Minimally Invasive Percutaneous Techniques for the Relief of Pain in Lumbar Disc Disease

Alleviation of back pain and/or any disability due to pain in patients with lumbar disc disease undoubtedly gives a sense of relief and well being. The use of noninvasive or minimally invasive interventional procedures for this condition is basically aimed at limiting pain and disability. A number of such minimally invasive percutaneous techniques for the treatment of lumbar disc disease have been developed over the years, with the common tenet being the ability to act directly on the disc content without violating the spinal channel or increasing subsequent risk of scarring. Electrosurgical technology has been developed for use in the spine and possesses few, if any of the drawbacks of the other percutaneous disc decompression techniques. These are usually plasma-mediated radiofrequencybased excision and allow precise etching of tissue. When used for tissue ablation (excision) in the disc, these procedures excise target material without gross thermal or structural damage to adjacent tissue (1). We have studied patients using the nucleoplasty procedure developed by Arthro Care Corporation (Sunnyvale, CA), which is performed using a plasma-mediated radiofrequency-based device. This procedure uses radiofrequency to excite the electrolytes in a conductive medium, such as saline solution, to create precisely focused plasma. The energized particles in the plasma have sufficient energy to break molecular bonds, excising or dissolving soft tissue at relatively low temperatures (2-4). In our study (5) on 83 patients the majority of patients reported substantial pain relief within one month following the nucleoplasty discectomy, with the majority of them reporting minimal or no pain or disability and satisfaction with results after one year. Our experience revealed that nucleoplasty discectomy is a suitable, minimally invasive technique that could be considered a valid alternative to surgery when evaluating possible treatment options in patients affected by contained lumbar disc herniation. It appears particularly indicated for patients that have exhausted other conservative treatment modalities but have not yet reached clear-cut indications Minimally Invasive Percutaneous Techniques for the Relief of Pain in Lumbar Disc Disease Tariq Sinan , Mehraj Sheikh 2