What are Intradiscal Procedures?
Intradiscal procedures are minimally invasive outpatient surgical procedures that have been developed over the last few years to treat patients with chronic low back pain that is caused by tears or small herniations of the lumbar discs. They all work under the principle of reduction of intradiscal pressure, either by electrothermal catheters or by insertion of a small instrument to remove disc tissue. These procedures include Annuloplasty, IDET Procedure, Nucleoplasty, and Percutaneous Discectomy.
What are Annuloplasty and the IDET Procedure?
Annuloplasty and the IDET procedure involves thermal heating of the annulus (outer area of the disc) to seal annular tears and destroy nerve fibers that innervate the outer third of the annulus. This controlled heating of the disc material may result in disc related shrinkage and reduction in pain. The IDET procedure requires threading a curved resistive heating wire around the posterolateral annulus under fluoroscopic guidance. The wire is then heated to 90 degrees C.
What are Nucleoplasty and Percutaneous Discectomy?
Nucleoplasty involves removal of intraventrebral disc nucleus (center of disc) by coblation plasma technology. This is a fairly new technology that decompresses the disc while preserving healthy tissue. Percutaneous Discectomy involves using an instrument called the Kekompressor. This device connects to a 17 gauge shaving needle used to remove portions of the nucleus. This device is helpful for small contained disc protrusions.
How is the procedure performed?
Intradiscal procedures are performed by Dr. Jagodowicz in an operating room setting as an outpatient. An IV will be started so that relaxation medication can be given during the procedure. You will be lying on your stomach on a special x-ray table. All precautions will be taken to ensure a sterile environment during the procedure. A local anesthetic will be used to numb the skin over the back area. Dr. Jagodowicz will then direct a special needle or device using x-ray guidance, into the disc space. When proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, the treatment will begin.
Is the Procedure Painful?
You may feel some pressure sensation as the disc space is entered. You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.
Are there any Risks or Side effects from the Procedure?
Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for this procedure. Although rare, nerve injury may occur and you might develop an infection of the disc known as discitis.
Who should not have this procedure?
If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure. The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. If you are pregnant, you should not have this procedure.
What are my Pre/Post Procedure Instructions?
Patients should have nothing by mouth for at least 6 hrs. prior to the procedure. You may take your regular medication (blood Pressure) with a sip of water. You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.