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Changing Evidence Standards Undermine the Artificial Disc

on Wall Street and in the mass media as a “game-changing” technology, one that might revolutionize spine care. But to be a game-changing technology, artificial discs will first have to get into the game on a large-scale basis. If insurers, health systems, and institutional payers in the United States have anything to do with it, this may be a slow process. Several recent evidence reviews by payers and related organizations have concluded that the efficacy and safety of disc replacement with the Charité disc (Johnson & Johnson/Depuy Spine, Raynham, MA) are anything but proven—and that the existing evidence is flawed. Many U.S. insurance companies— some say the majority—are declining to underwrite the substantial costs of disc replacement. Several have suggested that disc replacement should remain an “investigational” treatment, pending better scientific evidence.