Percutaneous intradiscal radiofrequency treatment of the intervertebral disc nucleus for low back pain

3 The procedure

3.1 Percutaneous intradiscal radiofrequency treatment aims to enhance the structural integrity of the intervertebral disc. It aims to reduce low back pain by using radiofrequency heat energy to alter the biomechanics of the intervertebral disc and to destroy the nociceptive pain fibres.

3.2 Provocative discography is sometimes used before this procedure, to identify the symptomatic disc. The procedure is done with the patient under sedation in the prone position and using local anaesthesia. A needle is inserted into the disc under fluoroscopic guidance. An electrode or flexible catheter is then passed through the needle and into the centre of the disc nucleus. Once in position, it is slowly heated and kept at the chosen temperature (around 70ºC) for a predetermined time, usually for about 1–2 minutes, before it is removed.

3.3 A recent modification to this procedure uses pulsed radiofrequency, which generates less heat in the disc nucleus but is applied for a longer period of time.