Percutaneous image-guided lumbar decompression (PILD) describes a minimally invasive laminotomy/laminectomy procedure (interlaminar approach) for decompression of the lumbar spine for a primary diagnosis of lumbar spinal stenosis (LSS) under indirect image guidance (eg. fluoroscopic, CT) with or without the use of an endoscope. This procedure is proposed as a treatment for symptomatic LSS that is unresponsive to conservative therapy.

LSS is the narrowing of the space around the spinal cord and the spinal nerve roots. The most common symptom of LSS is back pain with neurogenic claudication, i.e., pain, numbness, or weakness in the legs that worsens with standing or walking and is alleviated with sitting or leaning forward. Degenerative spinal stenosis is often associated with age related changes in the spine. LSS is the most common reason for back surgery in adults over 65 years of age. The goal of surgical treatment is to decompress the spinal cord and/or nerve roots and alleviate the symptoms.

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if PILD for LSS is reasonable and necessary for coverage under the Medicare program. The scope of our review is inclusive of percutaneous lumbar laminotomy/laminectomy (interlaminar approach) for the decompression of neural elements (spinal cord, nerve roots), under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope. NOTE: Endoscopically assisted laminotomy/laminectomy, which requires open and direct visualization, as well as other open lumbar decompression procedures for LSS are not within the scope of this NCA.