The International Society for the Advancement of Spine Surgery updated its 2025 policy recommendations for bone-anchored annular closure in high-risk discectomy patients.
The updated position accounts for new five-year data showing significant reductions in symptomatic reherniation, reoperation, and device-related adverse events, Morgan Lorio, MD, ISASS past president and chair emeritus of the Coding & Reimbursement Task Force said in an email to Becker’s. Intrinsic Therapeutics’ Barricaid device for the procedure also has CPT and ICD-10 codes in place, and ISASS’ update urges coverage and appropriate clinical adoption.
“Discectomy alone leaves a structural vulnerability in high-risk patients,” Dr. Lorio said. “Bone-anchored annular closure addresses that gap — reducing repeat surgeries and sustaining long-term outcomes.”
Barricaid is a different device than other implants since its usage is very select, said April Spillane, vice president of health economics at Intrinsic.
“We’ve been fighting [insurers] on a case-by-case basis for a couple years, and the vast majority of the time we win,” Ms. Spillane told Becker’s. “The unique thing about Barricad is that it’s only indicated for a subset of discectomy patients, and [using it] is an intraoperative decision, and that’s also the only way to show medical necessity. Typically you would get prior authorization and you know what you’re going to do. In our scenario they’re saying that we’re going to do this procedure, and we might have to do this if the patient has a large hole in their disc.”
The implant has been used in thousands of cases globally, but in the U.S. it’s in the early adoption phase.
“I think medical directors and payers are looking to the specialty societies for guidance and recommendations on coverage criteria,” she said. “It’s a major need for patients to get access to new treatment, and we’re thrilled with this. We appreciate ISASS for being the first to kind of step up and recognize and publish this.”
