Procedures

If I have had previous spine surgery, can I still have this done?

Maybe. If there has been previous spinal fusion at the level of concern, it will be difficult, if not impossible. If the disc in question is outside the area of previous spine surgery, it is quite possible that this procedure can be performed.

If this does not work, will it cause a problem if I then need an open spine surgery?

No. If the procedure is not effective, there will be no problem if the patient decides or ultimately requires an open spine surgery. This does not damage or alter the tissue around the spine, nor does it change the internal spine anatomy except for the expected and desired changes inside the disc itself.

What are the alternatives?

If you have back or leg pain from a damaged disc, the alternatives are to treat the pain conservatively with medication, physical therapy, chiropractic and epidural or other spinal injections. An open surgical spine procedure such as laminectomy, diskectomy or spinal fusion is also an option.

What are the risks?

No serious or permanent injuries have been reported to date from the procedure itself. Still, there are always risks. Infection in the disc is a possibility and is a serious condition, so very careful sterility is used along with intravenous antibiotics at the time of the procedure. Unusual bleeding requiring surgery and nerve damage are also uncommon but possible risks. There is also the possibility that it might not help your back or leg pain, or that it might make it worse.

Will this procedure help me?

It is difficult to predict if this procedure will help. Thousands of patients have had this done in the United States, where the success rate for improvement in pain and function is about 70 percent. Success is considered at least a 50 percent improvement in pain. If the symptoms are right and you do not want to go ahead with an open spine surgery, this might be a good choice.

What should I do after the procedure?

The procedure is normally an outpatient procedure. You will need to have a ride home. You will need to wear an abdominal binder that will support your back and somewhat limit your motion for the first two weeks and occasionally longer. It is very important to limit your activities after the procedure to allow the disc sidewall to heal and the center of the disc where the material was removed to scar closed.

When will my pain get better?

Many patients are substantially improved right away or within the first few days after the procedure. Your pain should gradually improve over the weeks and months following the procedure. Improvement can occur as long as 6 to 12 months after the procedure.

When can I go back to work?

If everything goes well, most patients can resume limited activity the next day. Return to work with full activity usually begins at about two weeks after the procedure. Patients with very active jobs might be advised to take it easy a bit longer.

What should I expect after the procedure?

There might be a mild flare-up of your back pain for a few days after the procedure. You will be advised to use ice packs initially. Some patients might need extra medication during this time. Other patients feel better right away or within days and actually take less medication. Almost everyone is back to at least their usual level of pain within a week.

Will I be "put out" for the procedure?

Local anesthesia and mild sedation will be used to make you more comfortable during the procedure. You will need to be awake enough to tell your physician what you are experiencing during the procedure. However, some patients receive enough sedation that they cannot remember parts or all of the procedure afterwards.

Will the procedure hurt?

Local anesthesia and mild sedation will be used to make the patient more comfortable during the procedure. There is often mild pain and some pressure when the introducer needle is passed through the tissues and into the sidewall of the disc. During the actual cutting and heating, the patient might feel some mild reproduction of his or her usual lower back or leg pain. This pain should not be severe and is usually a sign that the procedure is being done in the correct area.

How is the procedure actually performed?

The procedure is usually performed as an outpatient procedure under sterile conditions. The patient lies face down on an x-ray table. Local anesthesia and mild sedation will be used to make the patient more comfortable during the procedure. Using x-ray guidance, an introducer needle is inserted into the sidewall of the disc. Then the device is passed through the needle and positioned in the internal portion of the disc under x-ray guidance. Once in proper position, the device is used to cut a small portion of disc material out of the center of the disc and then heat the tissue immediately around the area where tissue has just been removed. When done, the device and needle are removed and an adhesive bandage is placed over the needle insertion site.

How long does the procedure take?

The Procedure usually takes 60 minutes or less.

Can all damaged discs be treated with this procedure?

No. this procedure might not be appropriate if the disc is very narrowed, or if the spine is misaligned or otherwise unstable. Discs that do not have an intact annulus or rim are difficult to decompress with this procedure because, in theory, they have already decompressed themselves by extruding disc material through a tear in the annulus or rim. Damaged discs in the neck cannot be treated with this procedure, only discs in the back.

Is there anything else I should try before considering this procedure?

Most patients should try less invasive treatment, such as anti-inflammatory medications, physical therapy and epidural or other spinal injections.

Am I a candidate for this procedure?

If you have back or leg pain from a contained disc herniation or protrusion that does not respond to less invasive or more conservative therapies, you might benefit from this procedure. Most back or leg pain from a contained disc herniation or protrusion gets better on its own in the first month or two, so typically physicians do not consider this procedure until at least a month after the onset of back or leg pain. Also, if your back or leg pain is not severe enough to limit your activities, you probably should not have this procedure.

What is Endoscopic Radiofrequency Disc Ablation/Decompression/Nucleotomy?

This therapy is a recently developed technique for the treatment of pain coming from a spinal disc. A special probe is inserted into the spinal disc and is used to remove a small amount of disc tissue from the disc nucleus and then to apply controlled thermal energy or heat to the disc. This causes the pressure within the disc wall to decrease and allows the disc to bulge or protrude less.