The National Institute for Health and Clinical Excellence (NICE) has now issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on percutaneous radiofrequency thermocoagulation for lower back pain.
The Interventional Procedures Advisory Committee (IPAC) originally considered this procedure as part of percutaneous intradiscal thermocoagulation.
However, as a result of comments received during the initial consultation in August 2003, IPAC decided to consider the procedure separately for intradiscal thermocoagulation using electrothermal energy, and intradiscal thermocoagulation using radiofrequency energy. Guidance has now been produced for both procedures.
As part of the NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
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 typically conservative, consisting of pharmacotherapy and/or a multidisciplinary programme which may include exercises, education and behavioural therapy. Where these regimes have failed, patients may then choose to continue with conservative management or to undergo surgery (spinal fusion). Intradiscal radiofrequency thermocoagulation is particularly indicated in patients with persistent lower back pain.
Percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil. Patients are sedated and local anaesthetic is infiltrated over the affected disc. Under fluoroscopic guidance, a needle is inserted into the disc. The electrode or flexible catheter is then introduced into the centre of the nucleus through the needle, slowly heated to 50-80°C and kept at that temperature for 90-360 seconds.
V62.3 Primary percutaneous intradiscal radiofrequency thermocoagulation to lumbar intervertebral disc
or V63.3 Revisional percutaneous intradiscal radiofrequency thermocoagulation to lumbar intervertebral disc
V55.- Levels of spine
Y53.4 Approach to organ under fluoroscopic control
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.