BlueCross BlueShield of Tennessee Medical Policy Manual

Automated Percutaneous and Endoscopic Discectomy

DESCRIPTION

Surgical management of herniated intervertebral discs most commonly involves discectomy or microdiscectomy, performed manually through an open incision, to excise extruding disc material.  Minimally invasive options have been researched. Automated percutaneous discectomy involves placement of a probe within the intervertebral disc under imaging guidance with aspiration of disc material using a suction cutting device.  Endoscopic discectomy involves the percutaneous placement of a working channel under imaging guidance, followed by visualization of the working space and instruments through an endoscope, and aspiration of disc material.

The Dekompressor® Percutaneous Discectomy Probe (Stryker) and the Nucleotome®(Clarus Medical) are examples of percutaneous discectomy devices that have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process.  Both are labeled for use in aspiration of disc material during percutaneous discectomies in the lumbar, thoracic and cervical regions of the spine.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION   

There is insufficient published evidence from well-designed and executed randomized controlled trials to evaluate the impact of automated percutaneous discectomy on net health outcome. In addition, evidence from small randomized controlled trials, do not support the use of these procedures.

The majority of published randomized trials on endoscopic discectomy were conducted in Europe and at this time the published literature is insufficient to evaluate the health outcomes from endoscopic discectomy in U.S. centers.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2017). Automated percutaneous and percutaneous endoscopic discectomy (7.01.18). Retrieved April 25, 2017 from BlueWeb. (39 articles and/or guidelines reviewed)

Cong, L., Zhu, Y., & Tu, G. (2016). A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. European Spine Journal, 25 (1), 134-143. Abstract retrieved April 25, 2017 from PubMed database.

Gibson, J., Subramanian, A., & Scott, C. (2017). A randomized controlled trial of transforaminal endoscopic discectomy vs micro discectomy. European Spine Journal, 26 (3), 847-856. Abstract retrieved April 25, 2017 from PubMed database.

Lewis, R., Williams, N., Sutton, A., Burton, K., Din, N., Matar, H., et al. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine Journal, 15 (6), 1461-1477. Abstract retrieved April 25, 2017 from PubMed database.

Li, X., Zhong, C., Deng, G., Liang, R., & Huang, C. (2016). Full-endoscopic procedures versus traditional discectomy surgery for discectomy: a systematic review and meta-analysis of current global clinical trials. Pain Physician, 19, 103-118. (Level 1 evidence)

Manchikanti, L., Singh, V., Calodney, A. K., Helm, S., Deer, T. R., Benyamin, R. M., et al. (2013). Percutaneous lumbar mechanical disc decompression utilizing Dekompressor®:  An update of current evidence. Pain Physician, 16, SE1-SE24.

National Institute for Health and Care Excellence. (2005). Automated percutaneous mechanical lumbar discectomy. Retrieved July 7, 2016 from www.nice.org.uk/guidance/ipg141.

National Institute for Health and Care Excellence. (2016). Percutaneous interlaminar endoscopic lumbar discectomy for sciatica. Retrieved April 25, 2017 from www.nice.org.uk/guidance/ipg555.

National Institute for Health and Care Excellence. (2016). Percutaneous transforaminal endoscopic lumbar discectomy for sciatica. Retrieved April 25, 2017 from www.nice.org.uk/guidance/ipg556.

Ong, D., Chua, N. H., Vissers, K. (2014). Percutaneous disc decompression for lumbar radicular pain: A review article. Pain Practice, 2014, October. Abstract retrieved July 17, 2015 from PubMed database.

Phan, K., Xu, J., Schultz, K., Alvi, M., Lu, V., Kerezoudis, P., et al. (2017). Full-endoscopic versus micro-endoscopic and open discectomy: a systematic review and meta-analysis of outcomes and complications. Clinical Neurology and Neurosurgery, 154, 1-12. Abstract retrieved April 25, 2017 from PubMed database.

U. S. Food and Drug Administration. (2003, November). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K032473. Retrieved January 13, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf3/K032473.pdf.

U. S. Food and Drug Administration. (2004, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K040919. Retrieved January 13, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf4/K040919.pdf.

U. S. Food and Drug Administration. (2009, November). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K092877. Retrieved January 13, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf9/K092877.pdf.

Winifred S. Hayes, Inc. Medical Technology Directory. (2013, December; last update search November 2016). Automated percutaneous lumbar discectomy. Retrieved April 25, 2017 from www.Hayesinc.com/subscribers (43 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  11/1987

MOST RECENT REVIEW DATE:  6/8/2017

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