Percutaneous disc decompression using coblation for lower back pain

NICE interventional procedures guidance [IPG173] Published date:

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The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous disc decompression using coblation for lower back pain in May 2006. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in May 2009 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

  • Description

    Chronic back pain is a common condition. In most individuals, the pain resolves spontaneously within several months. However, for some people the pain persists, despite specific causes of back pain - such as herniated discs, osteoporosis and fractures - being excluded. Increasingly this pain is being attributed to degeneration of the intervertebral disc, and referred to as discogenic back pain.

    Typically, first-line treatment for chronic discogenic back pain is conservative, consisting of pharmacotherapy and/or a multidisciplinary programme which may include exercises, education and behavioural therapy. If the pain does not improve, patients can choose whether to continue with conservative management or to undergo surgery (spinal fusion). Potential candidates for percutaneous disc decompression using coblation are those patients with back and leg pain caused by contained herniated discs.

    Percutaneous disc decompression using coblation is usually performed on an outpatient basis under local anaesthesia and sedation. Under fluoroscopic guidance, a needle is inserted into the affected disc. A probe-like device is then introduced into the disc.  The device is heated up to 40-70°C, ablating the centre part of the disc and creating a channel. After stopping at a pre-determined depth, the probe is then withdrawn, coagulating the tissue as it is removed. Around six channels are created during the procedure, the number of channels depending on the desired amount of tissue reduction.

  • OPCS4.6 Code(s)

    V60.- Primary percutaneous decompression using coblation to intervertebral disc

    V55.- Levels of spine

    Y53.4 Approach to organ under fluoroscopic control

    or

    V61.-Revisional percutaneous decompression using coblation to intervertebral disc

    V55.- Levels of spine

    Y53.4 Approach to organ under fluoroscopic control

    Note: Codes from categories V60.- or V61.- are selected depending on the site in the spine that is operated on, and fourth character detail is required.

    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

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