Lumbar Disc Nucleus Replacement for Refractory Back Pain: A Case Report

Back pain is one of the most common sources of pain and disability in the world. The value of surgically treating discogenic low back pain (dLBP) is controversial and currently limited to fusion or total disc replacement. The clinical case presented is a 25-year-old man with 5 years of spontaneous onset low back pain refractory to medical care. The patient was enrolled in a Phase 1 clinical trial designed to test the safety profile of a novel nucleus replacement device. He underwent a left-sided anterior retroperitoneal approach, nuclectomy and implantation of the PerQdisc. At the 2-year follow up period his pain scores had improved significantly. Dynamic radiographs demonstrated 23.4 degrees of segmental motion with no suggestion of inflammation on MRI. This case demonstrates successful diagnosis of dLBP and surgical treatment using a novel motion-sparing and form-fitting nucleus replacement device, in the context of a clinical trial. While the diagnostic criteria used in this case report may be a useful guide to identify other patients with dLBP, the surgical treatment offered should be interpreted with caution until appropriate clinical trials are presented.