Back pain, as a symptom, refers to any pain in the lumbar spine (LUMB), regardless of the cause that causes it. 80% involve degeneration of the lower lumbar intervertebral discs (disc disease – herniated intervertebral disc KMD), which can progress to degeneration of the vertebral joints, instability and narrowing of the spinal canal. Along with back pain, a herniated disc can also press on a nerve root, causing pain in the lower limb (sciatica).

With conservative treatment (medication, physical therapy, special exercises, lumbar belt) the symptoms usually show a significant improvement within a few weeks from the onset.

In case of failure of conservative measures for 6-8 weeks, the attending physician is required to proceed with further treatment, which includes invasive methods such as classic microdiscectomy, percutaneous discectomy using laser, percutaneous endoscopic discectomy, percutaneous discoplasty.

However, there are also indications that require immediate surgical treatment, such as hippurid syndrome and the worsening of a neurological condition.

What is percutaneous discoplasty?

Although the classic treatment of intervertebral disc herniation is microdiscectomy, percutaneous discoplasty offers a new method with encouraging results in well-selected patient cases. The primary goal in the surgical treatment of CMD is to release the pressure on the nerve root by removing the projecting disc material. Percutaneous Discoplasty is a minimally invasive technique that treats the protrusion of the intervertebral disc internally. It is an attractive method because it reduces the surgical time, the patient does not experience intraoperative or postoperative pain, it is safe, it does not require a hospital stay of more than a few hours and it has a quick recovery (return to daily activities within 10-15 days).

Which patients are suitable to undergo percutaneous discoplasty

The successful outcome of the treatment depends entirely on the correct selection of patients, who are indicated to undergo percutaneous discoplasty. The method concerns patients who present with sciatica, of discogenic etiology (from CMD). Excluded are patients presenting with: intervertebral space stenosis >50% of normal space, rupture of the annulus fibrosus of the disc and exit of disc material, as a free segment, into the spinal canal, moderate to severe spinal stenosis, degenerative spondyloarthritis, fractures, tumors or microbial inflammations.

How does percutaneous discoplasty work to decompress the nerve root from the intervertebral disc?

The method differs from classic microdiscectomy in the point of action on the intervertebral disc. While in microdiscectomy there is removal of part of the projected intervertebral disc, percutaneous discoplasty works inside the disc.

More specifically, there are two ways of applying it. The first way involves the use of radio frequency technology and the second way is performed by injecting intradiscal material in gel form (Discogel).

Using radiofrequency application, a guide is initially inserted under fluoroscopic control into the intervertebral disc and directed anterior to the herniation. An electrode is inserted through the guide, the tip of which can move and turn 360ᵒ

The electrode is superheated through a source at a temperature of 40ᵒC – 70ᵒC (coblation – low temperature ablation). It is a method that uses a radio frequency electrode at low temperatures for a short period of 2′-3′, without damaging the adjacent tissues, but only acts on the desired point of the intervertebral disc.

In the second way, under fluoroscopic control, a material is injected percutaneously in the form of a gel (gel) and consists of ethanol, cellulose derivatives and tungsten radiopaque material. The injection takes place in the center of the disc, through a guide, and works instantly. The action of the solution is based on its physicochemical properties: absorbent effect of ethanol with water, contained in the disc, combined with an osmosis-dehydration phenomenon of the disc from its periphery to its core. Thus, the projection of the disk back towards its center is “absorbed”.

It should be noted that the percutaneous discoplasty method is also applied with great success in the treatment of CMD of the AMSS.

What are the results of percutaneous discoplasty in pain management?

The results of various scientific studies worldwide, find a continuous improvement in pain management for a period of 6 months after performing discoplasty. Complete resolution of pain or significant improvement (> 50% reduction of initial pain) is reported in 75-90% in the various studies for the first 6 months to the first year after discoplasty. Also, the improvement of the image in MRI/CT scan for the same period of time amounts to approximately the same percentages.

In conclusion, percutaneous discoplasty is an excellent alternative for patients with radicular pain who are candidates for microdiscectomy.

Minimally invasive method, bloodless, with quick recovery and daily hospitalization of a few hours.

Case 1: Radiography in Percutaneous Discoplasty using an electrode (RF) in O4-O5 intervertebral disc herniation.

Case 2: Radiography in Percutaneous Discoplasty using Discogel intradiscal material in O4-O5 intervertebral disc herniation.