[Interventions on the intervertebral discs. Indications, techniques and evidence levels].
OBJECTIVE
Over the last decades a number of different minimally invasive interventions have been proposed for the treatment of intervertebral disc herniation and degeneration. All of these interventions aim at relieving pressure from compressed nerve roots by mechanical ablation, chemical dissolution, evaporation or coagulation of disc tissue.


METHODS
Microsurgical sequestrectomy with direct visualization of the spinal canal.


METHODS
Minimally invasive intradiscal interventions, such as chemonucleolysis, manual and automated disc decompression, laser disc decompression, nucleoplasty and thermal anular radiofrequency (RF) techniques with posterolateral access to the intervertebral disc.


METHODS
The effectiveness and safety of the different minimally invasive procedures are compared to the standard surgical procedure on the basis of a literature review.


RESULTS
For patients with disc herniation requiring surgery, microsurgical sequestrectomy is the treatment of choice, while discectomy is obsolete. Intradiscal procedures have a low level of evidence while long-term results are still lacking. Randomized controlled trials are required to generate evidence-based results.


CONCLUSIONS
Indications for treatment should be established by an interdisciplinary team with the choice of treatment depending on the interventionalist's expertise and skills. In carefully selected patients scheduled for elective treatment, the different minimally invasive procedures allow adequate treatment when performed by an experienced interventionalist.
Klinik für Radiologie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. florian.streitparth@charite.de.
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Streitparth
Zentrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
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D001416:Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D018579:Patient Selection; D016896:Treatment Outcome
Herniated disc; Intervertebral disc degeneration; Low back pain; Minimally invasive techniques; Radiculopathy