Getting to the Center of Back Pain

In this study the results of 16 patients' treatment for leg pain from disc problems was reported. All were treated with a procedure called nucleoplasty. Some also had intradiscal electrothermal therapy (IDET) at the same time.

Nucleoplasty is a way to remove the center of the disc (nucleus) without opening the spine to do major surgery. A long, thin needle is inserted through a very small cut in the skin. Radiowaves are sent through the needle to the nucleus. The disc collapses slightly taking pressure off the nearby spinal nerve.

IDET is a form of heat that is used to seal small tears in the outer covering of the disc. This was done in some of the patients just before nucleoplasty. Success in all cases was measured by a 50 percent reduction in the patient's pain level. They were also asked about use of pain relievers and return to work.

Before the operation more than half the patients were using drugs daily to control their pain. After the operation only one patient reported pain relief of 50 percent or more. The rest either stayed the same or increased their drug use because of increased pain.

Most of the patients said that given the chance to do it over, they wouldn't have this treatment. The authors say the poor results of this study may have to do with patient selection. Other studies show that nucleoplasty works best in patients with small tears of the outer disc. Patients with more leg than back pain seem to have better results, too.

The authors don't think the use of nucleoplasty should be abandoned. Finding the right patients who respond to the treatment is the next goal of research.

Steven P. Cohen, MD, et al. Nucleoplasty with or without Intradiscal Electrothermal Therapy (IDET) as a Treatment for Lumbar Herniated Disc. In Journal of Spinal Disorders. February 2005. Vol. 18. Supplement 1. Pp. S119-S124.

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