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.