Nonoperative Diagnostic Spinal Ultrasound (Echography/Sonogram)
DESCRIPTION
Ultrasonography is a noninvasive imaging technique that uses high-frequency sound waves. A conducting gel is applied to the skin overlying the area to be examined. The individual then lies on an examination table or bed while the physician or technician passes a transducer over the area. The reflected sound waves are converted into images that are viewed on a monitor.
POLICY
The use of nonoperative diagnostic spinal ultrasound, to evaluate newborns and infants two years of age or younger, for congenital anomalies of the spine and spinal cord (e.g., spina bifida, spinal dysraphism) is considered medically necessary.
The use of nonoperative diagnostic spinal ultrasound, to evaluate back pain or radicular symptoms (e.g., disc herniation, spinal stenosis, nerve root pathology) or for evaluation of congenital anomalies for individuals over the age of two years is considered investigational.
ADDITIONAL INFORMATION
Well-designed studies were not found in the published literature to support the use of diagnostic spinal ultrasound for the investigational uses listed on this policy.
SOURCES
American Chiropractic College of Radiology. (2005). ACCR guideline for the use of diagnostic spinal ultrasound. Retrieved November 1, 2007 from http://www.acatoday.org/level2_css.cfm?T1ID=10&T2ID=117#27.
American Institute of Ultrasound in Medicine. (2002, June). Nonoperative spinal/paraspinal ultrasound in adults. Retrieved February 6, 2006 from http://www.aium.org/publications/statements/_statementSelected.asp?statement=18.
American Institute of Ultrasound Medicine. (2007, October). AIUM practice guideline for the performance of an ultrasound of the neonatal spine. Retrieved October 30, 2007 from http://www.aium.org/publications/clinical/neonatalSpine.pdf. (9 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues. (2007, July). Ultrasound diagnostic procedures (NCD 220.5, p. 2-165 & 2-166). St. Anthony Publishing.
Dick, E. A., de Bruyn, R. Patel, K. & Owens, C. M. (2001). Spinal ultrasound in cloacal exstrophy. Clinical Radiology, 56 (4), 289-294. Abstract retrieved June 5, 2002 from PubMed database.
Lin, K. L., Wang, H. S., Chou, M. L., & Lui, T. N. (2002). Sonography for detection of spinal dermal sinus tracts. American Journal of Ultrasound Medicine, 21 (8), 903-907. (16 articles and/or guidelines reviewed)
National Guideline Clearinghouse. (2006). Myleography. Retrieved October 30, 2007 from http://www.guideline.gov/summary/summary.aspx?doc_id=9598&nbr=005119&string=nonoperative+AND+spinal+AND+ultrasound.
National Guideline Clearinghouse. (1998, August). Review of the literature on spinal ultrasound for the evaluation of back pain and radicular disorders. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Retrieved September 6, 2002 from http://aan.com/professionals/practice/pdfs/pdf_1995_thru_1998/1998.51.343.pdf. (12 articles and/or guidelines reviewed)
Rohrschneider, W. K., Forsting, M., Darge, D., & Troger, J. (1996). Diagnostic value of spinal US; Comparative study with MR imaging in pediatric patients. Radiology, 200 (2), 383-388. (37 articles and /or guidelines reviewed)
Ultrasonography for the diagnosis of spinal and paraspinal disorders. (2004, April). Hayes Alert, 7 (4), 1.Retrieved October 30, 2007 from http://www.Hayesinc.com/subscribers. (21 articles and/or guidelines reviewed)
Warder, D. E. (2001). Tethered cord syndrome and occult spinal dysraphism. Neurosurgical Focus, 10, 1-9. (74 articles and/or guidelines reviewed)
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EFFECTIVE DATE |
12/13/2007 |
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