When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Amoretti N, Hauger O, Marcy PY, et al. Percutaneous discectomy on lumbar radiculopathy related to disk herniation: Why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol. 2011;81(6):1259-64.
Boswell MV, Trescot AM, Datta S, et al. American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic and spinal pain. Pain Physician. 2007;10(1):7-111.
Brouwer PA, Peul WC, Brand R, et al. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial. BMC Musculoskelet Disord. 2009;10:49.
Casal-Moro R, Castro-Menendez M, Hernandez-Blanco M, et al. Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery. 2011;68(6):1568-1575; discussion 1575.
Chaichankul C, Poopitaya S, Tassanawipas W. The effect of learning curve on the results of percutaneous transforaminal endoscopic lumbar discectomy. J Med Assoc Thai. 2012;94(S10):S206-12.
Chatterjee S, Foy PM, Findlay GF. Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine. 1995;20(6):734-8.
Chitagran R, Poopitaya S, Tassanwipas W. Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial. J Med Assoc Thai. 2012;95(S10):S198-205.
Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforminal lumbar disc herniations: extraforminal targeted fragmentectomy technique using working channel endoscope. Spine. 2007;32(2):E93-E99.
Choi KC, Lee JH, Kim JS, et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10 228 cases. Neurosurgery. 2015;76(4):372-381.
Chou R, Atlas SJ, Stanos SP, et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009; 34(10):1078-93.
Chou R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066-1077.
Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J. 2016;25(1):134-143.
Eloqayli H, Al-Omari M. Percutaneous discectomy: Minimally invasive method for treatment of recurrent lumbar disc herniation. Clin Neurol Neurosurg. 2012;114(7):871-5.
Franke J, Greiner-Perth R, Boehm H, Mahlfeld K, Grasshoff H, et al. Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial. Eur Spine J. 2009;18(7):992-1000.
Foster MR. Herniated nucleus pulposus. [eMedicine Web site]. 03/16/05. (Updated 02/03/2017). Available at: http://emedicine.medscape.com/article/1263961-overview. Accessed May 07, 2019.
Freeman BJ, Mehdian R. Intradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence? Curr Pain Headache Rep. 2008;12(1):14-21.
Garg B, Nagraja UB, Jayaswal A. Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg. 2011;19(1):30-34.
Gibson JN, Subramanian AS, Scott CE. A randomized controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26(3):847-856.
Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse. The Cochrane Database Syst Rev. 2007;18(2):CD001350.
Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine. 2007;32(16):1735-47.
Gibson JNA, Grant IC, Waddell G. Surgery for lumbar disc prolapse. The Cochrane Database of Syst Rev. 2003;2.
Gotecha S, Ranade D, Patil SV, et al. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations. J Craniovertebr Junction Spine. 2016;7(4):217-223.
Goupille P, Mulleman D, Mammou S, et al. Percutaneous laser disc decompression for the treatment of lumbar disc herniation: a review. Semin Arthritis Rheum. 2007;37(1):20-30.
Haines SJ, Jordan N, Boen JR, et al. Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial. J Clin Neurosci. 2002;9(4):411-417.
He SH, Zhao X, Wu XH, Ding H, Fang J. Percutaneous endoscopic lumbar discectomy for the treatment of upper lumbar disc herniation. Zhongguo Gu Shang. 2012;25(11):920-2.
Hermantin FU, Peters T, Quartararo L, et al. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic discectomy. J Bone Joint Surg Am. 1999;81(7):958-65.
Hirsch JA, Singh V, Falco FJ, et al. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician. 2009;12(3):601-620.
Hussein M, Abdeldayem A, Mattar MM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J. 2014;23(9):1992-1999.
Lee DY, Lee SH. Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir. 2008;48(9):383-388; discussion 388-389.
Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015;15(6):1461-1477.
Li XC, Zhong CF, Deng GB, et al. Full-endoscopic procedures versus traditional discectomy surgery for discectomy: a systematic review and meta-analysis of current global clinical trials. Pain Physician. 2016;19(3):103-118.
Liu WG, Wu XT, Guo JH, et al. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol. 2010;33(4):780-6.
Liu WG, Wu XT, Min J, Guo JH, Zhuang SY, et al. Long-term outcomes of percutaneous lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Zhonghua Yi Xue Za Zhi. 2009;89(11):750-3.
Manchikanti L, Abdi S, Alturi S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16:S49-S283.
Manchikanti L, Singh V, Calodney AK et al. Percutaneous lumbar mechanical disc decompression utilizing Dekompressor(R): an update of current evidence. Pain Physician. 2013;16(2 Suppl):SE1-24.
Manchikanti L, Singh V, Falco FJ et al. An updated review of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. Pain Physician. 2013;16(2 Suppl):SE151-84.
Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993;78(2):216-225.
Menchetti PP, Canero G, Bini W. Percutaneous laser discectomy: experience and long term follow-up. Acta Neurochir Suppl. 2011;108:117-21.
National Institute for Health and Clinical Excellence. Automated percutaneous mechanical lumbar discectomy. November 2005. Available at: http://www.nice.org.uk/guidance/IPG141/chapter/1-Guidance. Accessed May 07, 2019.
National Institute for Health and Clinical Excellence. Percutaneous endoscopic laser lumbar discectomy. May 2009. Available at: https://www.nice.org.uk/guidance/IPG300/chapter/1-Guidance. Accessed May 07, 2019.
National Institute for Health and Care Excellence (NICE). Percutaneous transforaminal endoscopic lumbar discectomy for sciatica. 2016. Available at: https://www.nice.org.uk/guidance/ipg556. Accessed May 07, 2019.
National Institute for Health and Care Excellence (NICE). Percutaneous interlaminar endoscopic lumbar discectomy for sciatica. 2016. Available at: https://www.nice.org.uk/guidance/ipg555. Accessed May 07, 2019.
Nezer D, Hermoni D. Percutaneous discectomy and Intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence. Harefuah. 2007;146(10):747-50.
Phan K, Xu J, Schultz K, et al. Full-endoscopic versus micro-endoscopic and open discectomy: A systematic review and meta-analysis of outcomes and complications. Clin Neurol Neurosurg.2017;154:1-12.
Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al. Minimally invasive discectomy versus
microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;9:CD010328.
Revel M, Payan C, Vallee C, et al. Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. Spine. 1993;18(1):1-7.
Ruetten S, Komp M, Merk H, et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop. 2009;33(6):1677-1682.
Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine. 2008;33(9):940-948.
Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(9):931-939.
Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech. 2009;22(2):122-129.
Singh V, Benyamin RM, Datta S, et al. Systematic review of percutaneous lumbar mechanical disc decompression utilizing Dekompressor. Pain Physician. 2009;12(3):589-599.
Singh V, Manchikanti L, Benyamin RM, et al. Percutaneous lumbar laser disc decompression: a systematic review of current evidence. Pain Physician.2009;12(3):573-88.
Smith N, Masters J, Jensen C et al. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J. 2013; 22(11):2458-65.
Tassi GP. Comparison of results of 500 microdiscectomies and 500 percutaneous laser disc decompression procedures for lumbar disc herniation. Photomed Laser Surg. 2006;24(6):694-7.
Teli M, Lovi A, Brayda-Bruno M, et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J. 2010;19(3):443-450.
Tenenbaum S, Arzi H, Herman A, et al. Percutaneous posterolateral transforaminal endoscopic discectomy: clinical outcome, complications, and learning curve evaluation. Surg Technol Int. 2011;21:278-283.
Timmermann J, Hahn M, Krueger K. Short-term follow-up: micro-invasive therapy of the cervical herniated disk by percutaneous nucleotomy. J Back Musculoskelet Rehabil. 2011;24(2):89-93.
Tzaan WC. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech. 2011;24(7):421-31.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Endius Spine Endoscope. Premarket notification database. [FDA Web site]. 01/27/1999. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf/k982819.pdf. Accessed May 07, 2019.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Laurimed Percutaneous Discectomy System. 510(k) Summary. 08/28/2008. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf8/K082194.pdf. Accessed May 07, 2019.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Stryker Dekompressor TM Percutaneous Discectomy Probe. Premarket notification database. [FDA Web site]. 11/07/2003. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf3/k032473.pdf. Accessed May 07, 2019.
Vorobeychik Y, Gordin V, Fuzaylov D, et al. Percutaneous mechanical disc decompression using Dekompressor device: an appraisal of the current literature. Pain Med. 2012;13(5):640-646.
Wang B, Lu G, Patel AA, et al. An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J. 2011;11(2):122-130.
Wang H, Cheng J, Xiao H, Li C, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg. 2013;115(8):1415-9.
Wang M, Zhou Y, Wang J, et al. A 10-year follow-up study on long-term clinical outcomes of lumbar microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg. 2012;73(4):195-198.
THE FOLLOWING CODE IS USED TO REPRESENT NEEDLE-BASED TECHNIQUES IN AREAS OTHER THAN THE LUMBAR REGION
Policy: 11.14.29c:Spinal Discectomy
Policy: 12.01.01as:Experimental/Investigational Services