DESCRIPTION
Laser energy (laser discectomy) and radiofrequency coblation (nucleoplasty) are being evaluated for decompression of the intervertebral disc. For laser discectomy under fluoroscopic guidance, a needle or catheter is inserted into the disc nucleus, and a laser beam is directed through it to vaporize tissue. A variety of different lasers have been investigated for laser disc decompression, including YAG, KTP, holmium, argon, and carbon dioxide lasers. Due to differences in absorption, the energy requirements and the rate of application differ among the lasers. In addition, it is unknown how much disc material must be removed to achieve decompression.
Radiofrequency ablation uses bipolar low-frequency energy in an electrical conductive fluid (e.g., saline) to generate a high-density plasma field around the energy source. This creates a low-temperature field of ionizing particles that break organic bonds within the target tissue. The disc nucleoplasty procedure is accomplished with a probe mounted with a radiofrequency coblation source. The proposed advantage of coblation is that the procedure provides for controlled and highly localized ablation resulting in minimal damage to surrounding tissue.
POLICY
Disc decompression and treatment of associated low back pain using localized, radiofrequency energy (disc nucleoplasty) or laser energy are considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
The available evidence is insufficient to draw conclusions regarding the efficacy of disc decompression using laser energy or radiofrequency coblation (nucleoplasty). Additional randomized controlled trials are needed to further evaluate this technology.
SOURCES
Abrishamkar, S., Kouchakzadeh, M., Mirhosseini, A., Tabesh, H., Rezvani, M., Moayednia, A., et al. (2015). Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation. Journal of Research in Medical Sciences, 20 (12), 1133-1137. (Level 2 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (5:2023). Decompression of the intervertebral disc using laser energy (laser discectomy) or radiofrequency coblation (nucleoplasty) (7.01.93). Retrieved December 11, 2023 from www.bcbsaoca.com/eps/. (19 articles and/or guidelines reviewed)
Brouwer, P. A., Brand, R., van den Akker-van Marle, M. E., Jacobs, W. C., Schenk, B., van den Berg-Huijsmans, A. A., et al. (2017). Percutaneous laser disc decompression versus conventional microdiscectomy for patients with sciatica: Two-year results of a randomised controlled trial. Interventional Neuroradiology: Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences, 23 (3), 313–324, doi: 10.1177/1591019917699981. (Level 2 evidence)
Centers for Medicare & Medicaid Services. CMS.gov. NCD for thermal intradiscal procedures (TIPs) (150.11). Retrieved September 17, 2015 from http://www.cms.gov.
Chitagran, R., Poopitaya, S., & Tassanawipas, W. (2012). Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial. Journal of the Medical Association of Thailand, Suppl 10, S198-S205. Abstract retrieved July 20, 2016 from PubMed database.
de Rooij, J., Harhangi, B., Aukes, H., Groeneweg, G., Stronks, D., & Huygen, F. (2020). The effect of percutaneous nucleoplasty vs anterior discectomy in patients with cervical radicular pain due to a single-level contained soft-disc herniation: A randomized controlled trial. Pain Physician, 23 (6), 553-564. (Level 2 evidence)
Eichen, P., Achilles, N., König, V., Mösges, R., Hellmich, M., Himpe, B., et al. (2014). Nucleoplasty, a minimally invasive procedure for disc decompression: A systematic review and meta-analysis of published clinical studies. Pain Physician, 2014 (17), E149-E173. (Level 4 evidence)
Manchikanti, L., Abdi, S., Atluri, S., Benyamin, R., Boswell, M., Buenaventura, R., et al. (2013). An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician, 16 (2 Suppl), S49-S283.
Manchikanti, l., Falco, F., Benyamin, R., Caraway, D., Deer, T., Singh, V., et al. (2013). An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty. Pain Physician, 16, SE25-SE54. (Level 1 evidence)
National Institute for Health and Care Excellence (NICE). (2016, January). Clinical guidance: Percutaneous coblation of the intervertebral disc for low back pain and sciatica. Retrieved July 20, 2016 from www.nice.org.uk.
Nie, H.Y., Qi, Y.B., Li, N., Wang, S.L., & Cao, Y.X. (2018). Comprehensive comparison of therapeutic efficacy of radiofrequency target disc decompression and nucleoplasty for lumbar disc herniation: a five year follow-up. International Orthopaedics, 42 (4), 843-849. Abstract retrieved February 13, 2019 from PubMed database.
Singh, V., Manchikanti, L., Calodney, A., Staats, P., Falco, F., Caraway, D., et al. (2013). Percutaneous lumbar laser disc decompression: an update of current evidence. Pain Physician, 2013, 16, SE229-SE260. (Level 1 evidence)
U. S. Food and Drug Administration. (2000, February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K000044. Retrieved January 21, 2011 from http://www.accessdata.fda.gov.
U. S. Food and Drug Administration. (2007, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070466. Retrieved January 21, 2011 from http://www.accessdata.fda.gov.
U. S. Food and Drug Administration. (2009, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K091909. Retrieved January 21, 2011 from http://www.accessdata.fda.gov.
Winifred S. Hayes, Inc. Medical Technology Directory. (2018, March; last update search March 2022). Percutaneous laser disc decompression for lumbar disc herniation. Retrieved November 23, 2022 from rlwww.Hayesinc.com/subscribers. (36 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 6/1/2004
MOST RECENT REVIEW DATE: 1/11/2024
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