What Is Percutaneous Discectomy?

Percutaneous Discectomy: is a minimally invasive, highly effective treatment for back Percutaneous Discectomyand neck pain caused by herniated and bulging discs[1]. It is designed to alleviate pressure on a compressed nerve by directly excising the disc that is pushing against the nerve root[2]. Decompression of the nerve root helps to restore functionality and relieve pain[3].
The minimally invasive nature of percutaneous discectomy provides compelling advantages over more invasive procedures such as open surgery. It permits herniated discs to be excised with minimal disturbance to surrounding skin, fascia and muscles[4], which promotes quicker recovery and lower risk of complications than more invasive treatments. It also allows the procedure to be performed in an outpatient setting. Due to these and other benefits, many spinal surgeons consider percutaneous discectomy to be the “gold standard” in treatment for lumbar disc herniation[5].
In most people, the spine or vertebral column is comprised of 33 interlocking bones, or vertebrae, which are connected by fibrous bands called ligaments and divided into five regions: cervical, thoracic, lumbar, sacral, and coccygeal. The vertebral column provides support for the upper body as well as protection for the spinal cord, and furnishes attachment points for the ribs and muscles of the back. Between the vertebrae are the elastic intervertebral discs, which cushion the bones of the spine and promote flexibility. The intervertebral discs are filled with a soft, gelatinous material called the nucleus pulposus. This jellylike material is designed to handle compression by dispersing pressure.
Percutaneous discectomy is intended to alleviate painful pressure exerted by deformed and displaced discs. Two common disc problems that involve distortion and dislocation of discs are bulging disc and herniated disc. Bulging disc occurs when excess pressure is put upon a disc, causing it to bulge out of place. Herniated disc occurs when a tear or softening in the outer fibrous layer (the annulus fibrosis) of an intervertebral disc forces the pliable inner material through the weakened part of the outer disc. Both bulging and herniated discs can produce pain by irritating adjacent nerves and compressing the spinal cord.
A common cause of herniated and bulging discs is Degenerative Disc Disease (DDD). This is a gradual deterioration of spinal discs that occurs due to a detrimental cascade of cellular, biochemical, structural and functional properties of spinal discs[6] that typically occurs as part of the aging process. Patients with DDD experience degenerative changes that lead to tears within the annulus fibrosis. These tears promote herniation of the soft inner nucleus pulposus through the outer covering of the disc. Herniated discs may compress adjacent nerve roots, leading to chronic, severe back or neck pain.
Decompression therapy is often considered when back or neck pain persists for more than a month and is radicular, or radiates. Called radiculitis, this type of pain is frequently described as “shooting” since it travels from the spine outward (e.g., down an arm or leg), and is usually indicative of harmful nerve root compression. When radiculitis goes untreated, complications such as muscle atrophy, reflex changes, and sensory loss may occur over time.
Percutaneous discectomy is a relatively quick and relatively painless procedure since it is minimally invasive. The patient usually receives light sedation to promote relaxation during the procedure, but remains awake. Using a small needle, the physician numbs the treatment area with local anesthetic. Subsequently, a larger needle is introduced into the affected disc with real-time x-ray guidance (fluoroscopy). A special single-use probe called the Stryker Dekompressor is placed through this needle and excess disc material is suctioned from bulging or herniated discs, thereby removing harmful pressure from compressed nerves and providing pain relief. The patient may feel pressure during the procedure but should not experience pain.
Benefits: Due to its minimally invasive nature, percutaneous discectomy provides an excellent alternative to more invasive procedures such as open discectomy in the treatment of displaced and deformed discs[7]. In fact, in comparison to traditional open surgery, percutaneous discectomy has been shown to be an equally effective intervention[8]. The small diameter of the probe used in percutaneous discectomy (maximum 1.5mm) allows the doctor to restrict the size of the cutaneous incision to only a few millimeters. A smaller incision reduces the risk of adverse effects to the nerve root[9] and other structures, reduces blood loss[10], lowers the probability of infection, and results in less scarring than open surgery. Moreover, the specialized angle of approach used in percutaneous discectomy decreases the risk of damaging adjacent ligaments and muscles[11]. Collectively, these attributes result in a shorter recovery time. In addition, according to a review, individuals who receive percutaneous discectomy report high satisfaction due to lowered usage of non-steroidal anti-inflammatory drugs (NSAIDs)[12].
Several studies support the efficacy of percutaneous discectomy. Notable recent studies include:
  • A retrospective study of 142 percutaneous discectomies, in which the procedure was declared safe and effective for treating disc herniations, and 89% of patients treated achieved successful outcomes from the therapy[13].
  • A clinical trial published in 2011 reported a decrease in pain as measured by lowered average visual analog score (VAS) of up to 71% in patients treated for herniated disks at 1 week, and 79% at six months[14].
  • Another 2011 study, a multi-center retrospective trial involving 900 patients suffering from relevant symptoms who had been therapy-resistant for an average of 6 months, reported a success rate of 70% at a mean follow-up of 5 years as well as a very low complication rate[15].
  • A study in 52 patients with chronic lower back pain who received percutaneous discectomy were followed up for 3-15 months; VAS score before the procedure, 1 month after the procedure, and at final follow-up decreased steadily, indicating the patients’ pain lessened significantly after undergoing the procedure.  In addition, using a different scale of evaluation, 11 cases were graded as excellent and 23 as good, and the excellent and good rate was 65.38%. The average procedure time was 30.7 minutes (range 21-36 minutes), and no complications occurred.
  • Patients given percutaneous discectomy to treat radicular pain associated with disc herniation were evaluated for VAS pain scores, analgesic (pain medication) usage, and activities of daily living at 6 and 12 months after the procedure. Sixty-four patients were treated at 76 lumbar levels. The average reported pain level as measured by VAS declined from 7.3 before the procedure to 2.1 after 12 months. Before the procedure, 61 patients (95%) used opioid or non-opioid analgesics regularly; after 1 year, a reduction in analgesic use was seen in 51 patients (80%). None of the patients reported procedure-related complications[16].
As with all medical interventions, percutaneous discectomy is associated with various risks. However, fewer and less severe complications have been reported with percutaneous discectomy procedures than with more invasive treatments such as traditional open back surgery.
It is common for patients to experience mild back pain at the injection site shortly after the procedure. Rarer, more serious complications include pneumothorax, discitis, or nerve damage[17] carotid artery injury, post-procedural headache[18], spinal cord compression, excessive intracranial pressure, bleeding, hematoma, and infection. However, these graver risks are decreased by the use of fluoroscopy, which helps the doctor visualize important anatomical structures, and sterile technique, which inhibits infection.
The reduction in pain realized by percutaneous discectomy is designed to help patients resume normal daily activities and regain quality of life. Additionally, it may eliminate the need for traditional surgical interventions, which are associated with more serious complications. Individuals who suffer from chronic back or neck pain are encouraged to contact Louisiana Pain Specialists today to learn more about the benefits of this advanced treatment. We are proud to offer numerous years of experience and cutting-edge therapies to the New Orleans area.
Sources:
[1] Yeom KS, & Choi YS. (2011). Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation. J Orthop Sci., 16(3), 263-9.
[2] Dezawa A. (2010). [Development of percutaneous endoscopic approach for lumbar disc herniations]. [Article in Japanese]. Nippon Rinsho., 68(7), 1383-90.
[3] Golovac S. (2010). Percutaneous lumbar discectomy. Neuroimaging Clin N Am., 20(2), 223-7.
[4] Postacchini F, & Postacchini R. (2011). Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl., 108, 17-21.
[5] Brouwer PA, Peul WC, Brand R, Arts MP, Koes BW, van den Berg AA, & van Buchem MA. (2009). Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial. BMC Musculoskelet Disord., 10, 49.
[6] Smith, LJ, Nerurkar, NL, Choi, KS, Harfe, BD, & Elliott, DM. (2011). Degeneration and regeneration of the intervertebral disc: lessons from development. Dis Model Mech., 4(1), 31-41.
[7] Golovac S. (2010). Percutaneous lumbar discectomy. Neuroimaging Clin N Am., 20(2), 223-7.
[8] Park Y, & Ha JW. (2007). Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976)., 32(5), 537-43.
[9] Dezawa A. (2010). [Development of percutaneous endoscopic approach for lumbar disc herniations].
[Article in Japanese]. Nippon Rinsho., 68(7), 1383-90.
[10] Park Y, & Ha JW. (2007). Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976)., 32(5), 537-43.
[11] Amoretti N, Hauger O, Marcy PY, Amoretti ME, Lesbats V, Yvonne M, Ianessi A, & Boileau P. (2011). Percutaneous discectomy on lumbar radiculopathy related to disk herniation: Why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol., 2011 Mar 26. [Epub ahead of print]
[12] Dezawa A. (2010). [Development of percutaneous endoscopic approach for lumbar disc herniations].
[Article in Japanese]. Nippon Rinsho., 68(7), 1383-90.
[13] Tzaan WC. (2007). Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Med J., 30(3), 226-34.
[14] Amoretti N, Hauger O, Marcy PY, Amoretti ME, Lesbats V, Yvonne M, Ianessi A, & Boileau P. (2011). Percutaneous discectomy on lumbar radiculopathy related to disk herniation: Why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol., 2011 Mar 26. [Epub ahead of print]
[15] Menchetti PP, Canero G, & Bini W. (2011). Percutaneous laser discectomy: experience and long term follow-up. Acta Neurochir Suppl., 108, 117-21.
[16] Lierz P, Alo KM, & Felleiter P. (2009). Percutaneous lumbar discectomy using the Dekompressor system under CT-control. Pain Pract., 9(3), 216-20.
[17] Haufe SM, Mork AR, Pyne M, & Baker RA. (2010). Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases. Int J Med Sci., 7(3):155-9.
[18] Tzaan WC. (2011). Anterior Percutaneous Endoscopic Cervical Discectomy for Cervical Intervertebral Disc Herniation: Outcome, Complications, and Technique. J Spinal Disord Tech., 2011 Mar 21. [Epub ahead of print]

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