August 2016 - NICE is updating this guidance (see the in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Lateral (including extreme, extra and direct lateral) interbody fusion in the lumbar spine.


As a person gets older, the discs between the back bones that provide support can deteriorate because of wear and tear. Sometimes this causes such severe pain and disability that surgery is considered.

Lateral interbody spinal fusion involves the removal of all, or part, of the damaged disc and the insertion of a supportive structure, together with a fragment of bone from the hip. It aims to join the two back bones together to prevent movement of the painful joint. The procedure is done through a cut in the patient’s side.

Coding recommendations

V33.8 Other specified primary excision  of lumbar intervertebral disc

V55. - Levels of spine

Y53.4 Approach to organ under fluoroscopic control

V38.8 Other specified primary fusion of other joint of spine

V55. - Levels of spine

Y53.4 Approach to organ under fluoroscopic control

Z67.5 Lumbar intervertebral joint

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.

Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control, if the method of image control is unspecified Y53.9 Unspecified approach to organ under image control is assigned.

It is not possible to indicate that a lateral approach has been used during this procedure using OPCS-4 codes.

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.

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