Discseel Procedure: Not Recommended Based on Available Evidence
The Discseel procedure lacks support from established clinical guidelines and high-quality evidence for the treatment of back pain due to annular tears, and therefore cannot be recommended over proven conservative or surgical interventions.
What is the Discseel Procedure?
The Discseel procedure is a proprietary intradiscal injection technique that purports to "seal" annular tears using a fibrin-based biologic agent. However, this procedure is not mentioned or endorsed in any major spine society guidelines including those from the American Association of Neurological Surgeons, North American Spine Society, or American Society of Anesthesiologists 1.
Evidence-Based Treatment for Annular Tears
Conservative Management (First-Line)
Comprehensive conservative treatment for at least 6 months is required before considering any invasive intervention for discogenic pain, including formal physical therapy focusing on core strengthening and flexibility exercises 2, 3.
Neuroleptic medications (gabapentin, pregabalin) provide effective neuropathic pain relief with Category A1 evidence for assessment periods of 5-12 weeks 1.
NSAIDs provide effective pain relief for patients with back pain for 2-12 weeks based on randomized controlled trials 1.
Diagnostic Considerations
Annular tears and disc herniations may exist in asymptomatic patients, making their clinical significance uncertain 4.
Provocative discography with analgesic injection shows that only 20-30% of patients with concordant pain provocation achieve ≥80% pain relief following local anesthetic injection, questioning whether annular tears are truly the pain source 5, 6.
The presence or absence of annular tears on MRI is not a significant predictive factor for clinical outcomes after disc interventions 7.
Guideline-Supported Interventional Options
Minimally Invasive Procedures with Evidence
Percutaneous disc decompression (nucleoplasty, coblation) provides effective pain relief for back and radicular pain for 2 weeks to 12 months based on observational studies (Category B2 evidence) 1.
Intradiscal electrothermal therapy (IDET) and endoscopic thermal annuloplasty have been studied, but results are conflicting, with only 43.3% achieving good-to-excellent results at 2 years 8.
When Surgical Fusion is Appropriate
Lumbar fusion should be reserved for documented instability, spondylolisthesis, or when extensive decompression might create instability 2.
Fusion requires failure of comprehensive conservative management for at least 3-6 months, significant functional impairment, and pain that correlates with degenerative changes 2.
There is no convincing medical evidence to support routine fusion for isolated disc pathology without instability 2.
Critical Pitfalls to Avoid
Do not pursue unproven proprietary procedures like Discseel when evidence-based alternatives exist with established safety profiles and outcomes data 1.
Annular tears detected on imaging do not necessarily correlate with clinical symptoms, as they occur in asymptomatic individuals 4.
Most lumbar disc herniations and annular tears improve over time with or without medical treatment 4.
Only 80% of painful discs identified by provocation discography demonstrate sufficient pain relief with intradiscal anesthetic, suggesting other pain sources may be present 6.
Recommended Treatment Algorithm
Initial Phase (0-6 months): Formal physical therapy, NSAIDs, and trial of neuroleptic medications 1, 2, 3.
Persistent Symptoms (6+ months): Consider epidural steroid injections for radicular symptoms, though evidence for pure axial back pain is limited 1.
Refractory Cases: Provocative discography with analgesic injection may help identify true discogenic pain sources, but only 20-30% will have convincing response 5, 6.
Surgical Consideration: Reserve for documented instability, spondylolisthesis, or progressive neurological deficits after comprehensive conservative failure 2.
The Discseel procedure does not appear in this evidence-based treatment pathway and lacks the rigorous clinical trial data required for guideline inclusion.