Lumbar fusion for degenerative disc disease

Degenerative disc disease (DDD) is a common condition associated with low back pain in many individuals. Lumbar fusion surgery, which involves the creation of a permanent connection across the vertebral space by means of a graft, is often considered when conservative treatments fail to relieve the patient's back and/or leg pain.

Lumbar fusion was initially reviewed by the HTA program in 2007.

In 2012, an update literature search was conducted to determine if newly available published evidence could change the original coverage determination. The topic was not selected for rereview.
In 2014, the HCA director selected lumbar fusion for rereview based on newly available published evidence that could change the original determination.

Status: Decision completed

View findings and decision

Why is lumbar fusion for DDD being reviewed?

Due to the prevalence of low back pain and the varying nature of the conditions that underlie it, numerous management options are available. These options vary substantially in their intensity, degree of invasiveness, and most importantly, level of evidence regarding their effectiveness. Although there is lack of consensus on when lumbar fusion surgery is indicated, how the surgery should be performed, and long-term prognosis after surgery (Christensen, 2004), the number of lumbar fusion surgeries performed in the U.S. has nevertheless increased more than two-fold between 2000 and 2009 (Yoshihara, 2014). In particular, some studies have shown poor success rates for lumbar fusion when used to treat low back pain caused by disk degeneration alone (Herkowitz, 1995). There is significant interest on the part of patients, clinicians, policymakers and other stakeholders in evaluating the clinical and economic impact of lumbar fusion for patients with chronic low back pain and degenerative disc disease (DDD).

Primary criteria ranking

Safety = High
Efficacy = High
Cost = High

Documentation

Type	Materials
Assessment (2015)	Draft key questions: comment and response Final key questions Draft evidence report: comment and response Final evidence report Final findings and decision
Update literature (2012)	Evidence update literature
Assessment (2007)	Final key questions Executive summary Final evidence report Final findings and decision

Assessment timeline

Draft key questions published: May 6, 2015
- Public comment period: May 6 to May 20, 2015
Final key questions published: June 3, 2015
Draft report published: August 18, 2015
- Public comment period: August 18 to September 17, 2015
Final report published: October 16, 2015
HTCC public meeting: November 20, 2015