The objective of NASS Appropriate Use Criteria is to define appropriate (meaning reasonable) care of spinal disorders. This document is intended to reflect contemporary treatment concepts and to assist in the delivery of optimum, efficacious treatment and functional recovery.  This document supersedes any other existing NASS documents, with the exception of current clinical guidelines.
The purpose of this document is to evaluate the appropriateness of fusion. As such, decompression is not always included in the scenarios. For clarification, where there is no reference to decompression, the reader should interpret any scenario as fusion with or without decompression. This document assumes that the reader can appropriately determine the need for decompression in those scenarios where decompression is not specified. In addition, where medical/interventional treatment is mentioned, the document assumes that the type of medical/interventional treatment provided was within an acceptable community standard of care to the reader.
Medical and psychosocial comorbidities are grouped by such terms as mild, moderate, severe, well-controlled, poorly controlled, etc. It is recognized that these terms are vague. In very simple terms, these modifiers will be absent, not that bad, or severe. It is acknowledged that this can be subjective, but nonetheless, it is assumed that the provider can group their patients accordingly when these modifying variables are present. Readers are strongly encouraged to review the full AUC documents available on the NASS website (
Patient Population
Patients aged 18-80 with the degenerative diagnoses of:
  • Acute herniated nucleus pulposus;
  • Spondylosis (without stenosis);
  • Spondylosis with foraminal stenosis;
  • Spondylosis with central stenosis.
This document applies to the skeletally mature spine only.
Disclaimer. These criteria do not represent a “standard of care,” nor are they intended as a fixed treatment protocol. It is anticipated that there will be patients who will require less or more treatment than the average. It is also acknowledged that in atypical cases, treatment falling outside these criteria will sometimes be necessary. This document should not be seen as prescribing the type, frequency or duration of intervention. Treatment may be based on this information in addition to an individual patient’s needs as well as the doctor’s professional judgment and experience. This document is designed to function as a guide and should not be used as the sole reason for denial of treatment and services. It is not intended to expand or restrict a health care provider’s scope of practice or to supersede applicable ethical standards or provisions of law. This is not a legal document.
This content of this document should not be construed as including all proper methods of care or excluding other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

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