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Lumbar Percutaneous Discectomy

What does “Lumbar Percutaneous Discectomy” mean?

Here is the meaning of each word:

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

Altogether, “Lumbar Percutaneous Discectomy” means removing a piece of a disc in the low back using a minimally invasive procedure.

Why is a Lumbar Percutaneous Discectomy done?

A Lumbar Percutaneous Discectomy is done to remove a piece of a disc in the low back which is causing pain. The pain could be in the low back itself or in the leg from an inflamed spinal nerve (sciatica).                           

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

  1. A Lumbar Percutaneous Discectomy is done through a needle placed into the disc. This procedure uses a small needle like device (e.g. nucleoplasty wand) which is placed through the needle, to remove disc material. It does not remove much disc material and does not put anything into the disc.
  2. Endoscopic Lumbar Discectomy. An Endoscopic Lumbar Discectomy uses an endoscope placed through tubes which are larger than the needle used for the Percutanous Discectomy. Also, the endoscopic instruments are larger and can remove more disc material if needed.
  3. A Lumbar Microdiscectomy requires an incision (cut in the skin) and has to remove a small amount of bone (laminotomy). A small retractor if used in hopes of avoiding trauma to the spine. The disc herniation can be seen directly. Larger disc herniation can be removed and the spinal nerve can be examined.
  4. A Lumbar Discectomy is an open surgery, meaning a cut (incision) is made and a dissection (cutting through tissue) of the structures has to be done to be able to see the disc herniation and remove it. A Lumbar Discectomy requires more dissection than a Microdiscectomy. It is a bigger surgery and has a longer recovery.

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

1. Nucleoplasty Wand

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

2. Lumbar 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 fluid.

3. Endoscopic Laser Discectomy (LASE)

A needle is placed into the disc. Over a wire, a very small endoscope with a Laser tip is placed into the disc. A Homium Yag Laser is used to generate the Laser energy for the tip of the endoscope. The Laser energy evaporates disc material. A small grasper (forceps) can also be used to remove more disc material.

4. 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 Lumbar Percutaneous Discectomy done?

Here are the steps of how a Lumbar 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 stomach (prone).
  4. The low-back is cleaned with a surgical antiseptic and sterile plastic sheets (drapes) 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 deeper into the disc and pulled back a number of times in different tracks 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 deeper 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. Endoscopic Laser Discectomy (LASE)

A needle is placed into the disc with the help of an X-Ray machine. A small endoscope with a Laser tip is placed into the disc. The endoscope is attached to a Homium Yag Laser. Sterile fluid is circulated through the endoscope. The Laser tip and potentially a small grasper (forceps) are used to remove excess disc material.

d. 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 Lumbar Percutaneous Discectomy?

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

What is the recovery from a Lumbar 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 can patients gain from a Lumbar 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.