OrthoNeuroSpine & Pain Institute

Percutaneous Discectomy

Percutaneous Discectomy for a Lumbar Herniated Disc

Percutaneous means "through the skin" or using a very small cut. Discectomy is surgery to remove herniated disc material that is pressing on a nerve root or on the spinal cord .

There are many different kinds of percutaneous discectomy procedures. All of them use small instruments that are inserted between the vertebrae and into the middle of the disc . Most of the time they are done in a surgery center using local or sedation.

A percutaneous discectomy treatment is a type of treatment that involves direct incision to remove the damaged disk from the back. This treatment is effective for removing herniated disks, which are usually caused by damage to the disk in the form of a tear, or similar cause of damage to the disk. The word percutaneous stands for ‘in the skin’, and percutaneuous discectomy treatment is effective for eliminating pain due to pressure on the nerves in the localized area, persistent pain, or damage within the spinal cord.

Benefits and Outcomes

There are a few different methods of percutaneous discectomy that are used to treat damage and pain present within the back. Although there are various methods, each procedure uses small medical tools, which are designed solely for the percutaneous discectomy. These clinical tools are inserted through the skin and directly into the middle of the damaged area to reach the affected disk.

The three most common methods of percutaneous discectomy include:

1 Invasive Removal: Removes the area of the disk that is damaged, and in some cases, the entire disk – if it will not cause additional health problems.

2 Laser Removal: While still penetrating to the skin, rather than using cutting tools for removal, a laser is used to break the disk apart, and then remove part of the whole disk.

3 Partial Suction: If damage is present within the center of the disk, a suction tool is used to remove the internal fluid, which can eliminate pain and reduce pressure due to inflammation.

X-rays help guide the movement of the instruments during surgery. The surgeon can remove disc tissue by either:

• Cutting it out.
• Sucking out the center of the disc.
• Using lasers to burn or destroy the disc.

Before the Procedure

Prior to the surgery, your physician will determine which percutaneous discectomy procedure is the best option for your disk condition by using unique imaging and testing devices. While standard imaging is still used today, such as an MRI, more advanced methods of analysis have proven to be more effective in determining the cause of pain in the back. Once your surgery is scheduled, your physician will provide you with information on how you can prepare for the surgery, and what you benefits and/or risks are present.

Before the operation, you will generally be given anesthesia, which will put you in a sleep-like state. The area of the incision is cleaned, then the method chosen for the percutaneous discectomy is used. While the treatment can be effective for some, it is not always the best choice for all disk issues. The surgeon is unable to see the nerve during the procedure, and the disk may not be removed entirely – thus reducing the rate of success if the procedure is used for nerve related issues.

After the Procedure

The length of time for this surgical procedure will vary based upon the process that is used, the level of damage present within the disk, as well as the location of the disk. Most patients are able to return home the same day as the surgery, but it can take several weeks to recover.

Certain activities need to be avoided during the recovery process to help improve the rate of success, including:

• Lifting anything over 10lbs
• Twisting the body outside of the normal range
• Bending over
• Sitting or standing for extensive periods of time

Conditions Treated with Percutaneous Discectomy

A percutaneous discectomy may be used as your method of treatment if one or more of the following are present:

Nerve pain has been present in the area of the disk for a period of four weeks of longer.

The pain you experience has taken away from your ability to perform your normal day-to-day tasks.

You experience signs of severe nerve damage.

Damage to the nerve is progressing and showing additional symptoms such as a numbing sensation, or loss of feeling.

Images taking of the disk show that it’s bulging. A bulged disk can lead to damage the areas around the nerve, and almost always results in nerve damage.

While a percutaneous discectomy is one form of treatment for herniated and buldging disks, there are actually other forms of a discectomy that can be used.

What To Expect After Surgery

You can expect to go home on the same day you have the procedure.

You can use prescription medicine to control pain while you recover.

For several weeks after surgery, you'll need to avoid long periods of sitting and avoid bending, twisting, and lifting.

Why It Is Done

• Lumbar (low back) percutaneous discectomy may be done if:
• Your medical history, physical exam, and diagnostic tests (such as MRI, CT scan, or myelogram) show that the disc is bulging, and the material inside the disc hasn't ruptured into the spinal canal.
• Pain and nerve damage have not improved after 4 or more weeks of nonsurgical treatment.
• Your symptoms are very bad and get in the way of doing normal activities.
• There are signs of serious nerve damage in your leg that may be getting worse. These signs include severe weakness, loss of coordination, or loss of feeling.

It should not be done if you have:

• Pieces of disc material in the spinal canal (as seen on a CT scan or MRI).
• Narrowing of the spinal canal (spinal stenosis).

How Well It Works

Although surgery for a lumbar herniated disc doesn't work for everyone, it works well for many people. Regular discectomy works a little better than percutaneous discectomy.

Risks

During a percutaneous discectomy, the surgeon has no way of seeing the herniated disc or the pinched nerve .

The surgery might not remove the disc tissue. So there is no guarantee that pressure on the nerve will improve.

There are risks with anesthesia.

What To Think About

More research needs to be done to compare this surgery to other types of discectomy and to nonsurgical treatment.