Percutaneous Lumbar Thermal Annular Procedures


A major source of low back pain is internal annular disruption of the intervertebral disc, which accounts for approximately 25% of cases of chronic low back pain. Internal annular disruption refers to the irritation of nerves growing in the damaged inner annulus during the attempt to heal annular tears. Diagnosis of internal annular disruption is achieved through a procedure called discography.

Many therapies can be used to treat internal annular disruption, including conservative treatments, such as physical therapy, and epidural injections, as well as more invasive procedures such as surgical fusion. Percutaneous lumbar thermal annular procedures serve as an alternative modality to treat internal annular disruption.

A minimally invasive, low-risk methodology, percutaneous lumbar thermal annular procedures involve the application of heat to the annulus. This procedure may alleviate symptoms in patients with persistent pain and loss of function from internal annular disruption.

The goal of percutaneous lumbar thermal annular procedures is to remove unwanted tissue, limit the expression of matrix components, minimize collagen tissue, and destroy pain receptors. Percutaneous lumbar thermal annular procedures can be accomplished through a variety of means, including:

  • Radiofrequency energy

  • Thermal cautery

  • Laser

  • Electrocautery


Indications for percutaneous lumbar thermal annular procedures vary depending on the type of procedure performed. Patients who meet the following criteria may be candidates:

  • Discogenic pain confirmed by discography

  • Failure to improve after at least 6 weeks of conservative treatment

  • Patient is younger than 55 years

  • No facet disease

  • Patient displays no signs of major psychological issues

  • Posterior annular deficit

  • Axial pain greater than leg pain for 3-6 months

  • Contained disc herniated

  • Preserved disc height (>50%)