DESCRIPTION
A variety of minimally invasive techniques have been investigated over the years as a treatment of low back pain related to disc disease. Techniques can be broadly divided into those that are designed to remove or ablate disc material which decompresses the disc, or those that are designed to alter the biomechanics of the disc annulus (e.g., percutaneous disc decompression using radiofrequency energy technology (e.g., DISC nucleoplasty™).
The DISC nucleoplasty™ procedure uses bipolar radiofrequency energy in a process referred to as coblation technology. The technique consists of small, multiple electrodes that emit a fraction of the energy required by traditional radiofrequency energy systems. The result is that a portion of nucleus tissue is ablated not with heat, but with a low-temperature plasma field of ionized particles. These particles have sufficient energy to break organic molecular bonds within tissue, creating small channels in the disc. The proposed advantage of this coblation technology is that the procedure provides for a controlled and highly localized ablation, resulting in minimal therapy damage to surrounding tissue.
Other techniques that alter the biomechanics of the disc annulus include intradiscal electrothermal annuloplasty (i.e., the IDET procedure) or percutaneous intradiscal radiofrequency thermocoagulation (PIRT). It should be noted that three of these procedures use radiofrequency energy - disc nucleoplasty, IDET, and PIRT - but apply the energy in distinctly different ways such that the procedures are unique.
Some examples of devices used for percutaneous disc decompression are AstroCare® Orthopedic Electrosurgery System, Quanta System LITHO Laser System, Radionics RF Disc Catheter Electrode System®, and Revolix Duo Laser System.
POLICY
Percutaneous disc decompression and treatment of associated low back pain using low-temperature, localized, radiofrequency energy is considered investigational.
See also:
Intradiscal Annuloplasty for the Treatment of Discogenic Back Pain (i.e., IDET or PIRT)
Percutaneous Discectomy
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
Percutaneous disc decompression and treatment of associated low back pain using low-temperature, localized, radiofrequency is relatively new technology, with minimal published literature and no controlled trials.
A 2009 American Pain Society clinical practice guideline on nonsurgical interventions for low back pain states that “there is insufficient (poor) evidence from randomized trials (conflicting trials, sparse and lower quality data, or no randomized trials) to reliably evaluate a number of interventions including coblation.”
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2010). Decompression of intervertebral disc using laser (laser discectomy) or radiofrequency coblation (nucleoplasty) (7.01.93). Retrieved January 20, 2011 from BlueWeb. (28 articles and/or guidelines reviewed)
Chou, R., Atlas, S. J., Stanos, S. P., Stanos, S. P., & Rosenquist, R. W. (2009). Nonsurgical interventional therapies for low back pain: A review of the evidence for an American Pain Society clinical practice guideline. Spine, 34 (10), 1078-1093.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Thermal intradiscal procedures (TIPS) (NCD 150.11, p. 2-73). Ingenix.
National Guideline Clearinghouse. (2010, April). Practice guidelines for chronic pain management. An updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Retrieved January 21, 2011 from http://www.guidelines.gov.
National Guideline Clearinghouse. (2009, July-August). Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Retrieved January 21, 2011 from http://www.guidelines.gov.
National Institute for Health and Clinical Excellence (NICE). (2006, May). Percutaneous disc decompression using coblation for lower back pain. Retrieved January 21, 2011 from http://www.nice.org.uk/nicemedia/live/11147/31277/31277.pdf.
Singh, V., Manchikanti, L., Benyamin, R. M., Helm, S., & Hirch, J. A. (2009). Percutaneous lumbar laser disc decompression: A systematic review of current evidence. Pain Physician, 12 (3), 573-588.
Singh, V. & Derby, R. (2006). Percutaneous lumbar disc decompression. Pain Physician, 9 (2), 139-146.
U. S. Food and Drug Administration. (2009, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K091909. Retrieved January 21, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf9/K091909.pdf.
U. S. Food and Drug Administration. (2007, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070466. Retrieved January 21, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K070466.pdf.
U. S. Food and Drug Administration. (2000, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K001741. Retrieved January 21, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K001741.pdf.
U. S. Food and Drug Administration. (2000, February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K000044. Retrieved January 21, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K000044.pdf.
ORIGINAL EFFECTIVE DATE: 6/1/2004
MOST RECENT REVIEW DATE: 2/10/2011
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