Disc Biacuplasty

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 26 January, 2011


For many years, chronic discogenic pain due to intradiscal degeneration was treated with conservative therapy that included rest, drugs, physiotherapy and epidural injections having a very brief in duration analgesic effect.

Whenever conservative treatment failed, patients would proceed to very high risk surgery of the spine. Disc Biacuplasty (discoplasty of annulus fibrosus) is a new minimally invasive technique bringing significant pain relief or even elimination of pain for a long period (about 2 years). Pain may not reccur. The patient avoids undergoing serious surgery and resumes quickly to various activities without depending much on analgesic drugs. It is applied when the pain is resistant to conservative treatment and before taking the decision for a big surgical operation.


Disc Biacuplasty is performed with the use of two special needles that are inserted into the intervertebral disc, two electrodes that are advanced intradiscally through the needles and an internally water-cooled system connecting electrodes with the radiofrequency generator. The two active ends of electrodes that are placed within the  annulus fibrosus of the disc create inbetween them an electric field of controlled temperature and deactivate the nociceptors that are  located in the annulus fibrosus at the posterior part of the intervertebral disc. The temperature developed in the disc periphery, next to the spinal canal, is lower than that developed in the interior of the disc, so that the nerve roots and spinal cord are not in risk for thermal lesion. Two different sensors attached to the electrodes, measure temperature values which appear on the generator screen. (7,8,10)


The intervention is performed under local anaesthesia of the skin and the deeper tissues located along the course the needles are going to follow in order to enter the disc. Local anaesthesia should not be done in big depth so as to avoid anaesthetizing the nerve root exiting the intervertebral foramen. In this way, the patient remains conscious with light sedation, communicating with the doctor and reporting any paraesthesia felt in case the needle potentially comes in contact with the nerve.

Needles and electrodes are placed into the disc under fluoroscopic guidance and under strictly aseptic conditions to avoid provocation of discitis (disc infection). As soon as electrodes are placed and their proper position is ensured by fluoroscopic images from anteroposterior and profile views, the radiofrequency treatment is performed with a duration of exactly 15 minutes.


As in every pharmaceutical and interventional treatment, there are some potential risks and complications which here, though, are very rare.  There is risk for infection and that is why the technique is applied under aseptic conditions and the patient takes preventive antibiotic therapy before and after the treatment. There is a risk for nerve injury while the needle advances to the disc but this is avoided because the technique is performed with the patient under conscious light sedation. Should the electrodes not be placed properly, there is risk for nerve thermal lesion, but this is controlled with the use of fluoroscopy that clearly shows the exact position of the active radiopaque electrode terminals. Should the patient report pain in the lower limbs or groin, the treatment has to be discontinued. During this procedure, the patient may feel mild pain in the low back.

Following the intervention, the patient may feel numbness in legs (disappearing several hours later when the local anaesthetic action is gone) and pain at the acupuncture sites. This latter pain is treated with simple analgesics and subsides within a few days.


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