As many as six million Americans suffer from chronic disabling back pain, and though there are several possible causes, lumbar disc herniations and tears are two of the most common. Until fairly recently, the only treatment option for these patients who could not find relief with conservative therapies was open discectomy. Although often effective, this inpatient procedure requires general anesthesia, muscle dissection, bone removal and, at times, bone fusion. At the high end, these open procedures can cost as much as $35,000.

Today, outpatient facilities have the option of offering these patients several high-technology procedures that are much less invasive and may avoid or postpone the need for open surgery and fusion. Three of these newest procedures include nucleoplasty, intradiscal electrothermal therapy (IDET), and selective endoscopic discectomy.

Nucleoplasty
Nucleoplasty is a method of decompressing a contained herniated disc by ablating and coagulating part of the nucleus (Figures 1a,b). A herniation is ?contained' when the nuclear material, although bulging, remains inside the disc wall, or annulus. The bulge can cause leg and lower back pain when it impinges on the nerve root or spinal cord. When the clinician removes part of the nucleus, the nuclear material can recentralize inside the disc, thereby reducing or eliminating the herniation and associated pain.

Postoperatively, there is typically little discomfort and no strict rehabilitation protocol. Some centers will use a soft brace, others will recommend two days of bed rest, and still others prefer a slower, progressive return to function.

Indication
Besides having a diagnosis of symptomatic contained herniated disc, the ideal candidate is young, has well-maintained disc height (