Surgical management of herniated intervertebral discs most commonly involves discectomy or microdiscectomy, traditionally performed 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. Endoscopic techniques may be intradiscal or may involve extraction of noncontained and sequestered disc fragments from inside the spinal canal using an interlaminar or transforaminal approach. Following insertion of the endoscope, decompression is performed under visual control.
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.
Automated percutaneous discectomy as a technique of intervertebral disc decompression in individuals with back pain and/or radiculopathy related to disc herniation in the lumbar, thoracic, or cervical spine is considered investigational.
Percutaneous endoscopic discectomy as a technique of intervertebral disc decompression in individuals with back pain and/or radiculopathy related to disc herniation in the lumbar, thoracic, or cervical spine is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
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 has conflicting results and is insufficient to evaluate the health outcomes from endoscopic discectomy in U.S. centers.
BlueCross BlueShield Association. Evidence Positioning System. (7:2020). Automated percutaneous and percutaneous endoscopic discectomy (7.01.18). Retrieved December 4, 2020 from https://www.evidencepositioningsystem/. (69 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.A., Williams, N.H., Sutton, A.J., Burton, K., Din, N.U., Matar, H.E., et al. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine Journal, 15 (6), 1461-77. Abstract retrieved December 4, 2020 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.
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.
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.
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.
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.
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.
ORIGINAL EFFECTIVE DATE: 11/1987
MOST RECENT REVIEW DATE: 2/11/2021
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