The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transaxial interbody lumbosacral fusion.


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

Transaxial interbody lumbosacral fusion is done through a small cut over the bony structure at the base of the spine connected to the pelvis. It involves removing all, or part, of the damaged disc and inserting an artificial implant and bone graft material into the remaining disc space. The aim is to encourage two spine bones to join together to prevent movement of the painful joint.

Coding recommendations

V33.8 Other specified primary excision  of lumbar intervertebral disc

V55. 1 One level of spine

Y53.4 Approach to organ under fluoroscopic control

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

V55. 1 One level of spine

Y53.4 Approach to organ under fluoroscopic control

Z67.6 Lumbosacral 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.

Supplemental posterior instrumentation to provide additional stabilisation and vertebral body spinal fusion of other levels with alternative approaches may be coded in addition depending on the type of instrumentation/stabilisation used or the type of vertebral body spinal fusion and approaches used.

It is not possible to indicate that a transaxial approach was used during this procedure using OPCS-4 codes.

The NHS Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.

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.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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