Intradiscal Procedures

Dekompressor Discectomy
Percutaneous Disc Nucleoplasty

If your discogram shows that your intervertebral disc is the source of your pain, we have a variety of procedures, other than surgery, to treat that problem. These procedures can focus on either the annulus, the “radial tire” outer portion of the disc or the nucleus, the “shock absorber” or “jelly filling” inside the disc.

Procedures focusing on the annulus include the IDET (Intradiscal Electrothermal therapy) procedure and the Disctrode procedure.

All these procedures use heat. The IDET and Disctrode procedures treat the low back component of low back pain rather than the pain going down the leg. There is some controversy as to how they work. One theory is that the heat causes the collagen in the disc to break down and, when it has healed, to become more compact and strong. A second theory is that the procedure destroys nerve endings in the disc, so that pain information is no longer sent to the brain. A third theory is that the procedures cause the cells of the disc to proliferate and grow, thereby healing the disc. Strong arguments exist against the first two theories; no good evidence supports the third, so that we are still uncertain as to the mode of action.

The best studied is the IDET procedure. In particular, there is one study which indicates that, in cases of very severe pain, there is a significant placebo response: In patients with severe pain, both treated patients and those who had a sham procedure got better, but neither got sufficiently better to regain significant function. However, in patients with significant, but not as severe pain, only the treated patients did better. On the whole, they got significantly better, with reduction of their pain to levels low enough to have meaningful increases in function.

The annuloplasties require prolonged post procedural therapy. A back brace with limited activity is required for the first 4-8 weeks. After 8 weeks, you will require therapy, first for stretching and later for strengthening. Depending on the type of work you do, you might require up to 4-6 months before you return to work.

Nucleoplasties are directed at treating chronic leg pain. Among the technologies available are the Viking procedure (heat), Coblation (vaporize), the Dekompressor (extraction) and the LASE procedure (vaporize). No evidence exists to demonstrate one approach is better than the others.

For contained disc protrusions, up to about 5 mm, these approaches offer a safe, effective means of treating radicular pain without the risks of surgery.