Physician Reference Manual

Size: px
Start display at page:

Download "Physician Reference Manual"

Transcription

1 Nucleotome Physician Reference Manual Automated Percutaneous Lumbar Discectomy , Page 1

2 Nucleotome Automated Percutaneous Lumbar Discectomy (APLD) Table of Contents Section 1 I. Description of Nucleotome System.. 3 II. U.S Food and Drug Administration Status 5 III. Indications and Contraindications for Nucleotome 6 IV. Patient Outcomes.. 8 V. Safety. 9 VI. APLD as Compared to Alternative Forms of Treatment.. 10 VII. Cost Benefits. 12 Reference List 13 Section 2 Clinical Study Summaries (Full articles are on file with Clarus Medical and are available upon request) , Page 2

3 I. Description of Nucleotome System 1. Basic Description of Procedure Nucleotome is a tradename for Automated Percutaneous Lumbar Discectomy (APLD). APLD is a minimally invasive method for treating patients contained disc herniations. The Nucleotome utilizes a mechanical suction and cutting system to decompress nucleus pulposus. 2. Nucleotome Kit Components A Nucleotome Probe Set may contain the following components and accessories required for APLD. NucleotomeProbe - Instrument used to aspirate and shave nucleus pulposus. A seal nut with O ring is included on the probe needle, which is used to lock into the cannula when the probe is activated and to provide an airtight seal. Marking Pen - Used to mark entry point into the body. Measuring Scale - Used to assist in marking the correct entry point. Scalpel - May be used to incise the skin to facilitate easy passage of components , Page 3

4 Guide Needle - Used for initial access inside the disc and ensure correct path of instruments. Cannula/Dilator - Passed over Guide Needle to create a working channel. Curved Cannula/Dilator Used in certain anatomy Trephine - Used to incise the annulus. 3. How Nucleotome Probe Works Once access is gained to the nucleus of the disc, the Nucleotome probe is inserted through the working channel cannula. The Nucleotome probe tip has a rounded tip with a side port near the distal end. Saline is pneumatically driven through the probe by the Nucleotome Console, which creates a vacuum effect and sucks nuclear material through the side port. As nuclear material is suspended in saline, a reciprocating inner cannula shaves the nucleus at a rate of up to 180 cuts per minute. Nucleus is suctioned through tubing attached to the Nucleotome handle and collected in a filter within an aspiration canister , Page 4

5 II. U.S. Food and Drug Administration (FDA) Status All Nucleotome products have received FDA clearance. The following is applicable for the models currently being marketed. 510(k) Device Name Decision Date K Nucleotome 11/29/84 K Nucleotome 3.5 mm Automated Percutaneous Discectomy 2/9/ , Page 5

6 III. Indications and Contraindications for Nucleotome In order to increase APLD s success rate in patients, it is recommended that the physician follow the strict indications. APLD is advised for patients with relatively small contained herniations, only after conservative treatment has failed. Chances of success significantly decrease in patients with larger extruded, or fragmented herniations. Following are patient indications and contraindications as listed on Nucleotome s Directions for Use: Indications Unilateral leg pain greater than back pain. Paresthetic discomfort in a specific dermatomal distribution. Positive straight leg raising test and/or positive bowstring sign. Patient demonstrates possible neurologic findings (wasting, weakness, sensory alteration, and reflex alteration). Patient shows no improvement after at least six weeks of conservative therapy. A positive CT or MRI that shows a subligamentous herniation at the location; consistent with clinical finding. Contraindications Radiologic evidence of a diffuse annular bulge extending out from the entire circumference of the vertebral body. Radiologic evidence of severe lateral recess stenosis, calcified disc herniations, severe degenerative facet disease and ligmentum flavum hypertrophy. Radiologic evidence of free or extruded disc fragments within the spinal canal. Clinical evidence of significant progressive neurologic deficits and/or cauda equina syndrome. The existence of other pathologies or conditions, such as fracture, tumor, pregnancy or active infection that would put patient at risk. Up to 80% of the population may complain of at least one episode of low back pain during their active life 15. Of these patients, APLD should only be considered for a very small minority, for which the indications are narrowly defined. In 1989, Mooney 1 described patient selection in a study that reported a 75% success rate; Selection of the proper patient for this procedure must be based on the demonstration of a structural abnormality creating nerve root irritation that is potentially reversible by decompression of nuclear material. Thus, if extruded nuclear material can be demonstrated, or if skeletal elements or ligamentum flavum is considered the source of nerve root irritation, decompression of the nucleus internally will be of no benefit. The starting point, therefore, must be based on a clinical evaluation. If the irritated nerve root is the source of the pain, leg pain must be expected as a part of the complaint. Ideally the leg pain is unilateral and more severe than back pain. Central disc herniations can occur, and in these situations , Page 6

7 bilateral leg pain or even back pain alone may be the clinical presentation. CT discography is the only sure way to differentiate symptomatic central herniation from an annular bulge. Ideally the pain should be intermittent and relievable by some posture or change of position. This suggests that nuclear flow is available Numerous published studies with results consistent with Dr. Mooney s adhere to proper selection criteria. 1,2,3,4,5,7 Conversely, in 1993, Revel et al. 16 published results of a study comparing APLD versus Chemonucleolysis. Of the 141 patients, 69 were treated with APLD. The rate of success was significantly lower (43%) than most studies. In this study, important labeling instructions were disregarded: The requirement of the contained, non-extruded disc for inclusion is not specified in the study protocol: At discography, 39% of the tested discs showed epidural leakage. The protocol allowed migration up to 5 mm beyond the disc space and the publication lists 71% of APLD patients in this category. However, the earlier patient data gave an incidence of 29% pf patients with migration of 5 to 10 mm, an apparent violation of the protocol. A concern that some of these cases had large extrusions of free fragments is further reinforced by the following incidences: - 8% of patients with bilateral leg pain; - 14% with large volume herniations; and - the inclusion of patients with a positive crossed straight leg raising test. The protocol or the publication does not specify the exclusion of discs with diffuse annular bulging for which APLD is not effective and is therefore contraindicated: - 16% incidence at discography of severely degenerated discs, and - 9% with marked disc space narrowing; tow cases are described as technical failures after it was impossible to introduce the probe into the disc space. There was no requirement that leg pain is greater than back pain for inclusion, although the publication insists that only sciatica patients were included in the study: - 21% of patients had severe back pain, but no correlation to leg pain was made. In summary, the reason for lower success rate of patients treated with APLD in the Revel study is improper patient selection. The significant percentages of selection factors listed above, singly or in combination, indicate that patients were included in this study that had extruded herniations, free fragments, or severely degenerated and bulging discs. An unfavorable rate of successful outcome after APLD is expected in patients with disc pathologies which are known to respond only marginally to this treatment, or for which treatment is even contraindicated , Page 7

8 IV. Patient Outcomes There have been a large number of high quality studies completed to document the success of Nucleotome. The results are consistent in the vast majority of the studies. Nucleotome has proven to be successful in approximately 75% of cases with properly selected patients. The risk factors for these patients were extremely low. (Please see chart below for reference). In addition, APLD is almost always performed on an outpatient basis, which allows the patient to return to a normal lifestyle more quickly with minimal postoperative pain. Article Study Number* 1 Mooney V., Percutaneous Discectomy, Spine: State of the Art Review, Jan 1989: Vol. 3, No. 1: Onik, G., Mooney, V., Maroon J., et al: Automated Percutaneous Discectomy: A Prospective Multi-Institutional Study, Neurosurgery 1990: Vol. 26, No. 2: Davis G., Onik G., Helms C., Automated Percutaneous Discectomy, Spine 1991: Vol. 16, No. 13: Gill K., Blumenthal S., Clinical Experience with Automated Percutaneous Discectomy: The Nucleotome System, Orthopedics 1991: 14: Teng, et al.: Automated Percutaneous Lumbar Discectomy: A Prospective Multi-institutional Study, Journal of Vascular Interventional Radiology, Vol. 8, No. 3: Patient Number Complicaton Rate Success Rate % % 75% % 85% % % 83% , Page 8

9 V. Safety Over 200,000 APLD procedures have been performed worldwide. In more than 50 published series, there has been no reported mortality or major nerve injury during a Nucleotome procedure. 8 Complication rates are consistently below 1%, 1,2,3,4,5,6,7 with the majority of the complications being relatively minor. The primary reasons for the positive safety record of Nucleotome include its design and technique. 1. Design Features The design of the Nucleotome probe has important safety advantages. The rounded tip of the probe nearly eliminates the risk of inadvertently advancing the probe through the opposite annulus once the probe is inserted into the disc. Thus, avoiding serious injury to major vessels and other abdominal structures. Another important safety feature is that material must be suctioned into the side port before being shaved by the internal cutting blade. Because of this design, the Nucleotome probe will not cut annulus or endplates. 2. Safe Technique APLD is performed under local anesthesia. This is important because it allows the physician to maintain constant communication with the patient, which minimizes risk of nerve injury. The use of general anesthesia is not advised. Furthermore, the physician works through a cannula that is less than 4 mm (which is the largest size) to limit morbidity of spinal pathologies , Page 9

10 VI. APLD as Compared to Alternative Forms of Treatment 1. Open Discectomy APLD is safer than open discectomy. In a study of 481 open discectomy procedures, Stolke et al. 11 reported a 13% complication rate, 1 death and 3 nerve injuries. Another study of open discectomy by Ramirez et al. 13 analyzed 28,395 patients and reported major complication in 1 in 64 patients, a serious neurologic complication in approximately 1 in 336 and death in 1 in APLD is minimally invasive, whereas open discectomy requires the dissection of tissue areas to gain access to disc space. Working percutaneously through a small cannula allows the physician to spare as much tissue as possible, thereby reducing the chance of creating spinal instability. In APLD it is not necessary to remove spinal elements to gain access to the disc space. APLD also avoids the epidural space, minimizing the risk of epidural fibrosis. Open procedures frequently disrupt the epidural space. APLD is more effective for properly selected patients. A recent study by Carragee, et al. 10 analyzed results of open discectomy by comparing 4 types of herniations. Results are as follows: Herniation Type Recurrence of Persistent Sciatica Reherniation Reoperation Oswestry Score Fragment-Defect 27.3% 27.3% 21.2% Fragment-Fissure 1.1% 1.1% 1.1% Fragment-Contained 11.9% 9.5% 4.8% No Fragment-Contained 37.5% 12.5% 6.3% Stanford Score The study by Carragee et al. clearly demonstrates that patients in the No Fragment-Contained herniation group are poor candidates for conventional open discectomy. These are exactly the patients that are excellent candidates for APLD , Page 10

11 2. Microdiscectomy APLD is also safer than microdiscectomy. Pappas et al. 9 reported a 10.8% complication rate, 1 death and 1 major bowel injury in 654 microdiscectomies. APLD utilizes the Nucleotome Probe as the primary instrument used for decompression. This limits the amount of times that the surgeon needs to enter the disc space for removal of nucleus pulposus, whereas microdiscectomy uses manual instruments that may need to reenter the disc several times. This may attribute to higher complication rates in microdiscectomy compared to APLD. Microdiscectomy is more invasive. Typically outer diameter of the cannula will be more than 5mm as compared to the 3-4mm diameter cannula used for APLD. There is evidence to show that microdiscectomy may lead to spinal instability 13. For patients that exhibit indications defined previously, APLD should be considered after conservative treatment and before more invasive treatments, such as open discectomy and microdiscectomy. APLD has proven effective and spares more healthy tissue than these alternative methods. Furthermore, APLD does not put the patient at undue risk and/or on track for potentially worsening pathologies , Page 11

12 VII. Cost Benefits APLD is much more cost effective than alternative treatments mentioned. APLD is done on an outpatient basis, under local anesthesia, making it cost effective. In a study by Maroon 17 of 1054 patients, operating time averaged 1.1 hours. Average post operative time was 6.5 hours, with 78% of the patients being released on the same day. A study by Kambin et al. 18 of microdiscectomy patients demonstrated an average hospital stay of 2.4 days. Many APLD patients are sent home with just a bandage or a single suture which limits costs. It has been demonstrated that 70% of patients are able to return to work within 2 weeks of an APLD procedure. 3,4 Davis et al., 7 compared a group of patients that underwent APLD versus open laminectomies and microdiscectomies and found that only 1 in 66 patients were able to return to work within 2 weeks following a laminectomy or microdiscectomy. The average hospital charge for APLD is less than half of the cost when compared to microdiscectomy and laminectomy , Page 12

13 References Reference Study Number 1 Mooney V., Percutaneous Discectomy, Spine: State of the Art Review, Jan 1989: Vol. 3, No. 1: Onik, G., Mooney, V., Maroon J., et al: Automated Percutaneous Discectomy: A Prospective Multi-Institutional Study, Neurosurgery 1990: Vol. 26, No. 2: Davis G., Onik G., Helms C., Automated Percutaneous Discectomy, Spine 1991: Vol. 16, No. 13: Gill K., Blumenthal S., Clinical Experience with Automated Percutaneous Discectomy: The Nucleotome System, Orthopedics 1991: 14: Teng, et al.: Automated Percutaneous Lumbar Discectomy: A Prospective Multi-institutional Study, Journal of Vascular Interventional Radiology, Vol. 8, No. 3: Bonaldi, G., Automated Percutaneous Lumbar Discectomy: technique, indications and clinical follow-up in over 1000 patients, Neuroradiology, 2003, 45: Davis G., Onik G., Clinical Experience with Automated Percutaneous Lumbar Discectomy, Clinical Orthopaedics and Related Research, 1989: Jan., No. 238: Onik: Percutaneous Diskectomy in the Treatment of Herniated Lumbar Disks, Spine Interventions, Pappas, et al., Outcome Analysis in 654 Surgically Treated Lumbar Disc Herniations. Neurosurgery, 30: , Carragee, et al., Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Annular Competence, The journal of Bone & Joint Surgery, Vol. 85-A, No. 1: , Stolke, et al., Intraoperative and postoperative complications associated with lumbar spine surgery, Spine, 14: 56-58, Hurme, Alaranta, Factors Predicting the Result of Surgery for Lumbar Intervertebral Disc Herniation, Spine, Vol. 12, No 9: , Kotilainen, et al., Acta Neurochir, Wien, Vol. 10: , Ramirez, et al., Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals, Neurosurgery, 25: , Bonaldi, et al., Percutaneous Discectomy using Onik s Method: 3 Years Experience, Neuroradiology: , Revel et al., Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica: A randomized multicenter trial. Spine. 14: 1-7, Maroon, J., A Retrospective Study of 1054 APLD Cases: A Twenty month follow-up at Thirty- Five U.S. Centers, Paper Thirty-seven, International Percutaneous Mtng., 1989 Spain 18 Kambin et al., Percutaneous lateral discectomy of the lumbar spine: A preliminary report, Clin. Orthop. 174: 127, , Page 13

14 Nucleotome Automated Percutaneous Lumbar Discectomy Clinical Study Summaries ARTICLE (A) Onik, G. Summation of APLD Clinical Experience, Paper Thirty eight, Presented at the International Percutaneous Mtng., 1989, Spain TYPE OF PAPER Retrospective Study: 10 Countries TIME FRAME November 1984 to May SUCCESS RATE 77% There were not deaths, major vascular or nerve damage reported. The average amount of Nucleus Resected = 3.2 grams. ARTICLE (B) Mooney V., Percutaneous Discectomy, Spine: State of the Art Review, Jan 1989: Vol. 3, No. 1: TYPE OF PAPER Retrospective Study TIME FRAME Not Given 64 SUCCESS RATE 75% Definition of success: 1. moderate to complete pain relief 2. not receiving narcotic medication 3. a return to pre-injury 4. patient had to be satisfied No complications reported , Page 14

15 ARTICLE (C) Morris, J., Percutaneous Discectomy, Orthopedics: October 1988, Vol. 11, No. 10: TYPE OF PAPER The author reported on the Multi-Institutional Study conducted from November 1984 to June 1987 TIME FRAME November 1984 to June SUCCESS RATE 73.5% Definition of success: 1. no further intervention needed 2. radicular pain moderately/totally improved 3. post-operative function was improved 4. no need for narcotic analgesics 5. both patient and surgeon satisfied No epidural scarring, allergic reaction, or serious neurologic complications ARTICLE (D) Onik, G., Mooney, V., Maroon J., et al: Automated Percutaneous Discectomy: A Prospective Multi-Institutional Study, Neurosurgery 1990: Vol. 26, No. 2: TYPE OF PAPER Prospective, Multi-institutional Study TIME FRAME November 1984 to May SUCCESS RATE 75.2% Definition of success: 1. radicular pain was moderately to totally improved 2. no longer receiving narcotic analgesics 3. improved functional status 4. patient satisfaction Only one complication reported which was a case of discitis and was successfully treated with antibiotics. 18 Surgeons participated Average hospital stay 0.3 days , Page 15

16 ARTICLE (E) Davis G., Onik G., Helms C., Automated Percutaneous Discectomy, Spine 1991: Vol. 16, No. 13: TYPE OF PAPER Prospective Study TIME FRAME Follow-up of 2 years 518 SUCCESS RATE 85% No complications reported. 427 non-compensation patients: 371 (87%) were successful 56 (13%) were failures 91 compensation patients: 68 (74%) were successful 23 (26%) were failures Of the failures: 23 patients had extruded disc fragments 5 patients had stenosis 41 patients had no anatomic explanation and refused further surgery 70% were able to return to work within 2 weeks. Most procedures done on outpatient basis, making overall cost significantly less than microdiscectomy ARTICLE (F) Maroon, J., A Retrospective Study of 1054 APLD Cases: A Twenty month follow-up at Thirty-Five U.S. Centers, Paper Thirtyseven, International Percutaneous Mtng., 1989 Spain TYPE OF PAPER Retrospective, Multi-institutional Study TIME FRAME January 1987 to February SUCCESS RATE 82.9% Only 3 complications (.002%) were reported. 35 U.S. surgeons participated in the study. Average of 7.4 weeks conservative treatment was attempted prior to surgery. Primary cause of failure was the presence of free fragments. Average amount of nucleus material removed was 2.4 grams, with the lowest being 1.0 and the highest % of patients were released the same day, which averaged 6.5 hours of post-operative hospital stay , Page 16

17 ARTICLE (G) Hammon, W., Percutaneous Lumbar Discectomy, Western Neurosurgical Society, April 1989 TYPE OF PAPER Retrospective Study TIME FRAME 50 Not mentioned SUCCESS RATE 79% Definition of success: 1. return to pre-injury status 2. return to normal activities 3. return to work No complications were reported ARTICLE (H) Gill K., Blumenthal S., Clinical Experience with Automated Percutaneous Discectomy: The Nucleotome System, Orthopedics 1991: 14: TYPE OF PAPER Retrospective Study TIME FRAME Follow-up of 2.2 to 4.5 years 62 SUCCESS RATE 79% No complications were reported Definition for success: 1. moderate to complete pain relief 2. not receiving narcotic medication 3. a return to pre-injury functions 93% of private paying patients were successful 65% compensation patients were successful. 70% of patients were able to return to work within 2 weeks , Page 17

18 ARTICLE (I) Swieckicki, M., Results of Automated Percutaneous Lumbar Discectomy Compared to Laminotomy and Chemonucleolysis, Paper 22, Presented at the International Percutaneous Meeting, 1989 TYPE OF PAPER Retrospective Study TIME FRAME Follow-up from 8 to 20 months 300 (100 in each sub-group) SUCCESS RATE 86% No complications reported using APLD Definition for success: 1. return to pre-injury status 2. return to work 86% of APLD patients returned to work as compared to 79% for laminotomy and 58% for chemonucleolysis Post-operative unemployment 2.3 months overall and APLD was the shortest with a 1.1 month average APLD patients had the lowest average for length of hospital stay ARTICLE (J) Davis G., Onik G., Clinical Experience with Automated Percutaneous Lumbar Discectomy, Clinical Orthopaedics and Related Research, 1989: Jan., No. 238: TYPE OF PAPER Prospective TIME FRAME Follow-up of 6 months 200 SUCCESS RATE 77.5% Definition of success: 1. moderate to complete relief 2. not receiving narcotic medication 3. a return to pre-injury functions 4. satisfaction with the results No complications reported 70% patients able to return to work within 2 weeks Patients returned to work sooner after percutaneous discectomy than after microdiscectomy or laminectomy. APLD averaged less than half the cost of microdiscectomy or laminectomy , Page 18

19 ARTICLE (K) TYPE OF PAPER TIME FRAME SUCCESS RATE Onik, Kambin, Chang: Controversy, Minimally Invasive Disc Surgery, Nucleotome Versus Fragmentectomy: Spine, 1997 Clinical Debate N/A N/A N/A No reported mortality in over 125,000 APLD procedures Cited long term study of 222 APLD patients observed for at least 4 years resulted in 74% success rate based on patient satisfaction and avoidance of further surgery. A failed central disc decompression would not preclude a successful open operation. Able to avoid the epidural space to minimize risk of epidural scarring ARTICLE (L) TYPE OF PAPER TIME FRAME SUCCESS RATE Bonaldi, Belloni, Prosetti, Moshini: Percutaneous Discectomy using Onik s Method: 3 Years Experience, Neuroradiology, 1991 Retrospective 3 years, with follow up between 11 months and 3 years 4 months % overall 75.8% success in patients meeting protocol criteria. 72.8% success in patients not meeting protocol criteria. 85.7% success in patients presenting with back pain only. Only 1 complication reported (0.26%) was disc infection, which cleared without clinical or radiologic sequelae. Good results obtained from older patients and patients who had previously undergone traditional surgery , Page 19

20 ARTICLE (M) TYPE OF PAPER TIME FRAME SUCCESS RATE Gill, Blumenthal: Automated Percutaneous Discectomy, Long-term clinical experience with the Nucleotome System, Acta Orthop Scand, 1993 Retrospective 1.3 to 5 year follow-up % overall 85% success rate in private pay patients. 70% success rate in work comp patients. 70% of patients were able to return to work within 2 weeks. Workers compensation patients average 4-6 weeks, while private pay average 3-4 days). No neurologic injuries or major vessel injuries occurred. Of the 23 failures, 13 underwent posterior lumbar interbody fusion. The remaining 10 patients underwent microdiscectomy, where free fragments were found. Procedure has the lowest morbidity rate of all treatment options in the care of patients with herniated lumbar discs. ARTICLE (N) TYPE OF PAPER TIME FRAME SUCCESS RATE Onik: Percutaneous Diskectomy in the Treatment of Herniated Lumbar Disks, Spine Interventions, 2000 Clinical Review N/A N/A N/A More than 140,000 procedures performed without a reported mortality. No reports of major nerve injury or great vessel damage in more than 50 published series. Diskitis rate of 0.2%, which is equivalent to discography. Safest treatment for herniated lumbar disks, in contrast to open diskectomy or microdiskectomy , Page 20

21 ARTICLE (O) TYPE OF PAPER TIME FRAME SUCCESS RATE Teng, et al.: Automated Percutaneous Lumbar Discectomy: A Prospective Multi-institutional Study, Journal of Vascular Interventional Radiology, Vol. 8, No. 3: Prospective, Multi-institutional 18.3 month mean follow-up % overall at 1 year 0.06 rate of discitis (which was only type of complication) 86% success in patients with protrusion vs. 72% with sequestration 89% success in patients with back pain alone vs. 80% with back and leg pain 85% success in patients with symptoms < 2 yrs vs. 79% with symptoms > 2 yrs 84% success in patients < 60 years of age vs. 76% in patients older than 60 76% success in post-surgical patients ARTICLE (P) Bonaldi, G., Automated Percutaneous Lumbar Discectomy: techniqu indications and clinical follow-up in over 1000 patien Neuroradiology, 2003, 45: TYPE OF PAPER Retrospective TIME FRAME 14 years of experience, with follow-up of at least 6 months in 1047 patients 1047 SUCCESS RATE 67.5% overall Age range Complication rate less than 1% 79.5% success in patients aged 70 or more 78% success in patients who had previously undergone open disc surgery at the same level and had recurrent disc protrusion after 6 months or more 2 cases of discitis (0.17%) 0.95% complication rate , Page 21

22 ARTICLE (Q) TYPE OF PAPER TIME FRAME SUCCESS RATE Castro, HM., et al; Restriction of Indication for Automated Percutaneous Lumbar Discectomy Based on Computed Tomographic Discography, Spine, 17, , 1992 Prospective 14 Months with 3-7 month follow-up 97 53% in first 67 patients 80% in second 30 patients with revised criteria No complications The shape of the dye distribution inside the protruded disc visualized by CT discography is important Patients who had a disc protrusion with a narrow dye base had a worse outcome. Patients who show a broad dye based protrusion on CT discography had much better outcomes Of the first 67 patients, 25/31 failures had a narrow dye based protrusion Of the second group of 30 patients that had revised indications, which included adding criteria for broad dye base protrusions. There was no indication if those among the 20% failures were narrow or broad based dye protrusions. ARTICLE (R) Carragee, et al., Clinical Outcomes After Lumbar Discectomy for Sciatica: The Effects of Fragment Type and Annular Competence, The journal of Bone & Joint Surgery, Vol. 85- A, No. 1: , 2003 APLD is more effective for properly selected patients. A recent study by Carragee, et al. analyzed results of open discectomy by comparing 4 types of herniations. Results are as follows: Herniation Type Recurrence of Persistent Sciatica Reherniation Reoperation Oswestry Score Fragment-Defect 27.3% 27.3% 21.2% Fragment-Fissure 1.1% 1.1% 1.1% Fragment-Contained 11.9% 9.5% 4.8% No Fragment-Contained 37.5% 12.5% 6.3% Stanford Score The study by Carragee et al. clearly demonstrates that patients in the No Fragment-Contained herniation group are poor candidates for conventional open discectomy. These are exactly the patients that are excellent candidates for APLD , Page 22

Lumbar Disc Prolapse. Dr. Ahmed Salah Eldin Hassan. Professor of Neurosurgery & Consultant spinal surgeon

Lumbar Disc Prolapse. Dr. Ahmed Salah Eldin Hassan. Professor of Neurosurgery & Consultant spinal surgeon Lumbar Disc Prolapse By Dr. Ahmed Salah Eldin Hassan Professor of Neurosurgery & Consultant spinal surgeon 1-What are the Functions of the Spine Structural support for upright posture Protection of Spinal

More information

LASE Efficacy and Safety More Effective Less Costly

LASE Efficacy and Safety More Effective Less Costly LASE Efficacy and Safety More Effective Less Costly Table of Contents Overview: A Product and a Technique for Percutaneous Lumbar Discectomy of Contained Herniations Discussion: A Product and a Technique

More information

Erginousakis D et al. Radiology 2011;260:

Erginousakis D et al. Radiology 2011;260: Comparative Prospective Randomized Study Comparing Conservative Treatment and Percutaneous Disk Decompression for Treatment of Intervertebral Disk Herniation Erginousakis D et al. Radiology 2011;260:487-493

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Image-Guided Minimally Invasive Decompression (IG-MLD) for File Name: Origination: Last CAP Review: Next CAP Review: Last Review: image-guided_minimally_invasive_decompression_for_spinal_stenosis

More information

Degenerative Disease of the Spine

Degenerative Disease of the Spine Degenerative Disease of the Spine Introduction: I. Anatomy Talk Overview II. Overview of Disease Processes: A. Spondylosis B. Intervertebral Disc Disease III. Diagnosis IV. Therapy Introduction: Myelopathy

More information

ProDisc-L Total Disc Replacement. IDE Clinical Study.

ProDisc-L Total Disc Replacement. IDE Clinical Study. ProDisc-L Total Disc Replacement. IDE Clinical Study. A multi-center, prospective, randomized clinical trial. Instruments and implants approved by the AO Foundation Table of Contents Indications, Contraindications

More information

ProDisc-L Total Disc Replacement. IDE Clinical Study

ProDisc-L Total Disc Replacement. IDE Clinical Study Total Disc Replacement IDE Clinical Study Study Design TDR vs. circumferential fusion: Multi-center, prospective, randomized trial 17 centers, 292 patients 162 patients 80 fusion patients 50 non-randomized

More information

LUMBAR SPINAL STENOSIS

LUMBAR SPINAL STENOSIS LUMBAR SPINAL STENOSIS Always occurs in the mobile segment. Factors play role in Stenosis Pre existing congenital or developmental narrowing of the lumbar spinal canal Translation of one anatomic segment

More information

paracentral disc herniations, especially disc extrusions and disc sequestrations, remains challenging.

paracentral disc herniations, especially disc extrusions and disc sequestrations, remains challenging. Orthopaedic Surgery SURGICAL TECHNOLOGY INTERNATIONAL XIX Transforaminal Endoscopic Lumbar Procedure for Disc Herniations: A "Between" Technique KAI-XUAN LIU, M.D, PH.D. ATLANTIC SPINAL CARE EDISON, NEW

More information

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of automated percutaneous mechanical lumbar discectomy Introduction This overview has been

More information

REFERENCE DOCTOR Percutaneous Endoscopic Discectomy Transforaminal / Interlaminar. Hyeun Sung Kim, MD, PhD,

REFERENCE DOCTOR Percutaneous Endoscopic Discectomy Transforaminal / Interlaminar. Hyeun Sung Kim, MD, PhD, Percutaneous Endoscopic Discectomy Transforaminal / Interlaminar Medical College of Chosun University, Gwangju, South Korea (1994) / Board of Neurosurgery (1999) MEMBERSHIPS & PROFESSIONAL SOCIETIES Korean

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous coblation of the intervertebral disc for low back pain and sciatica

More information

NUCLEOPLASTY PERCUTANEOUS DISC DECOMPRESSION

NUCLEOPLASTY PERCUTANEOUS DISC DECOMPRESSION NUCLEOPLASTY PERCUTANEOUS DISC DECOMPRESSION ISSUE Blue Shield has received requests for coverage of nucleoplasty percutaneous disc decompression for herniated discs. The Medical Policy Committee on Quality

More information

Corporate Medical Policy Automated Percutaneous and Endoscopic Discectomy

Corporate Medical Policy Automated Percutaneous and Endoscopic Discectomy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: percutaneous_discectomy 9/1991 5/2017 5/2018 5/2017 Description of Procedure or Service Surgical management

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Epidural Steroid Injections for Back Pain File Name: Origination: Last CAP Review: Next CAP Review: Last Review: epidural_steroid_injections_for_back_pain 2/2016 4/2017 4/2018

More information

Recurrent Lumbar Disk Herniation With or Without Posterolateral Fusion. Ahmed Zaater, MD, Alaa Azzazi, MD, Sameh Sakr, MD, and Ahmed Elsayed, MD

Recurrent Lumbar Disk Herniation With or Without Posterolateral Fusion. Ahmed Zaater, MD, Alaa Azzazi, MD, Sameh Sakr, MD, and Ahmed Elsayed, MD ORIGINAL ARTICLE Recurrent Lumbar Disk Herniation With or Without Posterolateral Fusion Ahmed Zaater, MD, Alaa Azzazi, MD, Sameh Sakr, MD, and Ahmed Elsayed, MD Study Design: A prospective study assessing

More information

Lumbar disc herniation

Lumbar disc herniation Lumbar disc herniation Thomas Kishen Spine Surgeon Sparsh Hospital for Advanced Surgeries Bangalore Symptoms and Signs Radicular Pain in the distribution of the involved nerve Neurological deficit motor,

More information

Original Contribution

Original Contribution Original Contribution Pain Physician, Volume 5, Number 2, pp 121-126 2002, American Society of Interventional Pain Physicians ISSN 1533-3159 Percutaneous Disc Decompression Using Nucleoplasty Lewis S.

More information

Automated Percutaneous and Endoscopic Discectomy. Original Policy Date

Automated Percutaneous and Endoscopic Discectomy. Original Policy Date MP 7.01.13 Automated Percutaneous and Endoscopic Discectomy Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return

More information

Lumbar Laminotomy DEFINING APPROPRIATE COVERAGE POSITIONS NASS COVERAGE POLICY RECOMMENDATIONS TASKFORCE

Lumbar Laminotomy DEFINING APPROPRIATE COVERAGE POSITIONS NASS COVERAGE POLICY RECOMMENDATIONS TASKFORCE NASS COVERAGE POLICY RECOMMENDATIONS Lumbar Laminotomy DEFINING APPROPRIATE COVERAGE POSITIONS North American Spine Society 7075 Veterans Blvd. Burr Ridge, IL 60527 TASKFORCE Introduction North American

More information

Module: #15 Lumbar Spine Fusion. Author(s): Jenni Buckley, PhD. Date Created: March 27 th, Last Updated:

Module: #15 Lumbar Spine Fusion. Author(s): Jenni Buckley, PhD. Date Created: March 27 th, Last Updated: Module: #15 Lumbar Spine Fusion Author(s): Jenni Buckley, PhD Date Created: March 27 th, 2011 Last Updated: Summary: Students will perform a single level lumbar spine fusion to treat lumbar spinal stenosis.

More information

Open Discectomy. North American Spine Society Public Education Series

Open Discectomy. North American Spine Society Public Education Series Open Discectomy North American Spine Society Public Education Series What Is Open Discectomy? Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine.

More information

Medical Policy Title: Lumbar Discectomy- ARBenefits Approval: <Date>

Medical Policy Title: Lumbar Discectomy- ARBenefits Approval: <Date> Medical Policy Title: Lumbar Discectomy- ARBenefits Approval: Percutaneous, Manual, Automated or Laser Effective Date: 01/01/2012 Document: ARB0275 Revision Date: Code(s): 62287 Aspiration or decompression

More information

Lumbar disc prolapse. Done by : Areej Al-Hadidi

Lumbar disc prolapse. Done by : Areej Al-Hadidi Lumbar disc prolapse Done by : Areej Al-Hadidi Anatomy of IVD IVD is composed of two components: 1. anulus fibrosus : it is the outer fibrous layer (fibrocartilage ) **It is comressible &tough 2. nucleus

More information

Current Spine Procedures

Current Spine Procedures SPINE BOOT CAMP: WHAT YOU DON T KNOW MAY COST YOU! David Abraham, M.D. The Reading Neck and Spine Center Reading, PA Current Spine Procedures Epidural/Transforaminal Injections Lumbar Procedures Laminectomy

More information

Original Date: October 2015 LUMBAR SPINAL FUSION FOR

Original Date: October 2015 LUMBAR SPINAL FUSION FOR National Imaging Associates, Inc. Clinical guidelines Original Date: October 2015 LUMBAR SPINAL FUSION FOR Page 1 of 9 INSTABILITY AND DEGENERATIVE DISC CONDITIONS FOR CMS (MEDICARE) MEMBERS ONLY CPT4

More information

Medical Policy Original Effective Date: Revised Date: Page 1 of 11

Medical Policy Original Effective Date: Revised Date: Page 1 of 11 Page 1 of 11 Content Disclaimer Description Coverage Determination Clinical Indications Lumbar Spine Surgery Lumbar Spine Surgery Description Indication Coding Lumbar Spinal Fusion (single level)surgery

More information

Percutaneous lumbar discectomy with a working endoscope and laser assistance

Percutaneous lumbar discectomy with a working endoscope and laser assistance Neurosurg Focus 4 (2):Article 9, 1998 Percutaneous lumbar discectomy with a working endoscope and laser assistance Martin H. Savitz, M.D., Howard Doughty, R.N., and Paul Burns, M.D. Division of Neurosurgery,

More information

Herniated Disk in the Lower Back

Herniated Disk in the Lower Back Herniated Disk in the Lower Back This article is also available in Spanish: Hernia de disco en la columna lumbar (topic.cfm?topic=a00730). Sometimes called a slipped or ruptured disk, a herniated disk

More information

MOHAMED LOTFY, M.D.*; SAMEH A. SAKR, M.D.* and ASHRAF E. ZAGHLOUL, M.D.**

MOHAMED LOTFY, M.D.*; SAMEH A. SAKR, M.D.* and ASHRAF E. ZAGHLOUL, M.D.** Med. J. Cairo Univ., Vol. 84, No. 1, December: 1463-1469, 216 www.medicaljournalofcairouniversity.net Extensive Laminectomy for Redo Lumbar Discectomy; Could it Be A Successful Alternative Option in Stable

More information

Fusion and repeat discectomy following single level open lumbar discectomies. Survival analysis

Fusion and repeat discectomy following single level open lumbar discectomies. Survival analysis Fusion and repeat discectomy following single level open lumbar discectomies. Survival analysis Dr John Mortimer Mr Chris Hoffman CCDHB and TBI Health group Sciatica = Leg Dominant Pain Patients referred

More information

Interventional Pain Management

Interventional Pain Management Origination: 5/21/08 Revised: 10/02/17 Annual Review: 11/02/17 Purpose: To provide interventional pain management clinical coordination criteria for the Medical Department staff to reference when making

More information

Epidemiology of Low back pain

Epidemiology of Low back pain Low Back Pain Definition Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like the mid or upper back, a inguinal

More information

Patient Selection and Lumbar Operative Interventions

Patient Selection and Lumbar Operative Interventions Patient Selection and Lumbar Operative Interventions John C France MD Professor of Orthopaedic & Neurosurgery West Virginia University Low back pain is a symptom not a diagnosis Epidemiology of LBP General

More information

Spinal canal stenosis Degenerative diseases F 06

Spinal canal stenosis Degenerative diseases F 06 What is spinal canal stenosis? The condition known as spinal canal stenosis is a narrowing (stenosis) of the spinal canal that in most cases develops due to the degenerative (wear-induced) deformation

More information

Populations Interventions Comparators Outcomes Individuals: With lumbar spinal stenosis

Populations Interventions Comparators Outcomes Individuals: With lumbar spinal stenosis Image-Guided Minimally Invasive Decompression for Spinal (701126) (Formerly Image-Guided Minimally Invasive Lumbar Decompression for Spinal ) Medical Benefit Effective Date: 10/01/17 Next Review Date:

More information

EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON INTRADISCAL PRESSURE

EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON INTRADISCAL PRESSURE EFFECTS OF VERTEBRAL AXIAL DECOMPRESSION (VAX-D) ON Gustavo Ramos, M.D., William Marin, M.D. Journal of Neursurgery 81:35-353 1994 Departments of Neurosurgery and Radiology, Rio Grande Regional Hospital,

More information

ACDF. Anterior Cervical Discectomy and Fusion. An introduction to

ACDF. Anterior Cervical Discectomy and Fusion. An introduction to An introduction to ACDF Anterior Cervical Discectomy and Fusion This booklet provides general information on ACDF. It is not meant to replace any personal conversations that you might wish to have with

More information

Common Thoraco- Lumbar Problems in the Mature Athlete

Common Thoraco- Lumbar Problems in the Mature Athlete Common Thoraco- Lumbar Problems in the Mature Athlete Diana Heiman, MD Associate Professor, Family Medicine Residency Director East Tennessee State University Objectives Review the pathophysiology of the

More information

Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy

Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy Case Report Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy Ryutaro Shiboi 1,2, Yasushi Oshima 1,2,3, Takeshi Kaneko

More information

Anthem Blue Cross and Blue Shield Central Region Clinical Claim Edit

Anthem Blue Cross and Blue Shield Central Region Clinical Claim Edit Subject: Laminotomy (Hemilaminectomy) with Decompression of Nerve Root(s), Including Partial Facetectomy, Foraminotomy and/or Excision of Herniated Intervertebral Disc, Reexploration, Single Interspace-Lumbar

More information

Degenerative spondylolisthesis at the L4 L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: A case report

Degenerative spondylolisthesis at the L4 L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: A case report Journal of Orthopaedic Surgery 2003: 11(2): 202 206 Degenerative spondylolisthesis at the L4 L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: A case report RB Winter Clinical Professor,

More information

Cervical Plasma disc decompression (Nucleoplasty): Indications Results and Limits. Alessandro Cesaroni

Cervical Plasma disc decompression (Nucleoplasty): Indications Results and Limits. Alessandro Cesaroni Cervical Plasma disc decompression (Nucleoplasty): Indications Results and Limits Alessandro Cesaroni PRESSURER Change in Temperature (ºC) Nucleoplasty Porcine Intradiscal Thermal Mapping Is a minimally

More information

The Role of Surgery in the Treatment of Low Back Pain and Radiculopathy. Christian Etter, MD, Spine Surgeon Zürich, Switzerland

The Role of Surgery in the Treatment of Low Back Pain and Radiculopathy. Christian Etter, MD, Spine Surgeon Zürich, Switzerland The Role of Surgery in the Treatment of Low Back Pain and Radiculopathy Christian Etter, MD, Spine Surgeon Zürich, Switzerland WW Fusion Volume by Disorder 2004E % Tumor/Trauma 11% Deformity 15% Degeneration

More information

QF-78. S. Tanaka 1, T.Yokoyama 1, K.Takeuchi 1, K.Wada 2, T. Tanaka 2, S.Abrakawa 2, G.Kumagai 2, T.Asari 2, A.Ono 2, Y.

QF-78. S. Tanaka 1, T.Yokoyama 1, K.Takeuchi 1, K.Wada 2, T. Tanaka 2, S.Abrakawa 2, G.Kumagai 2, T.Asari 2, A.Ono 2, Y. QF-78 Patient-oriented outcomes after musclepreserving interlaminar decompression for patients with lumbar spinal canal stenosis: Multi-center study to identify risk factors for poor outcomes S. Tanaka

More information

Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy

Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy Original Article Page 1 of 5 Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy Thomas A. Kosztowski, David Choi, Jared Fridley, Michael Galgano, Ziya Gokaslan, Adetokunbo Oyelese,

More information

Basic Intradiscal techniques. Amar salti.md,edra Consultant Anesthesia and Pain Medicine SKMC - Abu Dhabi - UAE

Basic Intradiscal techniques. Amar salti.md,edra Consultant Anesthesia and Pain Medicine SKMC - Abu Dhabi - UAE Basic Intradiscal techniques Amar salti.md,edra Consultant Anesthesia and Pain Medicine SKMC - Abu Dhabi - UAE Learning Objectives Indications for IntraDiscal tech. Discogenic Back Pain Diagnostic Discography

More information

POSTERIOR CERVICAL FUSION

POSTERIOR CERVICAL FUSION AN INTRODUCTION TO PCF POSTERIOR CERVICAL FUSION This booklet provides general information on the Posterior Cervical Fusion (PCF) surgical procedure for you to discuss with your physician. It is not meant

More information

Posterior decompression via total laminectomy and

Posterior decompression via total laminectomy and CASE REPORT J Neurosurg Spine 27:352 356, 2017 Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases Kimberly-Anne Tan, MBBS, 1,2 Mathew

More information

Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: , 1994 ABSTRACT

Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: , 1994 ABSTRACT Effects of Vertebral Axial Decompression On Intradiscal Pressure. Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: 350353, 1994 ABSTRACT The object of this study was to examine the effect of vertebral

More information

PARADIGM SPINE. Patient Information. Treatment of a Narrow Lumbar Spinal Canal

PARADIGM SPINE. Patient Information. Treatment of a Narrow Lumbar Spinal Canal PARADIGM SPINE Patient Information Treatment of a Narrow Lumbar Spinal Canal Dear Patient, This brochure is intended to inform you of a possible treatment option for narrowing of the spinal canal, often

More information

Review date: February Lumbar Discectomy

Review date: February Lumbar Discectomy Review date: February 2019 Lumbar Discectomy Following your recent MRI scan and consultation with your spinal surgeon, you have been diagnosed as having a lumbar disc protrusion, resulting in nerve root

More information

Percutaneous Discectomy

Percutaneous Discectomy Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

The spine is made of a column of bones. Each bone, or vertebra, is formed by a round block of bone, called a vertebral body. A bony ring attaches to the back of the vertebral body. When the vertebra bones

More information

Back Pain Policies Summary

Back Pain Policies Summary Back Pain Policies Summary These policies are part of the wider project, Reviewing local health policies, which is reviewing and updating more than 100 policies, of which back pain are part of. This review

More information

Cox Technic Case Report #169 published at (sent 5/9/17) 1

Cox Technic Case Report #169 published at  (sent 5/9/17) 1 Cox Technic Case Report #169 published at www.coxtechnic.com (sent 5/9/17) 1 Management of Lumbar Radiculopathy Associated with an Extruded L4 L5 disc and concurrent L5 S1 Spondylolytic Spondylolisthesis

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous endoscopic laser lumbar discectomy Symptomatic lumbar disc prolapse

More information

North American Spine Society Public Education Series

North American Spine Society Public Education Series Herniated Lumbar Disc North American Spine Society Public Education Series What Is a Herniated Disc? The spine is made up of a series of connected bones called vertebrae. The disc is a combination of strong

More information

2012 CPT Coding Update AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

2012 CPT Coding Update AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves 2012 CPT Coding Update AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Joseph S. Cheng, M.D., M.S. Associate Professor of Neurological Surgery, Orthopedic Surgery, and Rehabilitation

More information

MAS TLIF MAXIMUM ACCESS SURGERY TRANSFORAMINAL LUMBAR INTERBODY FUSION AN INTRODUCTION TO

MAS TLIF MAXIMUM ACCESS SURGERY TRANSFORAMINAL LUMBAR INTERBODY FUSION AN INTRODUCTION TO AN INTRODUCTION TO MAS TLIF MAXIMUM ACCESS SURGERY TRANSFORAMINAL LUMBAR INTERBODY FUSION This booklet is designed to inform you about the Maximum Access Surgery (MAS ) Transforaminal Lumbar Interbody

More information

Bilateral Foot Drop Without Cauda Equinae Syndrome Due To L4-L5 Disc Prolapse: A Case Report

Bilateral Foot Drop Without Cauda Equinae Syndrome Due To L4-L5 Disc Prolapse: A Case Report ISPUB.COM The Internet Journal of Neurosurgery Volume 5 Number 1 Bilateral Foot Drop Without Cauda Equinae Syndrome Due To L4-L5 Disc Prolapse: A Case Report R Ramnaryan, C Palinikumar Citation R Ramnaryan,

More information

Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level

Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level Case report Videosurgery Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level Łukasz Kubaszewski 1, Jacek Kaczmarczyk 1, Andrzej Nowakowski

More information

Populations Interventions Comparators Outcomes Individuals: With lumbar spinal stenosis

Populations Interventions Comparators Outcomes Individuals: With lumbar spinal stenosis Image-Guided Minimally Invasive Decompression for Spinal (701126) Medical Benefit Effective Date: 10/01/18 Next Review Date: 07/19 Preauthorization No Review Dates: 09/10, 07/11, 07/12, 07/13, 07/14, 07/15,

More information

Cox Technic Case Report #124 published at ( sent October 2013 ) 1

Cox Technic Case Report #124 published at  ( sent October 2013 ) 1 Cox Technic Case Report #124 published at www.coxtechnic.com ( sent October 2013 ) 1 5 th Lumbar Disc Herniation with Spondylolisthesis Treated with Cox Technic Flexion Distraction by Travis Cross BS,

More information

Cervical intervertebral disc disease Degenerative diseases F 04

Cervical intervertebral disc disease Degenerative diseases F 04 Cervical intervertebral disc disease Degenerative diseases F 04 How is a herniated cervical intervertebral disc treated? Conservative treatment is generally sufficient for mild symptoms not complicated

More information

Percutaneous endoscopic discectomy: Gold standard technique for single level intervertebral disc prolapse

Percutaneous endoscopic discectomy: Gold standard technique for single level intervertebral disc prolapse 2018; 4(3): 586-590 ISSN: 2395-1958 IJOS 2018; 4(3): 586-590 2018 IJOS www.orthopaper.com Received: 11-05-2018 Accepted: 12-06-2018 Dr. Hardik Sethi M.S. Ortho, Senior Resident Dept. Of Orthopaedics Govt.

More information

Codes for Back and Spinal Procedures

Codes for Back and Spinal Procedures 20930 Allograft for spine surgery only; morselized 20931 Allograft for spine surgery only; structural 20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process,

More information

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis Lumbar Spinal Stenosis This article is also available in Spanish: Estenosis de la columna lumbar (topic.cfm?topic=a00701). A common cause of low back and leg pain is lumbar spinal stenosis. As we age,

More information

nvt Transforaminal Lumbar Interbody Fusion System

nvt Transforaminal Lumbar Interbody Fusion System nvt Transforaminal Lumbar Interbody Fusion System 1 IMPORTANT INFORMATION FOR PHYSICIANS, SURGEONS, AND/OR STAFF The nv a, nv p, and nv t are an intervertebral body fusion device used in the lumbar spine

More information

DEGENERATIVE SPINAL DISEASE PRABIN SHRESTHA ANISH M SINGH B&B HOSPITAL

DEGENERATIVE SPINAL DISEASE PRABIN SHRESTHA ANISH M SINGH B&B HOSPITAL SPINAL CHAPTER, NESON DEGENERATIVE SPINAL DISEASE PRABIN SHRESTHA ANISH M SINGH B&B HOSPITAL INTRODUCTION DEGENERATIVE SPINAL DISEASE Gradual loss of normal structure and function of spine with time Also

More information

Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis. Original Policy Date

Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis. Original Policy Date MP 7.01.107 Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed

More information

New York Science Journal 2017;10(8)

New York Science Journal 2017;10(8) Outcome of surgical intervention with different modalities in treatment of lumbar canal stenosis. Ahmed Mohamed Shaker Eidarous Elakhras 1, Ahmed M. El Sherif 2 and Mostafa Elsyed Mohamed 3 1 Neurosurgical

More information

This procedure lacks scientific evidence of effectiveness, and is not covered.

This procedure lacks scientific evidence of effectiveness, and is not covered. ARBenefits Approval: 09-21-2011 Effective Date: 01-01-2012 Revision Date: Code(s): 0275T Medical Policy Title: Minimally Invasive, Image-Guided Lumbar Decompression for Spinal Stenosis Document: ARB0186

More information

Incomplete cauda equina syndrome in adult monozygotic twins

Incomplete cauda equina syndrome in adult monozygotic twins Incomplete cauda equina syndrome in adult monozygotic twins J. Mohar, R. Kramar, N. Hero, R. J. Cirman Department of Spine Surgery and Paediatric Orthopaedics, Orthopaedic Hospital Valdoltra, Ankaran,

More information

SpineFAQs. Lumbar Spondylolisthesis

SpineFAQs. Lumbar Spondylolisthesis SpineFAQs Lumbar Spondylolisthesis Normally, the bones of the spine (the vertebrae) stand neatly stacked on top of one another. The ligaments and joints support the spine. Spondylolisthesis alters the

More information

Percutaneous Laser Discectomy: Experience and Long Term Follow-Up

Percutaneous Laser Discectomy: Experience and Long Term Follow-Up Percutaneous Laser Discectomy: Experience and Long Term Follow-Up P.P.M. Menchetti, G. Canero, and W. Bini Abstract The classical microsurgical approach in the treatment of herniated nucleus pulposus (HNP)

More information

Cox Technic Flexion Distraction and Decompression Relieves Right Lower Extremity Radiculopathy and Low Back Pain Post Laminectomy

Cox Technic Flexion Distraction and Decompression Relieves Right Lower Extremity Radiculopathy and Low Back Pain Post Laminectomy Cox Technic Case Report #94 published at www.coxtechnic.com ( sent April 2011 on 4/9/11 ) 1 Cox Technic Flexion Distraction and Decompression Relieves Right Lower Extremity Radiculopathy and Low Back Pain

More information

Wake me when this makes sense. Today s Objectives. Quote from Maitland. Quote from Maitland 8/4/2012

Wake me when this makes sense. Today s Objectives. Quote from Maitland. Quote from Maitland 8/4/2012 Wake me when this makes sense Today s Objectives Selection of techniques Order of efficacy of techniques Ground the theory in reality Application of techniques How do you do what you should do Quote from

More information

Responses to Key Questions for Washington State Health Care Authority Health Technology Assessment of Surgery for Symptomatic Lumbar Radiculopathy

Responses to Key Questions for Washington State Health Care Authority Health Technology Assessment of Surgery for Symptomatic Lumbar Radiculopathy The American Academy of Orthopaedic Surgeons (AAOS), American Association of Neurological Surgeons (AANS), AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (DSPN), Congress of Neurological

More information

Patient Information ACDF. Anterior Cervical Discectomy and Fusion

Patient Information ACDF. Anterior Cervical Discectomy and Fusion Patient Information ACDF Anterior Cervical Discectomy and Fusion Table of Contents Anatomy of the Spine...2-3 General Conditions of the Cervical Spine...4 5 What is an ACDF?...6 How is an ACDF performed?...7

More information

3D titanium interbody fusion cages sharx. White Paper

3D titanium interbody fusion cages sharx. White Paper 3D titanium interbody fusion cages sharx (SLM selective laser melted) Goal of the study: Does the sharx intervertebral cage due to innovative material, new design, and lordotic shape solve some problems

More information

EVALUATE, TREAT AND WHEN TO REFER RED FLAGS Mid Atlantic Occupational Regional Conference and Environmental Medicine October 6, 2018

EVALUATE, TREAT AND WHEN TO REFER RED FLAGS Mid Atlantic Occupational Regional Conference and Environmental Medicine October 6, 2018 EVALUATE, TREAT AND WHEN TO REFER RED FLAGS Mid Atlantic Occupational Regional Conference and Environmental Medicine October 6, 2018 Marc J. Levine, MD Rothman Institute Director Spine Surgery Program

More information

Transforaminal Endoscopic Decompression for a Giant Epidural Gas-Containing Pseudocyst: A Case Report and Literature Review

Transforaminal Endoscopic Decompression for a Giant Epidural Gas-Containing Pseudocyst: A Case Report and Literature Review Pain Physician 2017; 20:E445-E449 ISSN 2150-1149 Literature Review Transforaminal Endoscopic Decompression for a Giant Epidural Gas-Containing Pseudocyst: A Case Report and Literature Review Bin Zhu, MD,

More information

nvp Posterior Lumbar Interbody Fusion System

nvp Posterior Lumbar Interbody Fusion System nvp Posterior Lumbar Interbody Fusion System 1 IMPORTANT INFORMATION FOR PHYSICIANS, SURGEONS, AND/OR STAFF The nv a, nv p, and nv t are an intervertebral body fusion device used in the lumbar spine following

More information

Get back to: my life. Non-fusion treatment for lumbar spinal stenosis

Get back to: my life. Non-fusion treatment for lumbar spinal stenosis Get back to: my life Non-fusion treatment for lumbar spinal stenosis Do you have any of these symptoms? numbness, weakness or pain in the lower legs When any of these conditions occur, the spinal nerve,

More information

The ABC s of LUMBAR SPINE DISEASE

The ABC s of LUMBAR SPINE DISEASE The ABC s of LUMBAR SPINE DISEASE Susan O. Smith ANP-BC University of Rochester Department of Neurological Surgery Diagnosis/Imaging/Surgery of Lumbar Spine Disorders Objectives Identify the most common

More information

Classical open lumbar laminectomy and discectomy for disc herniations among manual labourers in India

Classical open lumbar laminectomy and discectomy for disc herniations among manual labourers in India International Journal of Research in Medical Sciences Chellarapu SK et al. Int J Res Med Sci. 2017 Dec;5(12):5156-5161 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175127

More information

The ABC s of LUMBAR SPINE DISEASE

The ABC s of LUMBAR SPINE DISEASE The ABC s of LUMBAR SPINE DISEASE Susan O. Smith ANP-BC University of Rochester Department of Neurological Surgery URMC Neurosurgery APP s Objectives Identify the most common pathology that leads to spine

More information

Placename CCG. Policies for the Commissioning of Healthcare. Policy for Managing Back Pain- Spinal Injections

Placename CCG. Policies for the Commissioning of Healthcare. Policy for Managing Back Pain- Spinal Injections Placename CCG Policies for the Commissioning of Healthcare Policy for Managing Back Pain- Spinal Injections 1 Introduction 1.1 This document is part of a suite of policies that the CCG uses to drive its

More information

nva Anterior Lumbar Interbody Fusion System

nva Anterior Lumbar Interbody Fusion System nva Anterior Lumbar Interbody Fusion System 1 IMPORTANT INFORMATION FOR PHYSICIANS, SURGEONS, AND/OR STAFF The nv a, nv p, and nv t are an intervertebral body fusion device used in the lumbar spine following

More information

Axial Lumbosacral Interbody Fusion. Description

Axial Lumbosacral Interbody Fusion. Description Section: Surgery Effective Date: April 15, 2014 Subject: Axial Lumbosacral Interbody Fusion Page: 1 of 6 Last Review Status/Date: March 2014 Axial Lumbosacral Interbody Fusion Description Axial lumbosacral

More information

Int J Clin Exp Med 2018;11(2): /ISSN: /IJCEM Yi Yang, Hao Liu, Yueming Song, Tao Li

Int J Clin Exp Med 2018;11(2): /ISSN: /IJCEM Yi Yang, Hao Liu, Yueming Song, Tao Li Int J Clin Exp Med 2018;11(2):1278-1284 www.ijcem.com /ISSN:1940-5901/IJCEM0063093 Case Report Dislocation and screws pull-out after application of an Isobar TTL dynamic stabilisation system at L2/3 in

More information

Spectrum of magnetic resonance imaging findings in chronic low back pain

Spectrum of magnetic resonance imaging findings in chronic low back pain Original article: Spectrum of magnetic resonance imaging findings in chronic low back pain Dr Sanjeev Sharma (1), Dr Monika Sharma (2), DR Bhardwaj (3), MD; Dr Asha Negi, (4) Department of Radiodiagnosis,

More information

Case Report A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation

Case Report A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation Case Reports in Orthopedics Volume 2016, Article ID 5963924, 4 pages http://dx.doi.org/10.1155/2016/5963924 Case Report A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/29800 holds various files of this Leiden University dissertation. Author: Moojen, Wouter Anton Title: Introducing new implants and imaging techniques for

More information

SpineFAQs. Neck Pain Diagnosis and Treatment

SpineFAQs. Neck Pain Diagnosis and Treatment SpineFAQs Neck Pain Diagnosis and Treatment Neck pain is a common reason people visit their doctor. Neck pain typically doesn't start from a single injury. Instead, the problem usually develops over time

More information

A NOVEL CAUSE FOR CAUDA- EQUINA SYNDROME WITH A NEW RADIOLOGICAL SIGN

A NOVEL CAUSE FOR CAUDA- EQUINA SYNDROME WITH A NEW RADIOLOGICAL SIGN A NOVEL CAUSE FOR CAUDA- EQUINA SYNDROME WITH A NEW RADIOLOGICAL SIGN W Singleton, D Ramnarine, N Patel, C Wigfield Department of Neurological Surgery, Frenchay Hospital, Bristol, UK Introduction We present

More information

Automated Percutaneous and Endoscopic Discectomy

Automated Percutaneous and Endoscopic Discectomy 7.01.18 Automated Percutaneous and Endoscopic Discectomy Section 7.0 Surgery Subsection Effective Date October 31, 2014 Original Policy Date October 31, 2014 Next Review Date October 2015 Description Traditionally,

More information