The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Balloon kyphoplasty for vertebral compression fractures in April 2006.
It replaces previous guidance on balloon kyphoplasty for vertebral compression fractures (Interventional Procedures Guidance no. 20, November 2003).
Further recommendations have been made as part of the clinical guideline on metastatic spinal cord compression published in November 2008, as follows:
Vertebroplasty or kyphoplasty should be considered for patients who have vertebral metastases and no evidence of MSCC or spinal instability if they have either:
- mechanical pain resistant to analgesia, or
- vertebral body collapse.
Vertebroplasty or kyphoplasty for spinal metastases should only be performed after agreement between appropriate specialists including an oncologist, interventional radiologist, and spinal surgeon, and in facilities where there is good access to spinal surgery.
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from www.nice.org.uk/CG75. The IP guidance on Balloon kyphoplasty for vertebral compression fractures remains current, and should be read in conjunction with the clinical guideline.
Balloon kyphoplasty is performed by inserting a balloon-like device (inflatable bone tamp) through a channel created by a hand drill in the fractured vertebrae. The tamp is positioned and inserted into the vertebral body. The ballon is then inflated slowly until normal height of the vertebral body is restored or the balloon reaches its maximum volume.
The procedure is intended to restore vertebral height and correct kyphosis. It may also help to improve pulmonary and gastrointestinal function and reduce the likelihood of subsequent vertebral compression fractures.
The inflation of the balloon tamp creates a cavity in the vertebral body so that when the bone tamp is withdrawn, cement can be injected into the cavity at a lower pressure, potentially reducing the risk of cement leakage. The cement increases the strength of the vertebra and is intended to provide pain relief.
SNOMED CT preferred term (concept ID)
Balloon kyphoplasty of fracture of spine (426243004)
V44.5 Balloon kyphoplasty of fracture of spine
V55.- Levels of spine
Note: Codes within category V55.- are assigned in second place each time a spinal operation is coded: if the levels of spine are not specified, V55.9 Unspecified levels of spine is used.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding
Diagnosis or health condition
SNOMED CT preferred term (concept ID)
Compression fracture of vertebral column (42942008)
SNOMED CT provides clinical terms for entry into the patient record to store clinical information relevant to that encounter. The mandated classifications (OPCS-4 or ICD-10) provide a method to collect and aggregate data to allow accurate and consistent data analysis.
The Clinical Classifications Service of the Health and Social Care Information Centre is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The Clinical Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. Clinical Classifications Service — Health and Social Care Information Centre