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Percutaneous Discectomy: Clinical Outcome 2005

Interventional Spine

Bethlehem na Gelaw, M.D.
Gary S Cohen , M.D., Non ASSR Member
Dimitry na Niman , M.D., Non ASSR Member

Purpose

To illustrate the response to percutaneous discectomy in a cohort of 30 patients treated with the Dekompressor 1.5 mm percutaneous discectomy probe (Stryker Instruments, Kalamazoo, Michigan) at 6-12 month follow-up.

Methods & Materials

30 patients who underwent percutaneous discectomy between January 1st and December 31st were followed at 6 to 12 months. Outcome was measured by pain reduction, analgesic use, self-reported functional improvement in activities of daily living, and overall satisfaction. Prior to the procedure, a detailed physical exam was performed for lumbar radicular involvement. Magnetic Resonance Imaging (MRI) was then assessed for presence of disc herniation. The discectomy procedure was as follows: after informed consent was obtained with full disclosure, the patient was placed in prone position. Adequate anesthesia care was provided with the patient remaining awake and interactive throughout the procedure. A gram of intravenous Cefazolin was administered. A posterolateral, extrapedicular approach was used to access the center of the disc using 1.5 mm (17 gauge) Dekompressor cannula with stylet (Fig. 1) After confirming position in the disc using AP and lateral views, the stylet was removed. Non-ionic contrast (0.5-1 cc of Isoview 200M) was injected to visualize the posterolateral nuclear/annular boundary (Fig. 2). The probe tip (titanium auger) was then advanced into the introducer cannula. The probe was connected to a disposable rotational motor, which mechanically aspirated nucleous towards a proximal chamber (Fig. 3). The probe was advanced very slowly to facilitate tissue removal. The probe was activated for a total time of approximately 60-90 seconds (0.75- 2.0cc of disc material removed). Confirmation of disc material was achieved visually and the probe was removed. 0.75 cc of Cefazolin (0.5 cc, 50 mg) mixed with sensorcaine (0.5 cc, 0.5%) was given through the cannula into the disc. The cannula was then removed.

Results

Fig. 4 demonstrates pre-procedure MRI of a patient with symptomatic L4-5 disc herniation. 79% of the patients surveyed reported a reduction in pain score of 50% or more, with an average reduction in pre-operative pain score of 59% (P<0.001). 84% reported reduction in analgesic use, 92 % reported improvement in activities of daily living. Overall satisfaction was 89%.

Conclusion

Percutaneous dicectomy is a safe and effective conservative treatment option for patients with chronic discogenic leg pain.

References

Alo KM, Wright RE, Sutcliffe J, Brandt SA. Percutaneous lumbar discectomy: Clinical response in an Initial cohort of fifty consecutive patients with chronic radicular pain. Pain Practice. 2004; 4(1): 19-29.

Images

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