In brief
- This is a supplementation procedure. It is not a repair of the outer disc wall and not a decompression; it does not remove a herniation or treat nerve compression.
- Expect increased back soreness for the first 3 to 7 days, occasionally up to 2 weeks.
- Meaningful change typically begins between 6 and 12 weeks and continues to build through 6 months. Do not judge it early.
- Escalating back pain days to three weeks afterward, worse at rest or at night, with fever or night sweats, could be discitis. Call immediately.
Understanding your diagnosis
The center of a spinal disc, the nucleus pulposus, is a gel-like matrix that holds water under pressure and allows the disc to carry and distribute load. As a disc degenerates, that matrix loses its proteoglycan content and its ability to hold water. The disc flattens, loses its internal pressure, and transfers load onto the outer ring of the disc and the facet joints behind it. Pain generated by the disc itself, discogenic pain, is typically deep, central, axial low back pain that worsens with sitting, bending forward, and prolonged loading, and eases when lying down.
The treatment
This procedure delivers particulated human nucleus pulposus tissue, from a screened and processed donor, directly into the center of the degenerated disc. The purpose is to supplement what the disc has lost: the structural matrix components, proteoglycans and collagen, that give the nucleus its water-holding capacity, along with the associated cellular and growth-factor content.
This is a supplementation procedure. It is not a repair of the outer disc wall, and it is not a decompression; it does not remove a herniation and does not treat nerve compression.
Our approach
The procedure is performed entirely through a needle, with no incision. Under live X-ray, a needle is advanced by a posterolateral approach, the same trajectory used for discography, into the center of the target disc. Position is confirmed on two planes before graft is delivered. Sterile technique is strict and antibiotics are given, because infection inside a disc is the principal serious risk of any intradiscal procedure.
Before your procedure
For your safety, certain medications must be held before your procedure to minimize the risk of bleeding, following American Society of Regional Anesthesia guidelines. This procedure requires the 24-hour NSAID hold.
| Medication type | Examples | Required hold |
|---|---|---|
| NSAIDs | Ibuprofen, Motrin, Aleve, naproxen, meloxicam | 24 hours |
| Salicylates | Aspirin, all doses | 24 hours |
| Antiplatelets | Plavix (clopidogrel), Brilinta | 7 days |
| Antiplatelets | Effient (prasugrel) | 10 days |
| Anticoagulants | Eliquis, Xarelto, Savaysa, Pradaxa | 5 days |
| Vitamin K antagonist | Coumadin, warfarin | 5 days (INR below 1.5) |
Restarting
Most medications can be restarted 24 hours after the procedure. NSAIDs and aspirin may be resumed immediately.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed under live X-ray (fluoroscopy) for precise needle placement.
- Antibiotics given beforehand, with strict sterile technique throughout.
- Local numbing medication with light IV sedation for comfort.
- No incision and no stitches. The procedure takes approximately 30 minutes.
- You go home the same day.
Benefits
- Targets the degenerated nucleus itself rather than only blocking pain signals.
- Percutaneous: no incision, no bone removal, no hardware, no fusion.
- Preserves motion at the treated segment.
- Does not close off future treatment options.
Recovery
- Same-day discharge; walking the same day.
- Expect increased back soreness for the first 3 to 7 days.
- Restrictions on bending, lifting, and twisting for 2 weeks.
- Improvement is gradual, generally beginning at 6 to 12 weeks and continuing over 3 to 6 months.
Afterward: what to expect
Discitis: the warning that matters most
Infection inside a disc (discitis) is uncommon but is the most serious complication of any intradiscal procedure. It characteristically appears as severe, escalating back pain beginning several days to three weeks after the procedure, pain that is worse at rest and at night rather than improving, often with fever or night sweats. Discs have very little blood supply, so these infections are difficult to treat and require prolonged intravenous antibiotics. Do not wait it out. Call immediately, or go to the emergency department after hours.
- The flare. An increase in back pain and stiffness for 3 to 7 days is expected and common. Occasionally it persists up to 2 weeks. Ice 20 minutes on, 20 off; continue your baseline medications.
- Timeline. This is not a procedure with immediate relief. Meaningful change typically begins between 6 and 12 weeks and continues to build through 6 months.
- Do not judge it early. Assessing benefit before 3 months is not meaningful and leads to abandoning a treatment that had not yet had time to work.
Activity
Puncture site care
Your procedure in one paragraph
You have undergone percutaneous intradiscal delivery of particulated nucleus pulposus allograft into the degenerated disc identified as your primary pain generator. Using live imaging, graft material was placed into the nucleus through a needle, with no incision. The intent is to supplement the disc's depleted matrix. Response develops over months, not days.
Follow-up schedule
- 1
2 weeks
Symptom check; lifting restrictions lifted.
- 2
6 weeks
Functional reassessment; therapy may begin.
- 3
3 and 6 months
Formal outcome assessment. Keep a simple record of pain and walking or sitting tolerance between visits.
Call us right away if you notice
- Back pain that escalates rather than settles after day 3 to 5, especially severe pain at rest or at night
- Fever, chills, or night sweats
- New leg weakness, numbness, or foot drop
- Loss of bowel or bladder control
- Redness, swelling, or drainage at the needle site
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.