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Scoliosis is a musculoskeletal disorder in which there is a lateral curvature of the spine. Scoliosis is a progressive condition that affects the spines of many children, adolescents and adults; most often adolescent females.
Scoliosis may be classified as functional or structural. Functional scoliosis is defined as a structurally normal spine that appears curved due to one or more underlying conditions (e.g., difference in leg length, inflammatory condition). Structural scoliosis involves a fixed lateral curve with rotation, and is associated with many conditions including neuropathic diseases such as cerebral palsy, poliomyelitis, and muscular dystrophy; congenital causes such as failure of formation or segmentation, and myelomeningocele; traumatic causes such as fracture or dislocation (non-paralytic) and post-radiation; soft tissue contractures such as post-empyema and burns; osteochondrodystrophies such as achondroplasia and spondyloepiphyseal dysplasia; tumor; and rheumatoid disease. However, the most common type of structural scoliosis is idiopathic scoliosis. Although idiopathic scoliosis is thought to have a genetic predisposition, its exact cause is still unknown.
Idiopathic scoliosis is divided into three categories: infantile (ages 0-3), juvenile (ages 3-10), and adolescent (ages > 10 but before maturity). Idiopathic scoliosis is defined as a 10 degree or greater lateral structural curvature of the spine that presents during the late juvenile or adolescent period in otherwise normal children.
Treatment of Scoliosis
Scoliosis treatment varies individually and is based on the patient’s age, growth schedule, degree and pattern of curve and type of scoliosis. The following treatment guidelines may be considered:
Depending of the severity of the curvature, most patients with idiopathic scoliosis can be treated conservatively. For relatively few patients for whom surgery is indicated to stabilize the spine and/or reduce the lateral curvature, a diskectomy and fusion is the established technique. Recently, new, less invasive techniques have been proposed to eliminate the fusion of the vertebral segments and allow for greater spinal mobility.
Endoscopic surgery for the treatment of scoliosis is a new evolving surgical technique which uses scopes to perform minimally invasive surgery on the spine. The potential benefits of this type of surgery includes less post-operative pain, improved rehabilitation, recovery and cosmetic results; however, there are no randomized, controlled clinical trials comparing the technique to standard surgical procedures. Patient selection criteria and the long term impact on outcomes remain unknown.
The Horizon® Eclipse® Spinal System (Medtronic, Inc., Beverly, MA) is an endoscopic instrumentation system specifically developed for minimally-invasive, endoscopic surgery. Although promising, the role of endoscopic surgery for scoliosis requires further study.
The vertebral stapling technique is designed for patients who have not reached skeletal maturity, and involves endoscopic placement of titanium alloy staples along the spinal curvature in an attempt to retard progression of the scoliosis as the patient matures. Early published results show that the technique is feasible and relatively safe; however, the data is insufficient to permit conclusions as to whether the technique improves health outcomes.
Vertebral stapling and endoscopic spinal surgery in the treatment of scoliosis is considered investigational.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
3/22/2007: Policy added. Reviewed and approved by the Medical Policy Advisory Committee (MPAC)
08/14/2015: Code Reference section updated for ICD-10.
06/01/2016: Policy number L.7.01.418 added. Investigative definition updated in Policy Guidelines.
American Academy of Orthopedic Surgeons. Scoliosis in children and adolescents. Accessed January 10, 2007. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=262&topcategory=Spine
Braun JT, Hoffman M, Akyuz E, et al. Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model. Spine. 2006; 31(12): 1314-1320.
Charles YP, Daures JP, de Rosa V, Dimaglio A. Progression risk of idiopathic juvenile scoliosis during pubertal growth. Spine. 2006; 31(17): 1933-1942.
Gillingham B, Fan R, Akbarnia B. Early onset idiopathic scoliosis. J Am Acad Orthop Surg. 2006; 14(2):101-112.
Little DG, Song KM, Katz D, Herring JA. Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg Am. 2000; 82(5): 685-693.
Medtronic Sofamor Danek. CD Horizon® Eclipse® Spinal System. Accessed January 10, 2007. Available at: http://www.sofamordanek.com/patient-minimal-eclipse.html
National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Disease. Questions and answers about scoliosis in children and adolescents. Accessed January 10, 2007. Available at: http://www.niams.nih.gov/hi/topics/scoliosis/scochild.htm
Song KM, Little DG. Peak height velocity as a maturity indicator for males with idiopathic scoliosis. J Pediatr Orthop. 2000; 20(3): 286-288.
This may not be a comprehensive list of procedure codes applicable to this policy.
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