Percutaneous discectomy is considered experimental/investigational as a technique for intervertebral disc decompression due to symptomatic disc herniation(s) in the lumbar, thoracic or cervical spine. The published data regarding percutaneous discectomy for treatment of herniated intervertebral discs are inadequate to permit scientific conclusions regarding the advantages of this procedure over standard surgical or non-surgical options.  Percutaneous discectomy is not covered and is not eligible for payment.  A participating, preferred, or network provider can bill the member for this service.

NOTE:

See Medical Policy Bulletin S-159 for guidelines on Nucleoplasty and Biacuplasty.

Description

Percutaneous discectomy is a surgical technique used for the removal of herniated disc material. This procedure is used as an alternative to the standard open discectomy or microdiscectomy for treatment of back pain related to disc hernation.

The probe used to perform this procedure is placed into the herniated disc through a small cannula under fluoroscopic guidance. Once positioned, the probe is used to remove the herniated disc material. This may be performed either manually, using cutting forceps, automatically, using an automated device to aspirate small pieces of herniated disc material, or by laser ablation.  Removal/ablation of disc material causes decompression of the disc, relieving painful pressure on surrounding nerves.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits, or a contract.  Benefits are determined by the Federal Employee Program.

Percutaneous Lumbar Discectomy, Medical Policy Reference Manual, Policy 7.01.18, 12/1/95; 9/18/07

Percutaneous Lumbar Discectomy, Consortium Health Plans, Inc., Policy 7.01.18, 12/1/95

Nuances in Percutaneous Discectomy, Radiologic Clinics of North America, Vol. 36, No. 3, 5/98

Slotman GJ, Stein SC. Laminectomy compared with laparoscopic discectomy and outpatient laparoscopic discectomy for herniated L5-S1 intervertebral disks. Journal of Laparoendoscopic and Advanced Surgical Techniques. 1998;8:261-7.

Haines SJ, Jordan N, Boen JR, Nyman JA, Oldridge NB, Lindgren BR, LAPDOG/LEAPDOG Investigators. Discectomy strategies for lumbar disc herniation: study design and implications for clinical research. Journal of Clinical Neuroscience. 2002;9:440-6.

Amoretti N, Huchot F, Flory P, Brunner P, Chavallier P, Bruneton JN.  Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Clinical Imaging. 2005;2:98-101.

Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, Shin SW, Kang HY. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine. 2006;31:E285-90.

Amoretti N, David P, Grimaud A, Flory P, Hovorka I, Roux C, Chevallier P, Bruneton JN. Clinical follow-up of 50 patients treated by percutaneous lumbar discectomy. Clinical Imaging. 2006; 30:242-4.

Lee SH, Ahn Y, Choi WC, Bhanot A, Shin SW. Photomedicine and Laser Surgery. Immediate pain improvement is a useful predictor of long-term favorable outcome after percutaneous laser disc decompression for cervical disc herniation. Photomedicine and Laser Surgery. 2006;24:508-13.

Lee SH, Chung SE, Ahn Y, Kim TH, Park JY, Shin SW. Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy for adolescent lumbar herniation: Surgical outcomes in 46 consecutive patients. Mt. Sinai Journal of Medicine. 2006;73:795-801.

Lee DY, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation: surgical outcomes in 46 consecutive patients. Mt. Sinai Journal of Medicine. 2006;73:864-70.

Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine. 2007;32:E93-9.

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Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse. Cochrane Database System Review. 2007;1:CD001350.

Tzaan WC. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Medical Journal. 2007;30:226-34.

Lee SH, Kim KT, Jeong BO, Seo EM, Suk KS, Lee JH, Lee GK. The safety zone of percutaneous cervical approach: a dynamic computed tomographic study. Spine. 2007;32:E569-74.

Freeman BJ, Mehdian R. Intradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence? Curr Pain Headache Rep.2008;12(1):14-21.

Hirsch JA, Singh V, Falco FJ, et al. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician. 2009;12(3):601-20.

Lee DY, Shim CS, Ahn Y, et al. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc. 2009;46(6):515-21.

Liu WG, Wu XT, Guo JH, et al. Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy. Cardiovascular Intervent Radiol. 2009 Oct 15 [Epub ahead of print].

Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12(4):699-802.

Singh V, Benyamin RM, Datta S, et al. Systematic review of percutaneous lumbar mechanical disc decompression utilizing Dekompressor. Pain Physician. 2009;12(3):589-99.

Singh V, Manchikanti L, Benyamin RM, et al. Percutaneous Lumbar Laser Disc Decompression: a Systematic Review of Current Evidence. Pain Physician. 200912(3):573-88.