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Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: Early results

Naresh Kumar, MBBS, MS (Orth), DNB (Orth), FRCS (Ed), FRCS (Orth & Trauma), DM (Orth),1 Aravind Kumar, MBBS, MRCS (Glasg), FRCS (Tr.&Orth.),2 Shah Siddharth M, MBBS, MS (Orth),3 Shah Sambhav P,MBBS, MS (Orth),1 Justin Tan, MBBS3

1University Spine Centre, National University Hospital, Singapore, 2Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore 3Department of Orthopaedic Surgery, National University Hospital, Singapore 



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.


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.


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).

Conclusions and level of evidence

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.

Clinical relevance

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.

Annulo-nucleoplasty, Disc-FX, lumbar disc disease, lumbar disc prolapse, degenerative disc disease
Volume 8 Article 18 - Endoscopic & Percutaneous Special Issue