Partial Excision of Lumbar Disk Eases Pain

A minimally invasive approach to treating herniated discs of the lumbar spine results in good outcomes, especially for patients with sciatica, according to a new study.

The procedure, called percutaneous diskectomy, is performed by inserting a cannula into the herniation through skin and muscle tissues, using x-ray guidance to direct it into the offending disk, to eliminate the portion of the bulging nucleus that is causing pain. Patients receive local pain relief at the injection site and enough anesthesia to relax, but remain awake so they can report any pain they experience. After accessing the disk, the puncturing stylet is removed, and the cannula is used to insert devices needed to vaporize or suction out excess gelatinous substance. Within two weeks, most patients say they are 50-60% better and by three months, they are 80-90% better.

Percutaneous diskectomy does not preclude surgery if still needed for pain relief. Ideal candidates typically have more leg pain than back pain, such as sciatica--pressure on the sciatic nerve--because the bulging disk is pressing on a nearby nerve and/or causing inflammation that causes referred leg pain. The disk herniation needs to be contained and in communication with the parent disk; if it is pinched off from the disk or has become fragmented and has migrated into the spinal canal, patients will require traditional surgery. The procedure was presented at the 44th annual meeting of the American Society of Neuroradiology held during April-May 2006 in San Diego (CA, USA).

"As we remove the nucleus, the pressure inside goes down so the pressure on the outside of the disk decompresses,” said presenter Dr. Jeffrey A. Stone, chief of the section of interventional neuroradiology at the Medical College of Georgia (MCG, Augusta, USA). "You are basically making a smaller disk so it's not pushing on surrounding structures.”



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Medical College of Georgia