laminotomy ISC ORG S-310-NC. Update to Clinical Indications for Procedure section requiring 6 weeks of physical therapy in addition to another nonoperative therapy for cervical radiculopathy (in the absence of progressive (i.e., worsening) neurologic deficits (e.g., weakness)). Reference added.  Guideline Customization Update section added. Medical Director review.  Notification given 12/13/22 for policy effective date 3/1/23.

3/3/23- Provided further clarification that nonoperative therapy must be tried for 6 weeks, not 3 months for certain indications and removed specific nonoperative treatment examples within the Clinical Indications for Procedure section.  Medical Director review.

Guideline title updated to Cervical Fusion, Anterior ISC ORG S-320-NC. Update to Clinical Indications for Procedure section requiring 6 weeks of physical therapy in addition to another nonoperative therapy for cervical radiculopathy (in the absence of progressive (i.e., worsening) neurologic deficits (e.g., weakness)). Reference added.  Guideline Customization Update section added.  Medical Director review.  Notification given 12/13/22 for effective date 3/1/23.

3/3/23- Provided further clarification that nonoperative treatment must be tried for 6 weeks, not 3 months for certain indications and removed specific nonoperative treatment examples within the Clinical Indications for Procedure section.  Medical Director review.

Guideline title updated to Lumbar Diskectomy, Foraminotomy, or Laminotomy ISC ORG S-810-NC. Update to Clinical Indications for Procedure section requiring physical therapy in addition to other nonoperative therapy for lumbar radiculopathy and clarified that 6 weeks of physical therapy is required as part of the nonoperative therapy for lumbar spondylolisthesis (in the absence of rapidly progressive or very severe neurologic deficits). Reference added.  Guideline Customization Update section added.  Medical Director review.  Notification given 12/13/22 for effective date 3/1/23.

3/3/23-Provided further clarification that nonoperative treatment must be tried for 6 weeks, not 3 months for certain indications and removed specific nonoperative treatment examples within the Clinical Indications for Procedure section. Also clarified that nonoperative treatment is not required for lumbar radiculopathy in the presence of rapidly progressive or severe neurologic deficits secondary to nerve root compression when confirmed by imaging. Medical Director review.

Guideline title updated to Lumbar Laminectomy ISC ORG S-830-NC. Update to Clinical Indications for Procedure section clarified that 6 weeks of physical therapy is required as part of the nonoperative therapy for lumbar spinal stenosis (in the absence of rapidly progressive or very severe symptoms of neurogenic claudication confirmed with imaging) and for lumbar spondylolisthesis (in the absence of rapidly progressive or severe neurologic deficits). This section also updated to require 6 weeks of physical therapy in addition to another nonoperative therapy for lumbar disk disease.  Reference added.  Guideline Customization Update section added.  Medical Director review.  Notification given 12/13/22 for effective date 3/1/23.

3/3/23-Provided further clarification that nonoperative treatment must be tried for 6 weeks, not 3 months for certain indications and removed specific nonoperative treatment examples within the Clinical Indications for Procedure section. Also clarified that nonoperative treatment is not required for lumbar disk disease in the presence of rapidly progressive or severe neurologic deficits secondary to nerve root compression when confirmed by imaging. Medical Director review.