Dr. Goltra on Percutaneous Discectomy

vertebral disc degeneration

Percutaneous means “through the skin” or using a very small incision. Discectomy is the surgical removal of herniateddisc material that presses on a nerve root or the spinal cord.

Percutaneous discectomy is different from conventional open discectomy or microdiscectomy. There are several percutaneous procedures. All of them involve inserting small instruments between the vertebrae and into the middle of the disc. X-ray monitoring is used during surgery to guide the movement of the surgical instruments. The surgeon can remove disc tissue by cutting it out, sucking out the center of the disc, or by using lasers to burn or evaporate the disc. The disc material that has herniated is not directly removed in these operations.

The use of percutaneous procedures to decompress intervertebral discs dates back to the 1960′s. Early procedures showed conclusively that percutaneous disc decompression effectively relieves pain for appropriate patients. Early procedures had limitations, and so over the years a variety of more advanced techniques have been developed.
An advanced form of percutaneous discectomy developed to date uses a plasma technology to remove tissue from the center of the disc. During the procedure, an instrument is introduced through a needle and placed into the center of the disc where a series of channels are created to remove tissue from the nucleus. Tissue removal from the nucleus acts to decompress the disc and relieve the pressure exerted by the disc on the nearby nerve root. As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures. There is little tissue trauma and recovery times may be improved in many patients.
Although long-term data is not available, early studies show sustained pain relief out to one-year, with patients remaining steady at their initial post-procedure pain levels. Evidence is mounting that pain relief is sustained through two years post-procedure and beyond.
Who is the right patient?
For appropriately selected patients, percutaneous discectomy can help relieve back and leg pain symptoms, including sciatica and radiculopathy and even pure axial pain caused by a ‘central focal protrusion’ or central bulge of the disc. Percutaneous discectomy is a widely accepted treatment for patients with small contained herniations for whom open surgical discectomy offers a outcome. It may also be a promising option for patients with large contained (non-ruptured disc) herniations for whom open surgery is not considered an appropriate treatment.
What to Expect:
Percutaneous discectomy is a straightforward procedure. The patient receives a local anesthetic and possibly mild sedation; no general anesthesia is required. Needle insertion is simple, with little pain. Once the needle is inserted into the disc, the disc decompression itself takes only a few minutes. The entire procedure takes about 30 minutes and the patient is able to leave the recovery area with only a small bandage over the needle insertion site.
Post-op recovery is not demanding. Patients typically feel little pain after the procedure. Patients are required to avoid lifting and strenuous exercise for a period of time. A patient may resume sedentary work after a week or two. Patients with more physically demanding occupations may need to wait longer to return to work. Physical therapy may be prescribed.

cervical percutaneous discectomy

Cervical Percutaneous Discectomy