الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Low back pain is one of the most common medical problems of the middle age population .Most of this low back pain arise from pathology in the intervertebral disc, either directly through disc prolapse,or indirectly via degenerative disc disease that transmits unfavourable load to other spinal segements.
Intervertebral discs are composed of a semiliquid central portion,the nucleus pulposus,two cartilage plates that separate the nucleus from the adjacent vertebral bodies,and a thick ring of fibrous tissue , the annulus fibrosus.
The intervertebral discs stabilize the spine and maintain its alignment by anchoring adjacent vertebral bodies to each other The intervertebral discs allow the movement between vertebrae that gives the spine its flexibility, and they absorb energy and distribute loads applied to the spine.
The degeneration process of lumbar discs is divided into three stages which are dysfunction,instability and stabilisation stage.Disc herniation is considered a complication of disc degeneration in the dysfunction and instability stages.Disc prolapse can be categorised into protruded, extruded and sequestrated.More than 90% of herniated lumbar discs located in the 4th and 5th interspaces with about the same frequency at these two levels.
Treatment of lumbar degenerative disc disease is ranging from non surgical conservative treatment up to open surgery.Several surgical procedures are used including the standard open discectomy, endoscopic microdiscectomy .
Intradiscal therapy including various techniques as Chemonucleolysis, Laser Nucleotomy, Intradiscal Electrothermal therapy (IDET), Attempt disc regeneration is used sucessfully in treatment of contained degenerative disc disease.
Chemonucleolysic is intradiscal enzyme therapy done by enzymatic dissolution of the nucleus pulposus by transcutaneous intradiscal injection of chymopapain or other enzymes by using intradscal needle under fluoroscopic visualization result in hydrolysis and shrinkage of the nucleus and relieves the pressure of the protruded disc on a nerve root and thereby relieves the pain.
The IDET is done by the use of intradiscal catheter which delivers thermal energy directly to annular wall tissues and the disc nucleus via a resistive heating coil. It is designed for creating temperature controlled coagulation, destroying annular nerve receptors, and shrinking collagenous tissue.
Percutaneous laser disc nucleotomy is aiming to vaporise a small portion of the nucleus pulposus of the intervertebral disc, thereby reducing the volume and pressure of a diseased disc. The central cavity that has been fashioned is believed to suck the protrusion back within the disc.
Percutaneous nucleoplasty is a technique which uses radiofrequency energy to ablate the nucleus pulposus in a controlled manner for disc decompression.
Selection of patients in the previous three procedures have inclusion criteria which is for patients with chronic back pain especially, with mild to moderate degenerative disc disease, absent radicular symptom’s, and a positive MRI Imaging and lumbar discography and that does not respond to at least 6 months of conservative treatment.