Surgical Discectomy (for lumbar disc prolapse) (Surgery to remove part of a damaged spinal disc)

(Back Surgery)

Threshold

This procedure will be funded if the following criteria can be met:

• The patient has had magnetic resonance imaging, showing disc herniation (protrusion, extrusion, or sequestered fragment) at a level and side corresponding to the clinical symptoms

AND at least one of the following:

• The patient has a corresponding neurological deficit (asymmetrical depressed reflex, decreased sensation in a dermatomal distribution, or weakness in a myotomal distribution, altered bowel or bladder function).
• The patient has radicular pain (below the knee for lower lumbar herniations, into the anterior thigh for upper lumbar herniations) consistent with the level of spinal involvement.
• There is evidence of nerve – root irritation with a positive nerve – root tension sign (straight leg raise – positive between 30° and 70° or positive femoral tension sign)

AND all of the following:

• Symptoms persist despite conservative management for at least 6 weeks e.g. physiotherapy, analgesics.
• The patient has focal pathology (unilateral and effecting 1 or 2 levels only).
• The patient must be 18 years or older – Adult service only.
• BMI <40

Exemptions: Patients with severe symptoms requiring emergency admission and those patients with recent neurological deficit e.g. foot drop and equine cauda will be exempt from the threshold criteria.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for this intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.