Intradiscal Procedures for Back Pain

Sometimes back pain comes from the fluid-filled disks that make up your spine.

Illustration of the spine and nerve groups

The spine's 24 bony vertebrae are hooked together in a way that allows the spine to bend and move. In between each vertebra is a flat, fluid-filled cushion called a disk. When the disks themselves are causing back pain or pain radiating to the legs, doctors sometimes do an intradiscal procedure to try to relieve the pain.

Intradiscal procedures are generally considered experimental or investigational. Medical opinion on them varies widely. Several small studies have said that intradiscal procedures are relatively safe methods to relieve back pain. But many experts say they haven't seen much proof that these procedures really ease pain. Although some research shows good results for certain procedures, other research shows less of an effect. For some procedures, more research needs to be done. And the research needs to be done with a larger number of people.

Modern intradiscal procedures can be done on an outpatient basis and are minimally invasive. This generally means you will have less pain from the treatment itself and a speedier return to daily life. But before having an intradiscal procedure, you'll want to discuss the risks and benefits in detail with your doctor. The healing process may limit your movements, so be sure you understand what you can and cannot do after a procedure. Also check to see whether your insurance company covers the procedure you're considering, because some do not.

Types of intradiscal procedures

Electrothermal coagulation

This is a minimally invasive procedure. The surgeon threads a thin, heat-providing coil into the disk that may be causing your pain. The doctor then applies heat, which changes the structure of the collagen in the disk. Animal studies have shown that heating the disk can help tighten and shrink collagen. And this can reduce pain. Studies of this technique in people say it may be possible to get short-term pain relief. But it's not clear how long the effect lasts.

This approach is one of many procedures called intradiscal electrothermal therapy, or IDET. Some doctors do these procedures on young patients whose disks are basically whole and healthy. Risks appear to be low, but the procedure is not recommended for people who are obese.

Percutaneous mechanical disk decompression

Decompression is a procedure in which your surgeon removes some bone or other tissue around a disk that is causing you pain. The goal is to remove as little material as possible, so that the disk remains stable. This is a minimally invasive procedure. The surgeon uses a needle to reach the disk and remove the extra material. It is usually done under local anesthetic in a doctor's office. Although your movement may be limited for a while after the procedure, healing is faster than with an open surgery.

Laser disk decompression

Another treatment takes some of the fluid out of the disk that is causing pain. Laser treatments have been used to deflate a disk somewhat. This is a minimally invasive procedure. The doctor inserts an optical fiber into the disk. The heat created takes out a small amount of the center of the disk. The heat may reduce pain by affecting the chemical structure and signaling in the disk.

Radiofrequency intradiscal/Annular neurolysis

In a similar approach to laser disk decompression, the surgeon may choose to place an electrode into the disk. The surgeon puts the electrode at the point where the annulus, or the tough outer ring of the disk, and the nucleus of the disk meet. Electrical pulses target sodium ions. The chemical effects of this treatment are thought to reduce pain.

Risks of the procedures

Like any surgery, these procedures carry some risks:

  • Infection

  • Damage to the disk

  • Damage to nearby tissues and nerves

  • Failure to resolve pain

  • Need for further surgery

Alternative approaches

The first-line treatment for degenerative disk disease is conservative care. This may mean a course of anti-inflammatory drugs or other pain medicines, physical therapy, exercise, and behavior modification. Many cases of lower back pain go away on their own with time, but some need further attention. The Center for Medicare and Medicaid Services recommends going to have conventional surgery such as spinal fusion if a conservative approach to back pain doesn't work.