There are three new guidelines from NICE about using various percutaneous treatments for intervertebral disc problems.
Percutaneous coblation of the intervertebral disc for low back pain and sciatica.
- NICE have advised that this procedure may be used to treat both low back pain and sciatica if conservative measures have failed and if open surgery is not suitable.
- There is good evidence for its efficacy and no major safety concerns.
- Treatment is done under sedation using local anaesthetic. Probes are inserted that allow radiofrequency to be applied to the nucleus of the disc, thus destroying it.
Percutaneous intradiscal radiofrequency treatment for low back pain.
- NICE have advised that this procedure can be used, but only with special follow-up, as the evidence for its efficacy is limited in both quality and quantity.
- In this situation, the aim is not to destroy the disc (as in coblation), but to enhance its structural integrity by altering its structure. Nociceptive fibres may also be destroyed.
- Again, it can be used where conservative treatments have failed and where open surgery is not suitable.
Percutaneous electrothermal treatment of the intervertebral disc annulus for low back pain and sciatica.
- NICE have advised that again this procedure should only be used with special follow-up as evidence on efficacy is inconsistent and of poor quality.
- The procedure is carried out in a similar way, but electrothermal energy is applied to the annulus to try to stiffen it and to destroy nociceptive fibres within it.
- They have not advised on when it is indicated.