What is an Endoscopic thermal annuloplasty?

An Endoscopic thermal annuloplasty treats the posterior third of the disc, this area of the disc is often the site of annular tears. An endoscopic thermal annuloplasty uses a thermal probe to treat the tear which is filled with fibrous tissue containing painful free nerve endings. The procedure may be performed through the endoscope using a transforaminal approach (off to the side) and may occur after a discectomy. 

What is an annular tear? 

Annular fissures, often diagnosed as Annular tears or commented on as Hyper intense zones (HIZ) on MRI, are areas in which the outer ring of the intervertebral disc has separated. Tearing or separation of fibers in the annulus occurs in the posterior portion of the disc due to the orientation of the fibers in this region.

 Are all annular tears painful? 

No. Literature review has indicated that the prevalence of annular tears in patients with low back pain range from 3 to 61%. While patients with annular tears who do not have low back pain have been noted in 2 to 3% of patients [1]. When controversy exists whether anatomical changes observed on MRI are painful, it is essential to remember that no imaging study alone is sufficient enough to make a clinical diagnosis. The location of pain sensing bundles called dorsal root ganglion (DRG) is variable within our spinal cord. If you are unlucky enough to have damage near your DRG, then you will be in pain. 

Why would an annular tear be painful? 

It is believed that local inflammatory reactions from the annulus fibrosus tear lead to irritation of adjacent nerve fibers, ligaments or traversing nerve roots. Furthermore, nerve rich tissue called granulation tissue can fill the tear and irritate adjacent ligaments during movement. Lastly, annular tears represent a deficiency in the disc’s ability to distribute load which may facilitate further disc derangement and pain. 

What are the symptoms of an annular tear? 

Persistent midline back pain that may or may not be associated with radiating leg pain. Prolonged sitting, bending, lifting, and straining often precipitate disc mediated or discogenic low back pain. Pain relief may occur with rest or change in position. What is the purpose of the procedure? To preserve the motion of your spine and the nucleus of your disc while treating discogenic mediated pain. 

How is pain relief obtained? 

An Endoscopic thermal annuloplasty may release intradiscal pressure while treating painful granulation tissue that can alleviate pain from an inflamed disc. 

What makes a good candidate?

Back pain that persists despite the conservative and interventional treatment of potential anatomical contributors. Imaging studies correlate with your symptoms. At that stage in care it would be an appropriate time to discuss endoscopically guided thermal annuloplasty with our physician. 

How is the procedure performed?

Endoscopic thermal annuloplasty is an outpatient procedure and is performed through a 7-8mm tube using a radiofrequency probe. A 1/4 inch incision is made in the skin to gain access to the disc annulus. 

What are other treatment options? 

Posture awareness, improved flexibility, aquatic therapy and weight control are essential nonsurgical treatment methods. Core stabilization is used to strengthen core musculature which can mitigate load bearing pressures on the side. Other surgical options for disc derangement include spinal fusions (with and without instrumentation), and total disc arthroplasty. 

 

Works Cited [1] Teraguchi, Masatoshi et al. “The association of high-intensityULTS!