The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on automated percutaneous mechanical lumbar discectomy.

As part of the NICE's work programme, the current guidance was considered for review in July 2009 but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.

Description

Lumbar radicular pain, also known as sciatica, refers to pain that begins in the lower back and radiates down one of the legs. It is commonly caused by a herniated (or prolapsed) lumbar intervertebral disc. The herniation is a result of a protrusion of the nucleus pulposus through a tear in the surrounding annulus fibrosus. The annulus fibrosus may rupture completely resulting in an extruded disc, or may remain intact but stretched resulting in a contained disc prolapse. This may then compress one or more nerve roots, resulting in pain, numbness or weakness in the leg.

Conservative treatments include the use of analgesics, non steroidal anti-inflammatory medicines, physical therapy and hot or cold compresses. Epidural injections of corticosteroid may also be used. Surgery to remove disc material is considered if there is nerve compression or persistent symptoms that are unresponsive to conservative treatment.

Surgical techniques include open repair procedures and minimally invasive alternatives using percutaneous approaches.

Automated percutaneous mechanical lumbar discectomy is performed using local anaesthetic with or without conscious sedation. Under fluoroscopic guidance, a cannula is placed centrally within the disc using a posterolateral approach on the symptomatic side. A probe connected to an automated cutting and aspiration device is then introduced through the cannula. The disc is aspirated until no more nuclear material can be obtained.

There are a number of different devices available that are used to perform this procedure.

Coding recommendations

V58.3 Primary automated percutaneous mechanical excision of lumbar intervertebral disc

V55.- Levels of spine

Y53.4 Approach to organ under fluoroscopic control

or

V59.3 Revisional automated percutaneous mechanical excision of 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.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.