Facet Arthroplasty

This policy addresses facet arthroplasty — implantation of posterior facet‑replacement, motion‑preserving prostheses (e.g., the TOPS System) as an adjunct to neural decompression or as an alternative to posterior spinal fusion to stabilize the operated segment while preserving intervertebral motion. Coverage is limited to selected patients age 35–80 with single‑level L3–L5 pathology (moderate–severe lumbar spinal stenosis and/or Grade 1 degenerative spondylolisthesis with ligamentum flavum thickening or facet capsule scarring) after failed conservative therapy; multilevel disease or Grade ≥2 spondylolisthesis is excluded, total facet arthroplasty for lumbar decompression is considered experimental/unproven, evidence is limited/interim, some devices are not U.S. commercially available, and coverage is subject to the member’s benefit plan.

"Implantation of a spinal prosthesis to restore posterior element structure and function as an adjunct to neural decompression"