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

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Spinal Surgery

Background:

• Herniated lumbar discs often cause debilitating radicular pain.
• Conservative treatments frequently fail to provide adequate relief for these patients.
• Existing surgical options may involve significant invasiveness and recovery times.

Purpose of the Study:

• To describe a new technique for percutaneous lumbar disc removal using a specialized suction/cutting probe.
• To evaluate the safety and efficacy of this nucleotome-assisted procedure in patients with herniated discs.

Main Methods:

• A 2-mm blunt-tipped nucleotome probe, adapted from ophthalmic surgery instrumentation, was used.
• The procedure was performed under local anesthesia with patients in the prone position and under fluoroscopic guidance.
• Twenty patients with herniated discs (L3-4 and L4-5) refractory to conservative care were treated.

Main Results:

• An average of 1 to 7 gm of disc material was removed in approximately 1 hour.
• Eighty percent of patients achieved good to excellent outcomes at 6-month follow-up.
• No significant complications were observed, though four patients later required conventional surgery for free fragments.

Conclusions:

• Percutaneous lumbar disc removal with the nucleotome is a viable option for select patients with herniated discs.
• The procedure is contraindicated for extruded fragments or L5-S1 herniations due to current instrumentation limitations.
• Longer-term studies are necessary to fully ascertain the benefits and limitations of this technique.