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Spine / Disc Annuloplasty
What Is Annuloplasty?
Annuloplasty, also known as an intradiscal electrothermal therapy (IDET), is a minimally invasive spine procedure used to treat discogenic low back pain caused by damage or small tears in the tough outer layer of an intervertebral disc. These tears allow disc material to leak and irritate nearby spinal nerves, leading to chronic pain.
A specialised device delivers heat or radiofrequency energy into the disc to seal the tears, stabilise the disc structure, and reduce nerve sensitivity. Annuloplasty is considered an alternative to open spine surgery for selected patients who have not responded to conservative treatments.
What Does Annuloplasty Treat?
Annuloplasty is commonly performed to address discogenic pain originating from the lumbar spine, a condition that can cause significant discomfort and limit daily function. It is generally considered for patients with:
Lumbar Discogenic Pain: This refers to persistent low back pain that arises from internal disc damage, particularly involving the annulus fibrosus—the tough outer layer of the intervertebral disc. Unlike pain caused by nerve root compression, discogenic pain is typically localized to the lower back and does not radiate down the legs.
Annular Tears: These are small fissures or tears in the annulus fibrosus. Such tears can allow inflammatory mediators and chemical irritants to leak out and irritate surrounding nerve endings, leading to chronic pain and discomfort.
Failed Conservative Treatment: Patients who have not experienced sufficient relief from non-surgical interventions may be considered candidates for annuloplasty. The procedure serves as a minimally invasive alternative before progressing to more extensive spinal surgery.
Who is a Suitable Candidate for Annuloplasty?
Annuloplasty is suitable for individuals whose symptoms align with specific criteria and have not responded to conservative care. Ideal candidates usually:
Have Chronic Low Back Pain: Particularly pain that has persisted for months and is unresponsive to medications, physiotherapy, or other non-surgical treatments. The pain is often dull, aching, or deep-seated rather than sharp or radiating.
Show Signs of Discogenic Pain: Diagnostic tools such as MRI, CT scans, or discography are used to identify internal disc disruptions or annular tears. Patients whose imaging shows damage to the disc (particularly the annulus fibrosus) are more likely to benefit.
Prefer a Less Invasive Option: Annuloplasty is a minimally invasive procedure performed through a small incision or via needle access on an outpatient basis. It appeals to patients who wish to avoid traditional open spine surgery.
Have Localised Pain Without Major Nerve Compression: Annuloplasty is generally more effective when the pain is discogenic and not due to conditions like herniated discs pressing on spinal nerves, or spinal stenosis.
How is Annuloplasty Performed?
Annuloplasty is typically performed as a day procedure under local anaesthesia with sedation. It is guided by fluoroscopy (real-time X-ray) to ensure precise access to the affected disc. The general steps include:
1.
Preparation: You will be positioned on your stomach, and the skin over your lower back is cleaned and numbed. Sedation will be given to keep you relaxed.
2.
Accessing the Disc: A small needle or cannula is inserted through the skin and soft tissues to reach the target disc under image guidance.
3.
Delivering Thermal Energy: A specialised catheter is placed into the disc’s annulus. Controlled heat is delivered to shrink collagen fibres, seal annular tears, and reduce pain-conducting nerve endings.
4.
Completion: The instruments are removed, and a small dressing is applied. No stitches are usually needed. Patients typically remain in a recovery area for observation before going home.
What to Expect Before and After Annuloplasty
Consultation: Your doctor will assess your medical history, symptoms, and imaging results to confirm whether your back pain is likely discogenic in origin.
Preoperative Instructions: You may be asked to avoid certain medications, fast before the procedure, and arrange for someone to accompany you home afterward.
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Frequently Asked Questions
The procedure typically lasts less than an hour, depending on whether it is performed alone or as part of another intervention.