Percutaneous Disc Decompression
Indication: Lumbar or cervical disc herniation
Over 300,000 spine surgeries are performed each year in the United States. A majority of these surgeries are conducted for lumbar disc herniation. Traditionally, neurosurgical and orthopedic techniques for lumbar disc herniation include lumbar laminectomy, discectomy, and lumbar fusion. A significant number of patients end up with so-called “failed back surgery syndrome”. Recurrent disc herniation, epidural abscess, scar tissue formation around nerve roots, facet joint syndrome, and muscle spasm may contribute to the clinical features of this syndrome. To avoid possible complications of open surgery, minimal invasive techniques for disc decompression have been developed. These techniques include Chymopapain, Nucleotome, laser discectomy, Nucleoplasty, and Disc DeKompressor. Chymopapain is a proteolytic enzyme from the Papaya fruit. This enzyme may induce enzymatic decompression of the nucleus pulposus of the herniated disc. Initial clinical reports were highly positive. However, due to its serious side effects, such anaphylactic shock, transverse myelitis and even death, chymopapain has been largely replaced by other techniques.
Percutaneous Nucleotome was developed by a Japanese orthopedic surgeon, Dr. Hijikata in 1975. This procedure inserts a 7-mm-diameter tube into the annulus and removes the disc material with specially designed forceps. This procedure has a reported success rate of 72%. However, due to the large diameter of the cannula, this technique is no longer commonly used. Ascher and Choy introduced YAG laser discectomy in 1986. This is still being commonly used by spine surgeons, neurosurgeons and some interventional pain specialists. This technique utilizes an 18 G probe, and generates laser energy to evaporate part of the nucleus pulposus. It decreases the intradiscal pressure with a reported success rate for back pain relief of 78% to 80%. Due to heat generated by the laser energy, patients may experience severe pain during the procedure and increased muscle spasm after the procedure.
Over the last six years, two new percutaneous disc decompression techniques have been reported. Introduced in 2000, DISC Nucleoplasty utilizes a unique plasma technology called Coblation® to remove tissue from the center of the disc. During the procedure, the DISC Nucleoplasty SpineWand is inserted into the center of the disc where a series of channels are created to remove tissue from the nucleus. The clinical efficacy of this technique, however, is yet to be confirmed.
Disc DeKompressor was introduced in 2003. This procedure uses a 1.5 mm percutaneous lumbar discectomy probe to aspirate the disc material. It is minimally invasive with less risk for nerve root damage. This technique is indicated for patients with contained disc herniation and lumbar radiculopathy. A preliminary study reported a decrease of pain of more than 70% in eight of ten patients. Generally, minimal invasive percutaneous disc decompressions provide alternatives for open surgery with less risk of the failed back surgery syndrome. However, more studies are needed to confirm the long-term efficacy of this procedure.
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