Percutaneous intradiscal laser ablation in the lumbar spine

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laser lumbar discectomy in December 2003.

NICE has reviewed this guidance and is reassessing the procedure. New guidance will be published as a result.  Until the new guidance is published the NHS should continue to follow the recommendations in the guidance below.

The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an Interventional Procedures Consultation Document about its safety and efficacy for 4 weeks public consultation. IPAC will then review the consultation document in the light of comments received and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.

If you wish to be updated to any developments with this procedure, you can express an interest here.

Description

This is a treatment for prolapsed intervertebral disc.

Low back pain is a common and expensive cause of chronic disability. While most people recover within 8 to 10 weeks, those who do not recover, account for most of the health care and social costs for spinal disorders. 

Herniated (or prolapsed) lumbar discs are a common cause of backache and sciatica. The herniation is a result of a protrusion of the nucleus pulposus through the tear in the surrounding annulus fibrosis. The annulus fibrosis may rupture completely resulting in an extruded disc or may remain intact but stretched resulting in a contained disc prolapse. This may then compress one or more nerve roots, resulting in pain along the sciatic nerve.

Surgery is considered where there is nerve compression or persistent symptoms that are intractable to conservative treatment. 

Laser discectomy works by vapourising part of a prolapsed disc and can be performed where the prolapse is contained. A probe is inserted into the disc through a small incision in the patient's back. The needle is inserted through the annulus and into the nucleus pulposus. Laser energy is delivered through the probe and used to vapourise part of the nucleus pulposus. Several lasers are available, each with differences in absorption, energy requirements, and rate of application. The procedure is performed under local and/or neuroleptic anaesthetic, and using radiographic imaging.

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Details

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Links:

	IPG27 Laser lumbar discectomy: guidance	17 December 2003
	IPG27 Laser lumbar discectomy: understanding NICE guidance	17 December 2003
	IPG27 Disgectomi meingefnol laser: deall canllawiau NICE	12 May 2009
	IPG27 Laser lumbar discectomy: distribution list	17 December 2003
	Overview of laser lumbar discectomy	26 August 2003
	Interventional procedures consultation document - laser lumbar discectomy	20 August 2003
	Consent - procedures for which the benefits and risks are uncertain	27 November 2003