Minimally Invasive Discectomies
Back pain is a very common condition that affects millions of adults in the United States. It is estimated that approximately 2% of the workforce in the U.S. files for workers’ compensation because of back pain. Oftentimes, back pain can be relieved with conservative treatment options including ice, heat, physical therapy, analgesic medication and non-steroidal anti-inflammatory drugs (NSAIDs). However, patients who experience more severe and chronic back pain are often treated with narcotics and invasive surgery.
Disc herniation is one of the most common causes of back pain, which results in chronic and sometimes debilitating pain. An intervertebral disc is comprised of an inner layer (nucleus pulposus) and an outer layer (annular fibrosis). If the outer layer of the disc begins to deteriorate, it can weaken, allowing the inner layer to push outward. The protruding inner layer may irritate or impinge on spinal nerves in the area, resulting in chronic back, and even extremity pain.
Patients who report back pain that is caused by a herniated disc rarely have pain relief with conservative treatment. Many different types of treatment have been developed over the last decade to offer non-invasive treatment options to these patients instead of invasive surgery. Percutaneous discectomy has been one of the developments.
Percutaneous discectomy is a minimally invasive procedure that is offered to patients who have a contained disc herniation that has not responded to conservative treatment options. This procedure was developed to shrink or remove the material surrounding the herniated disc that is thought to be causing the inflammation and back pain. After the material is removed, patients usually experience pain relief as well as less pressure on the surrounding spinal nerves. Studies have found that the success rate of percutaneous discectomy is over 80%.
Prior to the percutaneous discectomy procedure, the patient is given a sedative to help them remain calm during the procedure. The patient is placed in a prone position on the treatment table. The physician then injects a local anesthetic using a small needle to numb the area. Once the tissue is numb, a larger needle or probe is inserted through the skin into the affected intervertebral disc using fluoroscopic guidance.
Once the needle or probe is positioned properly, heat or radio waves are used to decrease the disc size and remove any disruptive disc material. Removing the disc material from the herniated discs helps to reduce pressure in the disc and provides pain relief. Following the percutaneous procedure, the patient is moved to a recovery area to be monitored.
Percutaneous discectomy generally takes approximately 30 minutes to perform and is completed in an outpatient setting. Typically patients can return home within one to three hours after the procedure. The injection site may be tender for 24 to 48 hours after the procedure. Heat or cold packs are recommended to ease any discomfort. Additionally, some physicians may prescribe pain medication for patients to take following the procedure. Patients are advised to rest and limit activity for about 24 hours after the procedure. While recovery times vary for each patient, most patients are able to resume normal work and leisure activities in one week.
The benefit of percutaneous discectomy is that it is a less invasive treatment option for spinal pain resulting from disc herniation than surgery. This procedure may help to decrease pain and increase mobility. Furthermore, this procedure results in less scarring and fibrosis, which are commonly seen with other treatment procedures. Percutaneous discectomy was developed to not only reduce pain but to treat the underlying condition as well.
Percutaneous discectomy is a non-invasive treatment option for patients suffering from chronic discogenic back pain that has not responded to conservative treatment methods. While it is considered a safe procedure, just like any type of medical procedure, there are risks associated with it. The most common side effect is injection site tenderness after the procedure. Less common side effects include spinal cord compression, increased intracranial pressure, bleeding, infection, and hematoma. Utilizing fluoroscopic guidance and sterile techniques during the procedure can minimize these risks.
Ideal patients for percutaneous discectomy are those who suffer from chronic back pain due to disc herniation that has not responded to conservative treatment methods including ice, heat, physical therapy, and analgesic and anti-inflammatory medication. Percutaneous discectomy should be recommended to patients before invasive surgical options are discussed.
Other patients that may benefit from percutaneous discectomy include those who have decreased mobility due to osteoporosis or other degenerative types of disease. These patients may experience improved physical and mental health following this procedure as damaged disc material is removed which helps to reduce pressure on the surrounding spinal nerves, thereby helping to reduce pain.
Percutaneous discectomy is a minimally invasive technique that has shown to be quite successful in providing pain relief for patients suffering from chronic discogenic back pain that has not responded to conservative treatment options. Ideal candidates for this procedure are those who have a contained disc herniation, osteoporosis, or other types of degenerative diseases. There are relatively few risks associated with this procedure, which makes it an attractive option compared to invasive surgical options. Patients suffering from chronic discogenic back pain should speak with their physicians about percutaneous discectomy prior to considering spinal surgery for back pain relief.