What is Disc Denervation?

Disc denervation explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Prolapsed DiscDisc denervation is a procedure designed to treat certain types of chronic back pain, more specifically, conditions caused by defects in the intervertebral disc located between pairs of vertebrae (spinal bones). Chronic pain associated with disc anomalies is also termed discogenic pain. Disc denervation is the disruption of spinal nerves that transmit discogenic pain signals with electrothermal probes. This renders these nerves unable to conduct signals and, therefore, brings relief from chronic pain. Disc denervation is also known as radiofrequency (RF) denervation, or radiofrequency ablation.

This procedure has been demonstrated safe, and effective in comparison to other minimally-invasive alternatives to spinal surgery. Disc denervation is a popular and widely-used procedure. Over 75,000 of these procedures have been performed in the last 16 years. Disc denervation results in a reduction of chronic pain and in the deficits in normal function and movement that often accompany this.

How is Disc Denervation Performed?

Procedure PreperationThe patient lies in a face-down position on an operating or X-ray table. Local anesthetics, and IV sedatives if required, are administered. Heart rate, breathing, and blood pressure are mechanically measured during the procedure. The spinal nerves, and the specific areas that control pain signaling, are located using imaging techniques such as fluoroscopy. The radiofrequency probe is inserted through anesthetized skin and delivered to the desired location. Electrothermal (i.e. RF) impulses are applied to the nervous tissue in question. This will create a lesion on the spinal nerve and prevent it from sending painful signals from the disc to the brain. The probe is then carefully removed and the insertion site is covered. Disc denervation procedures typically take under an hour to perform.

Radiofrequency denervation is reported as successful in inhibiting chronic pain in 60% to 70% of cases. In addition to pain relief, patients in whom denervation is a success show a significant improvement in mobility and functional status. There is a low incidence of adverse events associated with disc denervation. Risks include infection, bleeding, and discomfort at the probe insertion site.

Conditions Related to Disc Denervation

Bulging DiscPatients experiencing chronic, treatment-resistant pain for six months or more, that is diagnosed as being discogenic, may consider denervation to achieve adequate relief. Discogenic pain is most often associated with bulging (or herniation) in intervertebral discs. It is also associated with degeneration of disc tissue and spinal stenosis, which is a compression of the spinal cord due to the accumulation of scar tissue inside vertebrae.

Discogenic pain is best understood with an awareness of intervertebral discs and their structure. The part of the skeleton known as the spine is made up of 33 vertebrae, interconnected by joints known as facet joints. Each vertebra is separated from another by a disc that sits on the larger part of the bone below. The discs function as the shock absorbers of the spine, facilitate movement and protect the spine from dislocation or potentially harmful deformations.

Disc DenervationThe outer part of the disc, the annulus fibrosus, is made of tough fibrous material. The inner disc is called the nucleus pulposus and is made of softer, spongy tissue. If this breaks down, blood flow to the disc is interrupted and the inner ring desiccates. The annulus fibrosus simultaneously loses its strength and is prone to breakage. This is known as degenerative disc disease and is mostly associated with advancing age.

In cases of disc herniation, the annulus may weaken while the material of the nucleus protrudes outward, resulting in compression or irritation of spinal nerves, which causes chronic pain. This may be associated with natural wear and tear over time or with trauma, such as an accident or injury. This condition, also known as bulging disc syndrome, can cause numbness, tingling, and pain in the arms and hands if it occurs in the cervical spine. If discs bulge lower down in the back, this may create the same symptoms in the lower extremities.

Conclusion

Disc denervation has been shown to be a safe and effective method of treating chronic pain associated with defects or disorders of intervertebral discs. Denervation involves the disruption of spinal nerve tissue responsible for sending pain signals originating from discs to the brain. This is achieved via the insertion of radiofrequency probes. Disc denervation is effective in treating pain from degenerative or bulging discs in up to 70% of cases treated.

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References

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  3. Levin JH. Prospective, double-blind, randomized placebo-controlled trials in interventional spine: what the highest quality literature tells us. Spine J. 2009;9(8):690-703.
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