Traitements percutanés intra-discaux dans les lombosciatiques et les lombalgies

Percutaneous techniques have been developed with the aim of proposing a treatment of the sciatica more effective than epidural injections and less aggressive than surgery. Open studies suggest their capacity to bring a longer relief than the one of steroid injections. Their mechanism of action seems linked to a limitation of the suffusions of nucleus pulposus through the annulus fibrosus. Two techniques have been described: nucleolysis with physico-chemical action and nucleotomy with physical action. Controlled studies to evaluate their efficacy are rare but when they exist, they show a positive effect. In low back pain, the aim of percutaneous treatment is both to reduce pain, by reducing the intradiscal receptors of pain, and the intra- and peripheral disc inflammation. The method consists in thermal techniques and chemical techniques. The interest of the thermal techniques seems limited. The intradiscal injection of acetate of prednisolone might be indicated in Modic I discopathy.