Targeted Disc Decompression (TDD) for Contained Herniated Lumbar Discs

Exclusion Criteria

• •Negative response to a transforaminal epidural injection. Injection must be performed \< 6 weeks before start treatment but least 2 weeks before start treatment
• •Neurological investigation by neurologist. Symptoms should be clinical related to the disc herniation level.
• •Age \>18 and \< 50 years
• •Mean pain on visual analogue scale (VAS) \>50 mm (0 -100)
• •Herniated disc with more then 33% obliteration of the spinal channel.
• •Annulus rupture with sequestrated herniated disc.
• •Pain on VAS below 50 mm
• •Pain existing longer then one year
• •Less then 50% preserved disc height
• •Conflict with social security/insurance
• •Major motor impairment as a result of the herniation, paresis gr 3 MRC or more
• •Other degenerative causes of nerve root compression; ligament flavum or facet joint hypertrophy, degenerative spinal channel stenosis, loss of lumbar kyphosis, discopathy with signs of Schmorls' nodules and loss of nucleus pulposus signal. Other causes of radicular syndrome such as cancer, radiculitis or neural degeneration.
• •Spinal instability (spondylolisthesis, spinal fracture or tumor)
• •History of back surgery, chemonucleolysis or other intra discal procedures
• •Coagulopathies or oral anti-coagula therapy
• •Infection
• •Pregnancy