The North American Spine Society (NASS) is a medical specialty society representing orthopedic surgeons, neurosurgeons, physiatrists, pain management specialists, radiologists, chiropractors, nurses, nurse practitioners, physical therapists, psychologists, researchers and others committed to a multidisciplinary approach to spine care. NASS is dedicated to fostering the highest quality, ethical value-based and evidence-based spine care through education, research and advocacy.  

Appropriate Use Criteria: Objective

The objective of NASS Appropriate Use Criteria (AUC) is to define appropriate (meaning reasonable) care of spinal disorders. These documents are intended to reflect contemporary treatment concepts and to assist in the delivery of optimum, efficacious treatment and functional recovery. These documents supersede any other existing NASS documents, with the exception of current clinical guidelines.

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.  

These documents review appropriateness of treatment for various conditions. Conclusions are drawn from a methodology designed to provide answers to clinical scenarios based on the existing evidence and clinical expertise from a balanced panel of “thought leaders” in care. This does not represent a standard of care. However, it does provide an evidence- based review to help guide decision-making for patients, providers, payers and policy makers. The words are important. Appropriate does not mean anyone must follow a scenario, but rather that it would be reasonable to consider that line of treatment. Uncertainty implies either a lack of evidence or conflicting evidence that combined with experience does not establish clear certainty for treatment for a given scenario. Lastly, rarely appropriate is a fairly strong declaration of opposition, but does not mean that a scenario would be ill-advised in all circumstances. The scenarios were developed using variables the scenario writers and reviewers thought best represented the common clinical concerns for indications for specific conditions.

The full AUC documents with summaries and raw rating scores can be found on the NASS website: https://www.spine.org/Pages/ResearchClinicalCare/QualityImprovement/AppropriateUseCriteria.aspx  

Readers are strongly encouraged to review the full documents.   

Comments regarding these documents may be submitted to the North American Spine Society and will be considered in development of future revisions of the works.

Financial Statement

These appropriate use criteria were developed and funded in their entirety by the North American Spine Society (NASS). All participating authors have disclosed potential conflicts of interest consistent with NASS’ disclosure policy. Disclosures can be found in the documents’ appendices or on this website.  

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