[Percutaneous nucleotomy procedures in lumbar intervertebral disk displacement. Current status]

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e.g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30% good/very good results to almost 100% good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective stuides of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.