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Daniel K. Resnick, MD, MS, President
North American Spine Society
7075 Veterans Blvd.
Burr Ridge, IL 60527

Via e-mail: coverage@spine.org

Subject: NASS Draft Coverage Policy for Lumbar Artificial Disc Replacement

Dear Dr. Resnick,

The American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS) and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN) appreciate the opportunity to provide comments on the North American Spine Society (NASS) coverage policy recommendations for Lumbar Artificial Disc Replacement. Below are our recommendations.

NASS Coverage Recommendations

1. Lumbar Artificial Disc Replacement is indicated for patients with discogenic low back pain who meet ALL of the following criteria from the Lumbar Fusion Coverage Recommendation:

   Advanced single level disease noted on an MRI and plain radiographs of the lumbar spine at L4-5 or L5-S1, characterized by moderate to severe degeneration of the disc with Modic changes (defined as peridiscal bone signal above and below the disc space in question) as compared to other normal or mildly degenerative level (characterized by normal plain radiographic appearance and no or mild degeneration on MRI).

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