title: Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: early results.
abstract: BACKGROUND
  Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce.
  
  
  METHODS
  We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups - those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively.
  
  
  RESULTS
  The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11).
  Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence.
  
  
  CONCLUSIONS
  We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.
authors.affiliation: University Spine Centre, National University Hospital, Singapore.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
authors.forename: Aravind
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore.
authors.forename: Shah
authors.initials: S
authors.lastname: Siddharth M
authors.affiliation: University Spine Centre, National University Hospital, Singapore.
authors.forename: Shah
authors.initials: S
authors.lastname: Sambhav P
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore.
authors.forename: Justin
authors.initials: J
authors.lastname: Tan
keywords: Annulo-nucleoplasty; Disc-FX; degenerative disc disease; lumbar disc disease; lumbar disc prolapse