CLINICAL AND MRI-CONFIRMED IMPROVEMENT FOLLOWING MULTIMODAL PERCUTANEOUS NUCLEO-ANNULOPLASTY FOR SYMPTOMATIC L4–L5 LUMBAR DISC HERNIATION: ONE-YEAR FOLLOW-UP

F. Saturno¹, G. Monaco¹, A. Salerno¹, A. Cianciola², N. Cianciola², E. Cianciola³ | ¹Asl Salerno, Italy; ²UniCamillus, Italy; ³SAPRI, Italy

Introduction. Lumbar disc herniation is a frequent cause of radicular pain, disability, and reduced quality of life. When conservative treatment fails, minimally invasive percutaneous techniques may represent an alternative to open decompression in selected patients with contained disc herniation. This case report describes the clinical and radiological outcome of multimodal percutaneous nucleo-annuloplasty in a patient with symptomatic L4–L5 disc herniation.
Methods. A 44-year-old male presented with severe low back pain and left-sided radiculopathy associated with neurogenic claudication. Baseline pain intensity was 8/10 on the Visual Analogue Scale (VAS). Preoperative magnetic resonance imaging demonstrated a large contained L4–L5 disc herniation with marked compression of the dural sac and complete obliteration of the subarachnoid cerebrospinal fluid signal at the affected level. After failure of conservative management, the patient underwent fluoroscopy-guided multimodal percutaneous nucleo-annuloplasty through a posterolateral transforaminal approach. The procedure combined mechanical nucleotomy, bipolar radiofrequency ablation of residual nuclear tissue, and posterior annular modulation. The intervention was performed under local anesthesia and conscious sedation. No intraoperative or early postoperative complications occurred, and the patient was discharged on the same day.
Results. The patient experienced rapid clinical improvement after the procedure. At 30-day follow-up, pain had completely resolved (VAS 0/10) and neurogenic claudication disappeared. The clinical benefit remained stable at nearly one-year follow-up, with persistent absence of pain and full return to daily and professional activities. Follow-up MRI demonstrated objective radiological evidence of neural decompression, including complete re-expansion of the dural sac and restoration of the hyperintense cerebrospinal fluid signal surrounding the cauda equina nerve roots. A minimal residual disc bulge remained visible but no longer produced neural compression.
Conclusions. In this case, multimodal percutaneous nucleo-annuloplasty provided rapid and durable pain relief, associated with clear radiological evidence of spinal canal remodeling. Restoration of dural sac morphology and cerebrospinal fluid signal on MRI appears to represent a reliable radiological marker of successful neural decompression. This minimally invasive technique may be considered in carefully selected patients with symptomatic contained lumbar disc herniation, offering clinical improvement without bone resection or open surgical decompression. Informed consent for treatment and publication was obtained from the patient, and anonymity was preserved.