Policy number: SRP 096
Policy name: Spinal Surgery for Non-Acute Lumbar Conditions
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Mid and South Essex ICB commission Spinal Surgery for Non-Acute Lumbar Conditions on a restricted basis.
Funding will only be available under the following circumstance:
- Surgical discectomy (standard or microdiscectomy) in selected patients with sciatica secondary to disc prolapse where conservative management for at least 4-6 weeks has failed.
OR
- Lumbar decompression for sciatica with nerve root compression or severe central spinal stenosis with claudication symptoms in one of both legs.
NHS England commissions complex spinal surgery including:
- All spinal deformity surgery (adults and children).
- All spinal reconstruction surgery including tumour, trauma & infection (adults and children).
- Palliative or curative spinal oncology surgery (adults and children).
- All anterior, lateral and posterior thoracic surgery.
- All anterior lumbar surgery.
- All anterior cervical surgery greater than two levels.
- All corpectomy surgery at any level of the spine.
- Posterior cervical decompression surgery using instrumentation.
- Posterior lumbar instrumented surgery greater than two levels.
MSE ICB does not accept requests to fund spinal surgery for low back pain. NICE advises that clinicians:
Do not offer spinal injections for managing low back pain.
Do not offer ultrasound for managing low back pain with or without sciatica.
Do not offer PENS for managing low back pain with or without sciatica.
Do not offer TENS for managing low back pain with or without sciatica.
Do not offer interferential therapy for managing low back pain with or without sciatica.
Do not offer traction for managing low back pain with or without sciatica.
Do not offer belts or corsets for managing low back pain with or without sciatica.
Do not offer foot orthotics for managing low back pain with or without sciatica.
Do not offer rocker sole shoes for managing low back pain with or without sciatica
Do not offer disc replacement in people with low back pain.
Do not offer spinal fusion for people with low back pain unless as part of a randomised controlled trial.
Do not offer gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines for managing sciatica as there is no overall evidence of benefit and there is evidence of harm.
Do not offer opioids for managing chronic sciatica.
Do not offer paracetamol alone for managing low back pain.
Do not routinely offer opioids for managing acute low back pain
Do not offer opioids for managing chronic low back pain.
Do not offer selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors or tricyclic antidepressants for managing low back pain.
Do not offer gabapentinoids or antiepileptics for managing low back pain
Funding for patients not meeting the above criteria will only be granted in clinically exceptional circumstances.
Find out more information on applying for funding in exceptional clinical circumstances