Updates to AIM Spine Surgery Clinical Appropriateness Guideline

Addition of physical therapy or home therapy requirement and one complementary modality for all spine procedures based on preponderance of benefit over harm to conservative care

Changed the duration of conservative management from 1 year to 6 months based on the FDA prospective study that was done to approve the lumbar disc arthroplasty procedure

Added age, level requirements, and symptom/sign requirement and clarified contraindications in reflect these changes

Added exclusions criteria of Prior spine surgery of any form at the target level

Inclusion for implant failure similar to cervical spine

Consolidated  juvenile and congenital in adolescent idiopathic

Decreased duration of conservative management required based on lower evidence for efficacy in spinal stenosis and specialty panel feedback

Excluded anterior lumbar interbody fusion for foraminal stenosis without evidence of instability exclusion due to very low quality evidence for efficacy

Decreased duration of conservative care required for known spinal stenosis based on guidance from NASS and less evidence for efficacy of conservative management in this population

Aligned conservative care duration with discectomy criteria

Added new indication for synovial cyst

Clarification of guideline intent

Allow active nicotine use as a risk factor in lumbar uses of bone growth stimulation

Allow thoracic fusion similar to lumbar

Allow active nicotine use as a risk factor for pseudoarthrosis in graft failure