Percutaneous Discectomy

KEY FACTS

Terminology

• Percutaneous disc removal to reduce intradiscal pressure → protruded disc retracts back in place, reduced irritation on annulus nociceptive nerve receptors

  • Also decompresses nerve root from disc

  • Another proposed mechanism: Removing disc material may prevent release of chemical mediators that directly injure nerve root

Preprocedure

• Radicular pain usually greater than back pain/neck pain

• Positive CT or MR scan for disc herniation

• Contained herniated disc of < 6 mm

  • Contained herniated discs have intact outer annulus with displaced disc material held within outer annulus of contained herniated disc

  • Noncontained herniated disc has localized displacement of disc material beyond intervertebral disc space & breach in outer annulus

• No improvement of symptoms after 6-8 weeks of conservative therapy

• Before percutaneous discectomy (PD), pain relief should be confirmed after selective nerve root block has been performed

Post Procedure

• PD may provide appropriate relief in properly selected patients with contained lumbar disc prolapse

  • Reduced procedure time, lower costs, quick recovery, and low complication rates that can include discitis and possible nerve injury

Outcomes

• Complications: Nerve root or blood vessel injury

  • Infection, bleeding, discitis

TERMINOLOGY