Target-oriented Percutaneous Lumbar Annuloplasty in Ambulatory Spine Center: Proctorship Description of Technique

Objective: To describe an alternative technique of annuloplasty for treatment of chronic discogenic back pain in an ambulatory setting. Methods: A retrospective review of all patients presenting with chronic discogenic low back pain and managed by target-oriented thermal annuloplasty at our institute from May 2015 to June 2019 was performed. The procedure is carried out under local anaesthesia in prone position. The principle of the technique relies on dividing the posterior annulus into nine equal segments on AP-view of the C-arm. The trajectory is through the Kambin’s triangle in a horizontal trajectory as much as possible to target the posterior part of the disc annulus. Each of the nine segments is treated with radio-frequency probe to produce disc alterations required to relieve the pain. Results: A total of 9 patients were treated by this method with an average follow-up of 28.1±11.4 months. The average VAS improved from 4.1±1.2 to 2.5±0.4 at final follow-up. The ODI improved from 42±6.7 to 19.98±5.6. None of the patients had any complications. The patient satisfaction rate was 82%, the rate of return to daily life was 100% and recommendation rate to others was 100%. Conclusion: Target-oriented lumbar percutaneous nine point annuloplasty may be considered as a viable option for chronic discogenic back pain patients with relatively well-maintained disc heights. A successful outcome depends upon proper patient selection and correct trajectory.