Historically, open surgery (e.g. large incision) has been used to treat sciatica, by removing part of the intervertebral disc to provide decompression and relieve the pressure of the disc on adjacent nerve roots. Patients requiring decompression surgery are typically those suffering sciatica or leg pain caused by a herniated or slipped disc. Disc decompression surgical techniques have advanced and now the surgery is performed through small incisions and even through endoscopes — all done using a microscope or similar technology to view the surgical access into the disc.
For some patients, however, even more minimally invasive methods have been made available, whereby the entire decompression is performed percutaneously through a needle. Patients who may benefit from percutaneous disc decompression or 'percutaneous discectomy' as it is called, are those with pain arising from a contained herniated disc - that is a bulging disc where there is no rupture in the outer wall.
The use of percutaneous procedures to decompress intervertebral discs dates back to the 1960's. Early procedures showed conclusively that percutaneous disc decompression effectively relieves pain for appropriate patients. Early procedures had limitations, and so over the years a variety of more advanced techniques have been developed.
An advanced form of percutaneous discectomy developed to date uses a plasma technology to remove tissue from the center of the disc. During the procedure, an instrument is introduced through a needle and placed into the center of the disc where a series of channels are created to remove tissue from the nucleus. Tissue removal from the nucleus acts to decompress the disc and relieve the pressure exerted by the disc on the nearby nerve root. As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures. There is little tissue trauma and recovery times may be improved in many patients.
Although long-term data is not available, early studies show sustained pain relief out to one-year, with patients remaining steady at their initial post-procedure pain levels. Evidence is mounting that pain relief is sustained through two years post-procedure and beyond.
Who is the right patient?
For appropriately selected patients, percutaneous discectomy can help relieve back and leg pain symptoms, including sciatica and radiculopathy and even pure axial pain caused by a 'central focal protrusion' or central bulge of the disc. Percutaneous discectomy is a widely accepted treatment for patients with small contained herniations for whom open surgical discectomy offers a outcome. It may also be a promising option for patients with large contained (non-ruptured disc) herniations for whom open surgery is not considered an appropriate treatment.
What to Expect
Percutaneous discectomy is a straightforward procedure. The patient receives a local anesthetic and possibly mild sedation; no general anesthesia is required. Needle insertion is simple, with little pain. Once the needle is inserted into the disc, the disc decompression itself takes only a few minutes. The entire procedure takes about 30 minutes and the patient is able to leave the recovery area with only a small bandage over the needle insertion site.
Post-op recovery is not demanding. Patients typically feel little pain after the procedure. Patients are required to avoid lifting and strenuous exercise for a period of time. A patient may resume sedentary work after a week or two. Patients with more physically demanding occupations may need to wait longer to return to work. Physical therapy may be prescribed.