Percutaneous Disc Decompression for Lumbar Radicular Pain: A Review Article
Damian Ong1, Nicholas H L Chua2, Kris Vissers1,2,3
1Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore City, Singapore.
Pain Practice : the Official Journal of World Institute of Pain
|October 30, 2014
Summary
Percutaneous disc decompression (PDD) offers alternatives for lumbar radicular pain when open discectomy fails. Nucleoplasty and Dekompressor show promise, while provocative discography is not recommended.
Area of Science:
- Minimally Invasive Spine Surgery
- Pain Management
- Neurosurgery
Background:
- Open discectomy is standard for lumbar radicular pain from prolapsed discs.
- Open discectomy may yield poor results for small, contained herniations.
- Percutaneous disc decompression (PDD) techniques address this patient group.
Purpose of the Study:
- To review and evaluate various percutaneous disc decompression (PDD) techniques for lumbar radicular pain.
- To assess the evidence supporting different PDD methods and diagnostic adjuncts.
Main Methods:
- Literature search on PDD techniques for lumbar radicular pain.
- Included chymopapain chemonucleolysis, percutaneous laser disc decompression (PLDD), automated percutaneous lumbar discectomy (APLD), Dekompressor, nucleoplasty, and targeted disc decompression (TDD).
- Discussed rationale for provocative discography, selective nerve root injections, and intra-operative discograms.
Main Results:
- Dekompressor and nucleoplasty demonstrated the strongest evidence (2B+).
- Chymopapain chemonucleolysis had numerous publications but significant complications (2B+/-).
- Other techniques had limited evidence (0 to 2B+/-); provocative discography lacked supporting evidence.
Conclusions:
- Nucleoplasty and Dekompressor have a weak positive recommendation for lumbar radicular pain.
- Provocative discography has no role in this patient group.
- Evidence for selective nerve root injection and intra-operative discograms remains inconclusive.
