Discography, IDET, Percutaneous Discectomy, and Nucleoplasty: Complications and Their Prevention

ABSTRACT Objective.  The ability to access the intervertebral disk percutaneously using image guidance has proven to be a safe approach that allows for diagnostic and therapeutic interventions within the nucleus pulposus. Among the most common techniques currently in use are discography, intradiscal electrothermal therapy (IDET), and nucleoplasty; complications have been described but are uncommon. The objective of the current manuscript is to review the available literature regarding complications associated with these intradiscal techniques. Design.  This report describes a patient with chronic low back pain associated with lumbar degenerative disc disease who is a typical candidate for diagnostic discography and treatment with intradiscal approaches. In the current manuscript, the available reports detailing complications associated with each of these techniques are reviewed, and recommendations for prevention are outlined. Conclusions.  All of these techniques share the common element of introducing a cannula into the nucleus pulposus using a percutaneous approach, and direct trauma to the spinal nerve can occur. Likewise, bleeding and infection can follow the introduction of the cannula. With any of these intradiscal techniques, discitis is an inherent risk, a delayed and insidious infection within the disk space that can be difficult to diagnose and treat. The thermal wire used to perform IDET is subject to mechanical breakage, and the thermal energy delivered during both IDET and nucleoplasty can cause direct thermal injury to neural elements when incorrectly positioned. With use of prophylactic antibiotics, sterile technique, and disciplined use of image guidance, the incidence of these complications can be minimized.