Intradiscal Biacuplasty Treating Lumbar Degenerative Disc Disease: Long-Term Results of More Than 100 Patients.

Purpose: Intradiscal biacuplasty (IDB) has emerged as an effective treatment for lumbar degenerative disc disease (DDD), yet long-term outcomes and decisive prognostic factors remain underexplored. This study enrolled over 100 patients with symptoms for as long as two years to examine clinical efficacy and radiological predictors of surgical success. Methods: A neurosurgeon conducted a prospective study on 117 patients who underwent IDB at a single medical center. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria at multiple time points up to two years postoperatively. Preoperative MRI scans were evaluated for disc morphology, degeneration severity, and facet joint pathology. Statistical analyses were performed to identify factors associated with clinical outcomes, satisfaction, and the need for secondary interventions. Results: Significant reductions in VAS and ODI scores were observed from one week postoperatively and sustained over two years (ΔVAS: 95% Cl = 3.81-6.07, Cohen's d = 2.27, p < 0.001; ΔODI: 95% Cl = 21.13-35.53, Cohen's d = 1.83,). Mean VAS and ODI improvements reached 62% and 63% at six months. Over 76% of patients reported satisfactory outcomes. Disc extrusion was associated with better pain relief; in contrast, advanced facet joint degeneration led to significantly poorer VAS and ODI improvement (VAS: β= -17.48, 95% Cl = -31.70--3.26, p < 0.05; ODI: β= -21.92, 95% Cl = -37.25--6.59, p < 0.01). Moreover, a higher global degeneration score increased the risk of secondary surgery and was associated with patient dissatisfaction. Conclusion: IDB is an effective and durable treatment for selected patients with lumbar DDD, especially those with disc extrusion and limited facet joint degeneration. These findings underscore the importance of careful patient selection and radiological assessment in optimizing IDB outcomes.