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Spinal fusion is a common surgical treatment for degenerative disc disease when conservative treatment fails. However, spinal fusion alters the normal biomechanics of the back, which may potentially lead to premature disc degeneration at adjacent levels. A variety of implants have been investigated as alternatives to rigid interbody or posterolateral intertransverse spinal fusion. This policy addresses the implantation of prostheses intended to replace the facet joints and excised posterior elements, termed facet arthroplasty. The objective of facet arthroplasty is to stabilize the spine while retaining normal intervertebral motion of the surgically removed segment following neural decompression. It is proposed that facet arthroplasty should also maintain the normal biomechanics of the adjacent vertebrae. If normal motion patterns are achieved by artificial joints in the spine, the risk of adjacent-level degeneration thought to be associated with fusion may be mitigated.

No facet arthroplasty devices have been approved by the U.S. Food and Drug Administration (FDA) at this time. The Total Facet Arthroplasty System™ (TFAS™, Archus Orthopedics) is currently being evaluated as part of an ongoing FDA-approved investigational device exemption (IDE) protocol (Facet Solutions acquired Archus Orthopedics and all of their assets in November 2009. Facet Solutions is developing the ACADIA™ Facet Replacement System.) The objective of the IDE trial is to evaluate the efficacy and safety of TFAS™ for the stabilization of spinal segments in skeletally mature patients as an adjunct to neural decompression with facetectomy in the treatment of the following acute or chronic instabilities or deformities of the lumbar spine at levels L3-L4 or L4-L5, single level only: degenerative disease of the facets, degenerative disease of the facets with instability, Grade I degenerative spondylolisthesis with objective evidence of neurologic impairment, central or lateral stenosis. Another implant design, the Total Posterior-element System (TOPS™, Impliant, Israel), is currently in development.

Related medical policies are Artificial Intervetebral Disc: Lumbar Spine and Interspinous Distraction Devices (Spacers).

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

08/03/2011: Policy reviewed; no changes.

09/25/2012: Policy reviewed; no changes.

Non-Covered Codes

This is not an all-inclusive list of non-covered procedure codes.

All codes billed for this procedure are considered investigational and not eligible for coverage. 

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