Percutaneous disc decompression refers to nonsurgical procedures designed to reduce disc volume, thereby decreasing the pressure exerted on pain generators either within the disc or at the spinal nerve. Only certain patients are candidates for this procedure. Appropriate candidates have a positive disc stimulation procedure. The positive disc must demonstrate contained intradiscal contrast spread, well-maintained height and no evidence of spondylolisthetic vertebral segment. While initially developed for contained disc herniations, these techniques have been used successfully for axial disc pain. Since this technique is new, studies are not yet completed and long term outcomes are not yet known.
Nucleoplasty is a technique which places a small wand into the disc annulus and uses a technique called coblation to disintegrate nuclear material along a series of channels and thereby reduce the disc volume. Another technique uses a DeKompressor probe to aspirate nuclear disc material, thereby reducing disc volume and decreasing pain.
Intradiscal Electrothermal Annuloplasty (IDEA), also called IDET, is a therapeutic technique that is designed to decrease discogenic pain. Essentially, a disc deemed symptomatic by disc stimulation may benefit from this procedure. In IDET, a needle is placed into the mid portion of the disc similar to discography. A wire is threaded through the needle and directed under X-ray such that it curves around the sides and back of the internal part of the disc. This wire is then heated, coagulating the small nerves which transmit pain.
Furthermore, the heat changes the structure of the outer portion of the disc, called the annulus, making it more anatomically sound and repairing internal areas of disruption. In carefully selected patients, this procedure can be quite effective. It requires a two to four week recovery period during which time a back brace is worn and no lifting is allowed and, thereafter, a four to eight week period of rehabilitation, including physical therapy. When successful, pain is significantly reduced without surgical reconstruction.
Long-term outcome data are not available and rigorous selection criteria for this procedure limits acceptable candidates.