BlueCross BlueShield of Tennessee Medical Policy Manual

Intervertebral Disc Decompression using Radiofrequency Coblation (Nucleoplasty) or Laser Energy (Laser Discectomy)

DESCRIPTION

Decompression of the intervertebral disc using laser energy (laser discectomy) or radiofrequency coblation (nucleoplasty) has been investigated as treatment of low back pain related to disc disease. These minimally invasive techniques are designed to remove or ablate disc material which results in the decompression of the disc.

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 damage to surrounding tissue.

For laser disc decompression/discectomy a needle or catheter is inserted into the disc nucleus under fluoroscopic guidance, and a laser beam is directed through it to vaporize tissue. A variety of different lasers have been investigated for laser disc decompression, including YAG, KTP, holmium, argon, and carbon dioxide lasers. Due to differences in absorption, the energy requirements and the rate of application differ among the lasers. In addition, it is unknown how much disc material must be removed to achieve decompression. Therefore, protocols vary according to the length of treatment, but typically the laser is activated for brief periods only.

Examples of devices used for percutaneous disc decompression by laser or radiofrequency are: ArthroCare® Orthopedic Electrosurgery System, Quanta System LITHO Laser System, Radionics RF Disc Catheter Electrode System®, YAG Laser System. and the RevoLix Duo Laser System.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

The available evidence is insufficient to draw conclusions regarding the efficacy of disc decompression using laser energy or radiofrequency coblation (nucleoplasty).  Additional randomized controlled trials are needed to further evaluate this technology.

SOURCES 

Abrishamkar, S., Kouchakzadeh, M., Mirhosseini, A., Tabesh, H., Rezvani, M.. Moayednia, A., et al. (2015). Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation. Journal of Research in Medical Sciences, 20 (12), 1133-1137. (Level 2 evidence)

American Society of Anesthesiologists and American Society of Regional Anesthesia and Pain Medicine. (2010). 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 July 20, 2016 from https://www.asahq.org/quality-and-practice-management/standards-and-guidelines.

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2015). Decompression of intervertebral disc using laser (laser discectomy) or radiofrequency coblation (nucleoplasty) (7.01.93). Retrieved September 17, 2015 from BlueWeb. (25 articles and/or guidelines reviewed)

Brouwer, P., Brand, R., van den Akker-van Marle, M., Jacobs, W., Schenk, B., van den Berg-Huijsmans, A., et al. (2015). Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. The Spine Journal, 15 (5), 857-865. Abstract retrieved July 20, 2016 from PubMed database.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for thermal intradiscal procedures (TIPs) (150.11). Retrieved September 17, 2015 from http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?from2=search1.asp&.

Chitagran, R., Poopitaya, S., & Tassanawipas, W. (2012). Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial. Journal of the Medical Association of Thailand, Suppl 10, S198-S205. Abstract retrieved July 20, 2016 from PubMed database.

ECRI Institute. Evidence Reports. (2010, April). Radiofrequency ablation for chronic spinal pain. Retrieved August 29, 2012 from ECRI Institute. (250 articles and/or guidelines reviewed)

Eichen, P., Achilles, N., König, V., Mösges, R., Hellmich, M., Himpe, B., et al. (2014). Nucleoplasty, a minimally invasive procedure for disc decompression: A systematic review and meta-analysis of published clinical studies. Pain Physician, 2014 (17), E149-E173. (Level 4 evidence - Industry sponsored)

Manchikanti, L., Abdi, S., Atluri, S., Benyamin, R., Boswell, M., Buenaventura, R., et al. (2013). An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician, 16 (2 Suppl), S49-S283.

Manchikanti, l., Falco, F., Benyamin, R., Caraway, D., Deer, T., Singh, V., et al. (2013). An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty. Pain Physician, 16, SE25-SE54. (Level 1 evidence)

National Institute for Health and Care Excellence (NICE). (2016, January). Percutaneous coblation of the intervertebral disc for low back pain and sciatica. Retrieved July 20, 2016 from www.nice.org.uk/guidance/ipg543.

National Institute for Health and Clinical Excellence (NICE). (2009, May). Percutaneous endoscopic laser lumbar discectomy. Retrieved August 29, 2012 from http://www.nice.org.uk/nicemedia/live/12073/44256/44256.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.

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. (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. (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.

ORIGINAL EFFECTIVE DATE:  6/1/2004

MOST RECENT REVIEW DATE:  8/11/2016

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