IPSIS Identifies Critical Flaws in AHRQ Draft Review on Lumbar Spine Treatments

Comments 🔒 submitted by IPSIS and endorsed by the North American Spine Society raise serious concerns about a draft systematic review by the U.S. Department of Health & Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ), The Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine.

While the report purports to assess fusion procedures for lumbar degenerative disease, its narrow focus on a single condition — stable degenerative lumbar spondylolisthesis — fails to meet its stated scope. More troublingly, the document conflates distinct clinical conditions (e.g., chronic low back pain, radicular pain, neurogenic claudication) and inconsistently applies terminology, leading to confusion and misinterpretation of evidence. Merging unrelated topics and imprecisely characterizing both surgical and non-surgical interventions, the review risks misleading health plans, providers, and policymakers.

Furthermore, the evaluation of non-surgical interventions, including radiofrequency neurotomy and epidural steroid injections, lacks clinical nuance. The review inappropriately groups thermal radiofrequency neurotomy with pulsed radiofrequency despite differing mechanisms and also fails to apply rigorous diagnostic criteria essential for assessing treatment efficacy. Important modalities such as basivertebral nerve ablation and intradiscal therapies are also omitted without explanation. To improve clarity, accuracy, and clinical utility, the comments recommend aligning the document’s title and objectives with its true content, clearly differentiating patient populations, and transparently addressing methodological limitations.

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