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Cervical Percutaneous Discectomy

What is a “Cervical Percutaneous Discectomy”?

Here is the meaning of each word:

  1. Cervical: the part of the spine located in the neck
  2. Percutaneous: a procedure done through the skin, i.e. minimally invasive
  3. Discectomy: removing a piece of a disc

Altogether, “Cervical Percutaneous Discectomy” means removing a small piece of disc material from the neck using minimally invasive means.

Why is a Cervical Percutaneous Discectomy done?

A Cervical Percutaneous Discectomy is done to remove a piece of a disc in the neck which is causing pain. The pain could be in the neck itself or in the arm from inflammation of a spinal nerve. This is usually caused by a disc herniation.

What is the difference between a Cervical Percutaneous Discectomy and other Cervical Discectomies?

  1. A Cervical Percutaneous Discectomy is done through a needle placed into the disc. This procedure uses a small needle like device (e.g. nucleoplasty wand) to remove disc material with the help of an X-Ray machine. It does not remove much disc material and does not put anything into the disc.
  2. A Cervical Endoscopic Discectomy places tubes into the spine to gain access to the disc and requires removing a small portion of bone (laminotomy) in the process. It is a minimally invasive procedure which uses small instruments to remove a piece of disc. This procedure can remove more disc material than a Cervical Percutaneous Discectomy. The disc can also be seen with the endoscope.
  3. An Anterior Cervical Discectomy and Fusion (ACDF) is an open surgery, not minimally invasive. It requires an incision and dissection (dividing tissue to see the next structure below). An ACDF surgery removes most of the disc and then places bone or bone-like material into the space to allow it to fuse together (become one piece of bone).

What devices can be used to perform a Cervical Percutanous Discectomy with?

  1. Cervical Nucleoplasty Wand:

A hollow needle is placed into the disc. Through the needle, the nucleoplasty wand is advanced into the disc. This wand uses radiofrequency energy to evaporate disc material. This can shrink a disc somewhat.

      2. Cervical Nucleotome:

A small wire is place into the disc. Over the wire, a small cannula (larger hollow needle) is advanced into the disc. The wire is removed, and the nucleotome device placed into the disc. This device has a small cutting device at the tip and uses fluid to circulate through the device. The cutter removes disc material which is then pulled out with the help of the fluid.

      3. Dekompressor

A small needle is placed into the disc. Through this needle, a small drill-like device is placed. Once activated, this device removes disc material like a drill on the reverse mode. The disc material is then collected in a chamber.

How is a Cervical Percutaneous Discectomy done?

Here are the steps of how a Cervical Percutaneous Discectomy is performed:

  1. An intravenous catheter (IV) is placed and an antibiotic given.
  2. The patient is either given relaxing medicine (sedation) or a General Anesthetic (put to sleep for the procedure).
  3. The patient is placed on their back (supine), often with the head turned.
  4. The neck is cleaned with a surgical antiseptic and sterile plastic sheets (drapes) are placed around the site of the surgery to keep the area clean.
  5. An X-Ray machine is used to find the correct disc level in the spine.
  6. A small amount of local anesthetic may be injected under the skin.
  7. At this point, one of the devices mentioned above can be used.

a. Nucleoplasty Wand:

A needle is placed into the disc with the help of an X-Ray machine. Through the needle, the nucleoplasty wand is inserted. It is then hooked up to a Radiofrequency Generator (generates targeted heat). The device is then turned on and disc material is evaporated with the nucleoplasty wand. The wand is pushed forward into the disc and pulled back a number of times in different directions to remove as much disc material as possible.

b. Nucleotome:

A small wire is first placed into the disc with the help of the X-Ray machine. Over the wire a small cannula (larger hollow needle like device) is advanced into the disc. The wire is withdrawn and the nucleotome is advanced through the cannula. The nucleotome is hooked up to fluid (normal saline) and activated. The nucleotome is then pushed forward into the disc and pulled back a number of times in order to remove disc material with the small cutter at the tip of the nucleotome.

c. Dekompressor:

A needle is placed into the disc with the help of an X-Ray machine. Through this needle, the Dekompressor’s drill-like tip is advanced into the disc. Once activated, the device removes disc material like a drill on reverse. The doctor moves the drill-like tip back and forth inside the disc until a sufficient amount of disc material has been removed.

     8. Once the doctor has removed sufficient amount of material, all the devices are pulled out of the disc and skin.

     9. A bandage (dressing) is then placed on the wound.

   10. The patient is then awoken from Anesthesia and brought to the Recovery Area for observation.

How long does it take to perform a Cervical Percutaneous Discectomy?

It may take 30-60 minutes to perform this procedure at one spinal level.

What is the recovery from a Cervical Percutaneous Discectomy like?

  1. This procedure is done on an outpatient basis. After a period of observation and recovery from the anesthetic, the patient is sent home.
  2. The wound area is kept clean and dry for at least 24 hours.
  3. The patient’s activity level is often restricted for a short period of time.
  4. The patient is usually seen by the doctor within a few weeks to reassess the symptoms.

What kind of benefit could patients gain from a Cervical Percutaneous Discectomy?

Results from disc procedures can vary. There is much debate among spine specialists as to how much disc material can be removed with these procedures. Patients can potentially benefit from this procedure for the long term. However, long-term studies have not been completed.