Intradiscal Therapies for Discogenic Pain

Stuart R. Pomerantz; Joshua A. Hirsch

doi:10.1055/s-2006-939030

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2006; 10(2): 125-136
DOI: 10.1055/s-2006-939030

Intradiscal Therapies for Discogenic Pain

Stuart R. Pomerantz¹ ^, ² , Joshua A. Hirsch¹ ^, ²

¹Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts
²Harvard Medical School, Boston, Massachusetts

Abstract

ABSTRACT

Since the first injection of chymopapain in 1963, percutaneous intradiscal therapies have been used to treat discogenic back and leg pain. The percutaneous discectomy techniques treat contained disc herniations not by resecting the prolapsed disc material but rather through central decompression of the disc. By removing a small volume of tissue from the disc nucleus, a large reduction in overall disc pressure is achieved with consequent relief of neural compression. DISC Nucleoplasty™ and Dekompressor™ are the two leading percutaneous discectomy technologies currently. Although rigorous clinical testing of their efficacy is ongoing, there has now been a 40-year history confirming the concept of percutaneous disc decompression, and initial results are very promising. Discogenic low back pain can also arise from annular tears and other forms of internal disc derangement (IDD). Annuloplasty techniques, such as IntraDiscal Electrothermal Therapy (IDET™) and discTRODE™, have been developed over the past decade that thermally treat the lesions of IDD. Although the therapeutic mechanisms of thermal annuloplasty have yet to be fully elucidated, research studies demonstrate that the procedure can be effective for appropriately selected patients with degenerative disc disease characterized by discographically proven painful annular fissures. Other novel intradiscal therapies are emerging for percutaneous treatment of discogenic pain and await more widespread clinical evaluation.

KEYWORDS

Discogenic pain - disc herniation - annular tear - percutaneous discectomy - Nucleoplasty - annuloplasty - Coblation - IDET - Dekompressor

Full Text

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Joshua A HirschM.D.

Interventional Neuroradiology, Massachusetts General Hospital

55 Fruit Street, GRB 289, Boston, MA 02114