I have slowly been working my way through a long list of treatment options for low back pain. I know I have disc degeneration. I just don't want to have surgery. I've tried acupuncture, exercise, and prolotherapy. What can you tell me about disc nucleolysis?

Lysis means to break down. Nucleolysis refers to breaking down the contents of the center or nucleus of the disc. Various methods of nucleolysis have been tried and tested around the world.

Chemonucleolysis is the injection of an enzyme into the disc. This enzyme called chemopapain causes the proteoglycan to shrink. The proteoglycan is a jelly-like substance that allows the disc to hold water. When the proteoglycan can't hold water, it shrinks. Less fluid in the disc takes pressure off the nearby spinal nerves.

The chemopapain had side effects in a small number of patients. The treatment isn't used as much anymore. Ozone therapy was the next idea tried. Ozone has three oxygen atoms. It's injected into the disc through a narrower needle than chemopapain. There are fewer problems. The period of discomfort after treatment is shorter.

Thermal nucleolysis can be done by heating the nucleus of the disc with high-intensity ultrasound (US). Another form of heat-induced nucleolysis uses a carbon dioxide laser beam. About 75 percent of the patients who had this type of vaporization nucleolysis got better.

Consider a total disc replacement if nucleolysis fails to improve your symptoms or function. The damaged disc is removed and the implant is placed between the two vertebrae. Your motion is restored with reduction of pain. If for some reason you don't get the relief you hoped for, a spinal fusion is always a final option.