This what some spine surgeons and interventional radiologist refer to as, non-surgical treatment. This procedure is considered a minimally invasive surgery in which special instruments are inserted under x-ray or CT guidance in the disc space, which allow mechanical excision of the disc material (decompression) from the intervertebral space. I prefer to describe it as indirect discectomy, and I feel it is suitable in cases of far lateral mild lumbar disc bulges rather than prolapse, but the results for large posterio-lateral, or central disc prolapses are not encouraging at all.
Intradiscal electrothermal annuloplasty (IDET), is a similar method but using radiofrequency generator to produce thermal energy within the disc to help shrinking and decompression of the disc bulge, rather than extracting the disc material mechanically.
The alternative is to use a Laser generator (Laser Nucleoplasty) rather than radiofrequency to produce the same effects. The success rate of these methods are approximately 50%, hence a careful patient selection has to be carried out trying to increase the success rate. These methods are not without risk of complication and in fact the rate of complication is higher than formal surgical discectomy in some reports.
Nucleoplasty should never be considered a replacement of open micro discectomy surgery or attempted before micro discectomy as a prior option. It is indicated on its merits whenever it is suitable. I believe it is valuable option in selected patient only.
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