the minimally invasive nature of percutaneous discectomy provides compelling advantages over more invasive procedures such as open surgery. it permits contained herniated discs to
be excised with minimal disturbance to surrounding skin, fascia and muscles, 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 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. in fact, in comparison to traditional open surgery, percutaneous discectomy has been shown to be an equally e ective intervention in patients with small disc herniations. 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 e ects to the nerve root and other structures, reduces blood loss, 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. 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 nonsteroidal anti-in ammatory drugs (nsaids).
in most people, the spine or vertebral column comprises 33 interlocking bones, or vertebrae, which are connected by brous bands called ligaments and divided into ve 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. there are seven cervical (neck) vertebra, twelve thoracic (upper and mid back) vertebra, and ve lumbar (lower back) vertebra. in between these vertebrae are discs that act like shock absorbers—they are called intervertebral discs. these elastic intervertebral discs cushion the bones of the spine and promote exibility.
these discs are made up of two substances: nucleus pulposus and annulus brosus. the intervertebral discs are lled with a soft, gelatinous material called the nucleus pulposus. the nucleus
Intervertebral Disc Makeup
pulposus is in the disc’s center. it contains water and what are called proteoglycans. the nucleus pulposus is surrounded by the annulus brosis. this jellylike material is designed to handle compression by dispersing pressure. the annulus brosus is made up of layer upon
layer of collagen bers. these layers are tightly packed together and make for a very tough and resilient structure that keeps the uid from the nucleus pulposus from leaking out. even though our discs are tough, strong structures, they can wear out over time or become damaged, resulting in cracks and tears (called ssures) or even start to bulge out. When this happens, pain can result.
common Disc Problems
Percutaneous dis decompression is intended to alleviate painful pressure exerted by deformed and displaced discs. two common
disc problems that involve distortion and dislocation of discs are pertruding discs and herniated discs. a pertruding disc occurs when excess pressure is put upon a disc, causing it to pertrude out of place. a 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 pertruding 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 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.
Percutaneous Dis DecomPression overview
When a disc pertrudes and herniates, it presses against a nerve. this pressure causes pain. Your interventional pain physician will use a special medical device to remove some of the nucleus pulposus. The material that has bulged out then moves back inwards, replacing the material that has been removed, thus relievingpressureandthepain.Thisprocedureisconsidered minimally invasive because a tiny puncture, similar to a simple injection, is all that is required for disc nucleoplasty.
Disc decompression may be performed with automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, mechanical disc decompression with Dekompressor®, and nucleoplasty.
APLD and laser disc decompression have been around for many, many years and have been used in large populations. While the traditional evidence with patient evaluations shows signi cant improvement, there are no large scale, scienti c – meaning randomized, double-blind placebo controlled trials to prove
their e ectiveness. Average pain reduction has been reported as signi cant – and patient satisfaction has been high. High patient satisfaction has largely been due to the ease of the procedure,
the lack of trauma or painful rehabilitation period, the fact that Percutaneous Discectomy does not diminish the e ectiveness
of any subsequent procedure – such as surgery, and in the rare instance that the procedure is not deemed a ‘success’, the patient is typically no worse o … there is no downside.
Automated percutaneous mechanical lumbar disc decompression (APLD)
Automatedpercutaneousmechanicallumbardisc decompression or APLD is performed with a nematically driven, suction-cuttingprobeinacannulawitha2.8mmouterdiameter with removal of one or 3 grams of disc material to reduce the intradiscalpressureanddecompressthenerveroots.
Percutaneous lumbar laser disc decompression isperformedby delivery of laser energy to the nucleus pulposus by means of a laser ber. The ber is inserted through
a thin needle via a posterolateral percutaneous approach under local anesthesia. The absorption of the applied laser energy leads to vaporization
Mechanical disc decompression with Dekompressor® utilizes a Dekompressor probe which is a mechanical high rotation per minute device designed to extract the nuclear material through an introducer cannula using an auger-like device that rotates at high speeds.
The Dekompressor system is a single-use probe intended for percutaneous discectomies under fluoroscopic imaging. The device removes a predetermined amount of disc material from the herniated disc, reducing pressure in the disc and the surrounding area. Using a cannula placement similar to that used for a standard discography, less pertinent scarring and less postoperative fibrosis may be expected
Indications of percutaneous mechanical disc decompression include the following:
1) Unilateral leg pain greater than back pain.
2) Radicular symptoms in a speci c dermatomal distribution
that correlates with MRI ndings.
3) Positive straight leg raising test or positive bowstring sign, or both. 4) Neurologic ndings or radicular symptoms.
5) No improvement after 6 weeks of conservative therapy.
6) Imaging studies (CT, MRI, discography) indicating a
subligamentous contained disc herniation. 7) Well maintained disc height of 60%.
Who is the Right Patient?
Percutaneous Discectomy is a widely accepted treatment for patients with small contained herniations for whom open surgical discectomy o ers a poor chance of success. It may also be a promising option for patients with large contained herniations for whom open surgery is not considered an appropriate treatment.
There are some medical conditions that may indicate that Percutaneous Discectomy is not right for you. Your diagnosing physician will know if these apply to you or not.
After medical sta has determined you have recovered enough to go home, you will be discharged. A responsible adult will need to drive you home. Plan on resting in bed for up to three days after your procedure. Limit sitting or walking to just 30 minutes at a time. Also, limit driving, bending, twisting, and lifting more than 10 pounds for the next few weeks. Many patients have found that applying ice to the treatment area for one to two hours a day for the next three days helps with pain and soreness at the injection site. Take the medications as prescribed by your doctor.
It is important to remember that recovery time varies with each patient. Do not try to rush your recovery. Approximately two weeks after your procedure, you will begin a directed physical therapy program. Follow your doctor’s or physical therapist’s instructions regarding your exercise program.
Practice Name Physical address PhoNe | Fax
Web address | email address
disC heRniation PinChes neRve Root, Causing Pain. Cannula is inseRted thRough the baCk
CaltahsetReR is inseRted
disC mateRial Removed. emPtY sPaCe dRaWs the disC Wall heRniation baCk
in PlaCe and Relieves Pain
with this device. The Dekompressor has been described as a minimally invasive technique with advantages over other techniques Percutaneous
disc decompression procedures are relatively painless procedures since they are minimally invasive.
NucleMechanical decompression with Dekompressor®oplasty
disC heRniation PinChes neRve Root, Causing Pain. thin needle, Cannula, inseRted thRough the baCk
With APLD, the disc is extracted with laser disc decompression. Endoscopy is used under visualization and laser is used. With Dekompressor, similar to APLD, the disc material is removed. With disc nucleoplasty, Coblation technology is utilized to remove tissue from the center of the disc
With APLD, the disc is extracted with laser disc decompression. Endoscopy is used under visualizaiton and laser is used. Dekompressor, similar to APLD, the disc material is removed. With disc nucleoplasty, Coblation techoogy is utilized to revove tissue from the center of the disc.
Rotating PRobe tiP
t o u g h outeR Wall Remains intaCt
of the water content of the nucleus pulposus and a change in its protein structure. The subsequent volume reduction causes a disproportionate decrease in intradiscal pressure, which in turn should theoretically decompress an entrapped nerve root.
Nucleoplasty, a minimally invasive procedure, uses radiofrequency energy to remove nuclear material and to create small channels within the disc. With Coblation technology, radiofrequency energy is applied to a conductive medium, creating the formation a highly focused plasma eld to form around the energized electrodes. The plasma eld is composed of highly ionized particles. The created channel is thermally treated, producing a zone of thermal coagulation. Thus, nucleoplasty combines coagulation and tissue ablation (patented Coblation
disC mateRial Removed. emPtY sPaCe dRaWs the disC Wall heRniation baCk
in PlaCe and Relieves Pain
disC heRniation PinChes sPinal CoRd oR neRve Root, Caus- ing Pain. Cannula is inseRted thRough the baCk
Radio Wave deviCe dissolves small PoRtions of disC. PRessuRe is Relieved fRom neRve Root
Radio Wave deviCe
tough outeR Wall Remains intaCt
usually receives light
sedation to promote
relaxation during the
procedure, but remains
awake. A special type of x-ray, called fluoroscopy, will be used by your doctor to guide the needle to the correct place. Using a small needle, the physician numbs the treatment area with local anesthetic. Subsequently, a larger needle is introduced into the affected disc. A special single-use probe 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. The total procedure time will be 30 to 45 minutes.
technology) to form channels in thenucleusand decompress the herniated disc. Claims have been made over the past few years that nucleoplasty can produce satisfactory results with fewer serious complications.