DESCRIPTION
Percutaneous discectomy is a technique in which disc decompression is accomplished by the physical removal of disc material rather than its ablation. Originally, PLD was performed manually, using cutting forceps to remove nuclear material from within the disc annulus. This manual technique has been replaced with automated devices that involve placement of a probe within the intervertebral disc and aspiration of disc material using a suction cutting device. Published material related to this technology basically references the treatment of back pain due to herniated lumbar intervertebral discs.
Examples of percutaneous discectomy devices include the Stryker DeKompressor Percutaneous Discectomy Probe (Stryker) and the Nucleotome (Clarus Medical). Both devices have the same FDA labeled intended use, i.e., “for use in aspiration of disc material during percutaneous discectomies in the lumbar, thoracic and cervical regions of the spine.”
POLICY
Percutaneous discectomy as a technique of intervertebral disc decompression in individuals with back pain related to disc herniation in the lumbar, thoracic, or cervical spine is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Published literature addresses the use of automated percutaneous discectomy in lumbar disc herniation. Overall, based on conflicting evidence, the literature remains insufficient to determine the efficacy of automated percutaneous discectomy as a technique for disc decompression. There were no clinical trials found that address percutaneous discectomy of cervical or thoracic disc herniation. Using a standard of controlled clinical trials to evaluate the safety and effectiveness of percutaneous discectomy, there is inadequate published data to permit scientific conclusions.
SOURCES
Amoretti, N., David, P., Grimaud, A., Flory, P., Hovorka, I.,Roux, C., et al. (2006). Clinical follow-up of 50 patients treated by percutaneous lumbar discectomy. Clinical Imaging, 30 (4), 242-244. Abstract retrieved October 19, 2006 from PubMed database.
BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2010). Percutaneous discectomy (7.01.18). Retrieved March 8, 2010 from BlueWeb. (12 articles and/or guidelines reviewed)
Boswel, M. V., Trescot, A. M., Datta, S., Schultz, D. M., Hansen, H. C., Abdi, Sl., et al. (2007). Task force of the American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician, 10 (1), 7-111. Abstract retrieved February 23, 2010 from PubMed database.
Hayes. Medical Technology Directory. (2006, May). Automated percutaneous lumbar discectomy. Retrieved February 23, 2010 from www.Hayesinc.com/subscribers. (36 articles and/or guidelines reviewed)
Mariconda, M., Galasso, O., Secondulfo, V., Rotonda, G. D., & Milano, C. (2006). Minimum 25-year outcome and functional assessment of lumbar discectomy. Spine, 31 (22), 2593-2599. Abstract retrieved October 26, 2006 from PubMed database.
National Institute for Health and Clinical Excellence (NICE). (2005, November). Automated percutaneous mechanical lumbar discectomy. Retrieved February 23, 2010 from http://www.nice.org.uk/nicemedia/pdf/ip/IPG141guidance.pdf.
ORIGINAL EFFECTIVE DATE: 11/1987
MOST RECENT REVIEW DATE: 7/10/2010
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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