Percutaneous discectomy is a non-surgical, treatment for pain radiating from the back and neck resulting from one or more herniated discs. This treatment provides prompt pain relief by decompressing the spinal discs which reduce the painful pressure exerted on the spinal cord and nerve roots.1 Decompression is accomplished by removing part of a herniated disc irritating a nerve. Percutaneous procedures are performed by needle-puncture of the skin.
The spinal column comprises bony vertebral bodies. Between each spinal vertebral body are discs that act as shock absorbers to minimize the impact that the spinal column receives. Each disc has an outer layer of tough tissue, which surrounds an inner jelly-like core. If the outer layer wall of the disc weakens, a portion of the inner disc may push through the wall, forming a herniation. Because the discs are soft and provide support, they usually herniate posteriorly (bulge backward) through the outer disc segment and ligaments. These bulging discs often irritate and pressure the adjacent nerves causing pain in the back, legs, neck, or arms. A herniated disc or disc bulge is a common disc problem also called a slipped or ruptured disc.
Neck and back pain may go into painless remission with periods of decreased or absent symptoms. However, the pain often returns. If your pain is severe and lasts longer than four weeks, see a pain specialist about treatment options. Early intervention decreases the incidence of developing chronic pain. Decompression therapy should be considered when the pain has not improved after a month and is radicular (radiating to the hips, buttocks, or legs), resulting from irritation of the nerve roots. However, the procedure is usually reserved for patients who have not had success with conservative treatments like medications or physical therapy.
Percutaneous discectomy is a minimally invasive procedure used to reduce a herniated disc through a probe placed under X-ray fluoroscopic guidance. It is performed with local anesthesia and mild sedation, which avoids the risks of general anesthesia. A sedative is provided that will relax you during the procedure.
Before the treatment begins, you will be positioned face down on the procedure table. A local anesthetic is injected with a small, thin needle to numb the area. Once the area is numb, a larger needle is placed into the affected disc with X-ray fluoroscopic guidance. This needle is thin enough to eliminate the need for an incision. A probe is placed through this needle, and the procedure is initiated.
The probe removes excessive disc material from bulging or contained herniated discs reducing pressure in the disc and providing immediate pain relief. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable. The procedure usually takes less than an hour.
A discectomy using this probe is a lower-risk treatment option for neck and back pain. The procedure may decrease pain, increase mobility, and eliminate the need for surgery. This treatment corrects the underlying problem and does not just relieve the symptoms. It is a minimally-invasive procedure that causes less scarring and fibrosis than surgery. Recovery is fast, and scarring is minimized because no muscles or bones are cut during the procedure. A 2007 study reported that "discectomy is minimally invasive, safe, and effective for treating disc herniations and that 89% of patients treated by this method stated they achieved successful outcomes from the therapy."2
Although much safer than surgery, there is a risk of complications. With risks much lower than back surgery, discectomy is an appropriate treatment for many patients who suffer from back and neck pain. The most common complaint is mild back pain at the injection site shortly after the procedure. Other more serious and far less common complications include spinal cord compression, excessive intracranial pressure, bleeding, hematoma, or infection. Using x-ray fluoroscopic guidance, sterile technique, and an experienced pain physician greatly decrease these risks.
A large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques stated that percutaneous discectomy using the Dekompressor probe resulted in greater than 70% improvement in pain in 79% of patients undergoing the treatment for postero-lateral disc herniations.3 The reduction in pain allows patients to become active again. Most patients go home within hours of the procedure, and many can resume work and normal daily activities within three to five days.
Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).
1 Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
2 Transforaminal percutaneous endoscopic lumbar discectomy. Tzaan WC. Chang Gung Med J. 2007 May-Jun;30(3):226-34 PMID: 17760273
3 Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025