Percutaneous automated discectomy: a new method for lumbar disc removal. Technical note

Abstract

A new technique for percutaneous lumbar disc removal is described. The specially designed 2-mm blunt-tipped suction/cutting probe (nucleotome) is similar to the automated vitrectomy instrumentation used by ophthalmic surgeons. The procedure is performed under local anesthesia, with the patient in the prone position and with fluoroscopic guidance. The nucleotome is inserted into the appropriate disc space with specially designed instrumentation, guided by landmarks similar to those used in needle placement for chemonucleolysis. The technique has been evaluated in 20 patients with herniated discs (one at the L3-4 level and 19 at the L4-5 level) confirmed by myelography and/or computerized tomography scans after all conservative therapy for primarily radicular pain had failed. From 1 to 7 gm of disc material was removed in an average total operative time of approximately 1 hour. Eighty percent of the patients had good to excellent results in a short-term follow-up period of 6 months. Four patients subsequently required standard surgical excision of free disc fragments. No significant complications occurred. The procedure is contraindicated in patients with extruded or free fragments of disc in the spinal canal or in patients with herniations at the L5-S1 level pending development of additional instrumentation for insertion at that level. More extensive long-term studies are needed to further evaluate this procedure.