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Percutaneous disc decompression using coblation for lower back pain

Guidance issued Guidance issued
 
IP Guidance Number: IPG173
 
Summary:

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in Scotland and Wales on percutaneous disc decompression using coblation for lower back pain

Description:

Chronic back pain is a common condition. In most individuals, the pain resolves spontaneously within several months. However, for some people the pain persists, despite specific causes of back pain - such as herniated discs, osteoporosis and fractures - being excluded. Increasingly this pain is being attributed to degeneration of the intervertebral disc, and referred to as discogenic back pain.

Typically, first-line treatment for chronic discogenic back pain is conservative, consisting of pharmacotherapy and/or a multidisciplinary programme which may include exercises, education and behavioural therapy. If the pain does not improve, patients can choose whether to continue with conservative management or to undergo surgery (spinal fusion). Potential candidates for percutaneous disc decompression using coblation are those patients with back and leg pain caused by contained herniated discs.

Percutaneous disc decompression using coblation is usually performed on an outpatient basis under local anaesthesia and sedation. Under fluoroscopic guidance, a needle is inserted into the affected disc. A probe-like device is then introduced into the disc.  The device is heated up to 40-70°C, ablating the centre part of the disc and creating a channel. After stopping at a pre-determined depth, the probe is then withdrawn, coagulating the tissue as it is removed. Around six channels are created during the procedure, the number of channels depending on the desired amount of tissue reduction.

Arrangements:

Other (see guidance)

Topic Area:

Musculoskeletal

Specialty:

Trauma and orthopaedic surgery

Specialist advice has
been sought from:
Date notified to NICE: 11 December 2003
Guidance Publication Date: 24 May 2006
Contact Details:
Project Manager
(for general enquiries or comments)
Ben Doak
ip@nice.org.uk
Technical Lead
(for procedure specific enquiries or comments)
Sally Wortley
ip@nice.org.uk
Contact Address:

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA


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