Indications for Minimally Invasive Disk and Vertebral Procedures

Objective.  This article reviews some of the interesting advances that have taken place in the treatment of chronic lower back discogenic pain and leg pain associated with disk protrusion. Indications, including patient‐selection criteria, of selected minimally invasive procedures are discussed. Design.  Comprehensive review. Results.  Several nonsurgical approaches to discogenic pain are described, including minimally invasive annular heating procedures like Intradiscal Electrothermal Therapy (Smith and Nephews, London, UK), DiscTrode (Radionics Inc., Burlington, MA) and Intradiscal Biacuplasty (Baylis Medical Inc., Montreal, Canada). Careful selection of the patients may significantly improve the success rates of these procedures. Significant advances in treatment of predominantly leg pain caused by contained disk protrusion are also described. A few percutaneous minimally invasive modalities of discectomy or disk decompression have become therapeutic alternatives to open surgical procedures and may produce similar clinical improvements. In addition, patients may rapidly return to their baseline functional capacity. Unfortunately, there are no good clinical comparison studies or even individual prospective controlled studies to confirm such a claim. Kyphoplasty and vertebroplasty are established as minimally invasive, interventional techniques that decrease pain and improve function in patients with fractured vertebrae due to osteoporosis and other osseous lesions such as metastases, multiple myeloma, and hemangiomas. Conclusions.  Several percutaneous minimally invasive disk and vertebral procedures for the treatment of back and neck pain were introduced recently. Sufficient clinical evidence to accept these new treatment modalities is still lacking and will probably require years to accumulate.