FAQ - Interdiskal Thermal Annuloplasty

Q :		What is an intervertebral disk or disk?
A :		An intervertebral disk is the structure between two vertebral bodies. These vertebral bodies are the weight bearing parts of the spine. Between each body is a structure which has two parts. The first is a circular ligament called the annulus which holds the two vertebrae together. The second is the nucleus which acts as a cushion between the two disks and is kept centered between the two disks by the annular ligament.

Q :		How can I get more information about the intradiskal thermal annuloplasty?
A :		Each individual presents special problems and considerations, and it is probably necessary to have an office visit and consultation with the physician to determine whether or not one might be a good candidate for the intradiskal thermal annuloplasty.

Q :		Then what is a herniated disk?
A :		A herniated disk occurs when the annular ligament fails to do it’s’ job and allows the nucleus to leak through the annular ligament or be herniated which in itself causes back pain. If the nucleus herniates completely through the disk, it will cause pressure on the nerves which traverse the neural canal and go down to the lower body parts causing sciatica. Herniated disks frequently start between age 25 and 35. They begin with an innocuous episode of low back pain, which improves after a period of several days or several weeks only to recur several months or years later. The episodes recur over and over again, each episode tending to be more severe and taking longer to improve. After one or more recurrences, the symptoms may prove to be on-going. Many conservative methods of treatment not involving surgery are available for herniated disks.

Q :		What is an intradiskal thermal annuloplasty?
A :		This is a new technique in which a heating element is placed in the disk, and the weakened area of the disk is “sealed over.” This part of the disk is shrunken and the small nerves in this area are deadened in order to eliminate discogenic pain.

Q :		How do I know if intradiskal thermal annuloplasty is for me?
A :		Intradiskal thermal annuloplasty is best for people who have not responded to conservative back treatment, have primarily back pain, and whose studies have demonstrated that the pain appears to be coming from a particular disk and the disk is not severely ruptured.

Q :		How much pain does the procedure intradiskal thermal annuloplasty cause?
A :		There is very little if any discomfort from the procedure itself. It is done in a hospital under local anesthesia with intravenous analgesia. There is usually no more than minimal low back pressure noted during the procedure. Minimal back discomfort if any is noted after the procedure which if present is usually easily controlled with oral pain medication.

Q :		How long do I need to be in hospital for intradiskal thermal annuloplasty?
A :		Usually and hour-and-a-half to two hours time in the hospital is sufficient.

Q :		What is the recovery time after intradiskal thermal annuloplasty?
A :		Recovery time after intradiskal thermal annuloplasty depends on one’s activity level and job requirements. We generally recommend that people keep their activities low to moderate for at least several days. Recovery may take up to four to six weeks, and if the symptoms persist, activity should be kept low. In general, only a little discomfort is present after the procedure.

Q :		What does the term intradiskal procedure mean?
A :		The term intradiskal procedure refers to minimally invasive surgery usually done under local anesthesia as an outpatient, the purpose of which is to remove some of the disk or alter the structure of the disk causing pain reduction in the low back. This usually includes either laser arthroscopic percutaneous diskectomy or intradiskal thermal annuloplasty.

Q :		What is the difference between intradiskal thermal annuloplasty and laser arthroscopic percutaneous diskectomy?
A :		Laser arthroscopic percutaneous diskectomy (also known as LAPD or lase) has the ability to actually remove some of the disk material pushing out through the annular ligament into the nerve canal. By decompressing the disk in this manner, frequently pain can be relieved. Laser arthroscopic percutaneous diskectomy is probably better for leg pain than for back pain, but it may relieve both. Intradiskal thermal annuloplasty relieves back pain by sealing over and contracting the annular ligament fibers, which have been injured in the disk. It also deadens the nerves in this region which are thought to be responsible for back pain. It in general tends to be better for back pain than for leg pain, but may also relieve leg pain.