11/30/2006 - Spinal Fusion for the Treatment of Low Back Pain Secondary to Lumbar Degenerative Disc Disease
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Issue |
The incidence of low back pain at some time in a person’s lifetime in the U.S. population is reported to be as high as 90%. There are numerous causes of low back pain and men and women are equally afflicted. The degenerative changes that occur in the intervertebral disc in the spine are thought to be part of the normal process of aging and do not always lead to low back pain. Low back pain secondary to lumbar degenerative disc disease (DDD) can usually be successfully treated conservatively. However, when conservative treatment is not successful, surgical intervention becomes an option to relieve the pain associated with DDD.
Since DDD is associated with the aging process, this is an affliction that is well represented in the Medicare population. CMS has a significant interest in discussing the evidence for surgical interventions for lumbar degenerative disc disease, with a specific focus on spinal fusion for low back pain associated with lumbar DDD in the Medicare population.
The Medicare Coverage Advisory Committee (MCAC) will hear presentations and discuss evidence relative to indications for spinal fusion, clinical outcomes (including adverse events) and the persistence of outcomes over time, outcome measurement tools, and outcomes related to different surgical spinal fusion procedures, as well as, the generalizability of this evidence to the Medicare population.
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Actions Taken |
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August 25, 2006 |
Federal Register notice is published announcing the Medicare Coverage Advisory Committee meeting on Thursday, November 30, 2006. |
August 30, 2006 |
Posted Federal Register notice [PDF, 84KB]. |
September 28, 2006 |
We are posting the questions [PDF, 38KB] that we expect to pose to the MCAC panel. Comments and presentations should focus on answers to these questions. Any modifications will be posted prior to the panel meeting. |
October 12, 2006 |
CMS requested the Agency for Healthcare Research and Quality to provide a technology assessment (TA) for the MCAC. We are posting the TA questions the TA focuses on. |
November 14, 2006 |
Posted the Technology Assessment |
November 27, 2006 |
Posted the roster and agenda. |
November 30, 2006 |
Medicare Coverage Advisory Committee has been renamed Medicare Evidence Development Coverage Advisory Committee. |
December 01, 2006 |
Posted Score Sheet [PDF, 80KB]. |
February 23, 2007 |
Posted minutes [PDF, 6MB]and transcript [PDF, 576KB]. |
Note: For security reasons, individuals planning to attend must register by the close of business on November 23, 2006 by contacting Maria Ellis at (410) 786–0309; e-mail to Maria.Ellis@cms.hhs.gov; or by regular mail to Maria Ellis, Centers for Medicare& Medicaid Services, OCSQ-Coverage and Analysis Group, C1–09–06, 7500, Security Boulevard, Baltimore, MD 21244.
| Federal Register Notice |
Agenda |
Agenda
Medicare Coverage Advisory Committee
November 30, 2006
7:30 AM – 4:30 PM
CMS Auditorium
Alex Krist, MD, Chairperson
Steve Phurrough, MD, MPA, Coverage and Analysis Group
Michelle Atkinson, Executive Secretary
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7:30 – 8:00 AM |
Registration |
8:00 – 8:10 AM |
Opening Remarks—M. Atkinson / S. Phurrough, MD, MPA/Alex Krist, MD |
8:10 - 8:20 AM |
CMS Presentation of Background and Voting & Discussion Questions – Shamiram Feinglass, MD, MPH |
8:20 – 9:00 AM |
TA Presentation: Douglas C. McCrory, MD, MHS, Associate Professor of Medicine, Duke University Medical Center, Center for Clinical Health Policy Research |
9:00 – 9:30 AM |
Steven R.Garfin, MD, Professor and Chairman, Department of Orthopaedic Surgery, UCSD School of Medicine |
9:30 - 10:00 AM |
Sohail K. Mirza, MD, MPH, Associate Professor, Department of Orthopedics and Department of Neurological Surgery, University of Washington |
10:00 - 10:50 AM |
Scheduled Public Comments
(Refer to Speaker List) |
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Public attendees, who have contacted the executive secretary prior to the meeting, will address the panel and present information relevant to the agenda. Speakers are asked to state whether or not they have any financial involvement with manufacturers of any products being discussed or with their competitors and who funded their travel to this meeting.
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10:50 – 11:00 AM |
Open Public Comments |
Public Attendees who wish to address the panel will be given that opportunity |
11:00 – 12:00 PM |
Questions to Presenters |
12:00 – 1:00 PM |
LUNCH (on your own) |
1:00 – 3:30 PM |
Open Panel Deliberations: Dr. Krist |
3:30 – 4:25 PM |
Formal Remarks and Vote |
The Chairperson will ask each panel member to state his or her position on the voting questions |
4:25 – 4:30 PM |
Closing Remarks / Adjournment: Dr. Phurrough, Dr. Krist |
4:30 PM |
ADJOURN |
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Minutes |
Download minutes [PDF, 6MB]
| Transcript |
Panel Voting Questions |
Download questions [PDF, 38KB] to panel.
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Contact Information |
Deirdre O'Connor deirdre.oconnor@cms.hhs.gov 1-410-786-3263
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Roster |
Medicare Coverage Advisory Committee
Roster
November 30, 2006
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Chair
Alexander H. Krist, MD
Family Physician
Fairfax Family Practice Center
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Stephen L. Ondra, MD
Associate Professor of Neurological Surgery, Dept. of Neurological Surgery
Northwestern Medical Faculty Foundation
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Mark V. Boswell, MD, PhD
Associate Professor of Anesthesiology Chief, Division of Pain Medicine
Director, Pain Medicine Fellowship Program
Department of Anesthesiology
Case Western Reserve University and University Hospitals of Cleveland
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Laxmaiah Manchikanti, M.D.
Pain Management Center of Paducah
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Barbara D. Boyan PhD
Price Gilbert, Jr. Chair in Tissue Engineering
Wallace H. Coulter Department of biomedical Engineering at Georgia Tech and Emory University Georgia Institute of Technology Institute of Bioengineering and Bioscience
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John S. Kirkpatrick, MD
Division of Orthopaedic Surgery
University of Alabama, Birmingham
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Kim J. Burchiel, M.D.
Department of Neurological Surgery, Oregon Health & Science University
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Industry Representatives
Kim K. Kuebler, MN, RN
Associate Director
Medical Respiratory Publications Boehringer Ingelheim Pharmaceuticals
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A. Mark Fendrick, MD
The University of Michigan
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Consumer Representative
Charles J. Queenan, III
Independent Management Consultant
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David R. Flum, MD, MPH, FACS
University of Washington Medical Center
Department of Surgery
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Guests
Tom Faciszewski, MD
Chairman, Dept. of Orthopaedic Surgery
Marshfield Clinic
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Jeffrey G. Jarvick, MD, MPH
Professor of Radiology and Neurological Surgery
University of Washington
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Jon D. Lurie, MD, MS
Associate Professor of Medicine
Dartmouth Medical School
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CMS Liaison
Steve Phurrough, MD, MPA
Director, Coverage and Analysis Group
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Michelle Atkinson
Coverage and Analysis Group
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