Guidance
The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of an annular disc implant at lumbar discectomy, in November 2014.
March 2022: The device used in this procedure no longer has a current CE mark. The CE mark is necessary for medical devices to be marketed in the European Union. A non CE marked device can only be used in the context of clinical investigations with MHRA and research ethical approval.
Description
Lumbar disc herniation occurs when the nucleus pulposus of an intervertebral disc protrudes through a tear in the surrounding annulus fibrosus. Symptoms include pain in the back or leg, and numbness or weakness in the leg. Serious neurological sequelae may sometimes occur.
Conservative treatments include analgesics, non-steroidal anti-inflammatory medication and physical therapy. Epidural corticosteroid injections can also be used to reduce nerve pain in the short term. Lumbar discectomy is considered if there is evidence of severe nerve compression or persistent symptoms that are unresponsive to conservative treatment. Surgical techniques include open discectomy or minimally invasive alternatives using percutaneous approaches.
Lumbar discectomy usually leaves a hole in the annulus fibrosus through which the nucleus herniated, which may lead to reherniation and progressive loss in disc height.
Coding recommendations
V33.8 Other specified primary excision of lumbar intervertebral disc
V55.- Levels of spine
Y36.8 Other specified introduction of non-removable material into organ NOC
Note: 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.