MA: Percutaneous Disc Procedures, including Percutaneous, Laser Disc Decompression, Percutaneous Radiofrequency Disc Decompression and Percutaeneous Spinal

Policy

1. Intradiscal electrothermal therapy (IDET) is considered investigational.
2. Endoscopic discectomy is considered investigational as a technique of intervertebral disc decompression in patients with back pain and/or radiculopathy related to disc herniation in the lumbar, thoracic, or cervical spine.
3. Percutaneous intradiscal radiofrequency thermocoagulation, percutaneous laser disc decompression, and percutaneous spinal discectomy are investigational for all indications.

Description

Intradiscal Electrothermal Therapy (IDET) is a minimally invasive treatment for discogenic low back pain intended to treat the protein wall of the disc and reduce the volume of disc material that causes nerve irritation.

Percutaneous intradiscal radiofrequency thermocoagulation In this procedure, the radiofrequency probe is placed into the center of the disc rather than around the annulus, and the device is activated for only 90 seconds at a temperature of 70 degrees centigrade. The mechanism of action of this procedure is not precisely understood, but is thought to be related to reducing the nociceptive pain input from the free nerve ending in the outer annulus fibrosis.

Percutaneous laser disc decompression (PLDD) is a procedure in which herniated intervertebral discs are treated by reduction of intradiscal pressure through laser energy. The laser is introduced by a needle inserted into the nucleus pulposus under local anesthesia and fluoroscopic monitoring. The volume of nucleus vaporized results in a sharp fall of intradiscal pressure, with consequent migration of the herniation away from the nerve root.

Percutaneous spinal discectomy is a procedure in which the disc decompression is accomplished by the physical removal of disc material rather than its ablation. Originally, spinal discectomy was performed manually, using cutting forceps to remove nuclear material from within the disc annulus. This technique has been replaced with automated devices that involve placement of a probe within the intervertebral disc and aspiration of disc material using a suction cutting device.

Codes