Lumbar percutaneous automated nucleotomy. Technique, patient selection and preliminary results

The purpose of this study was to evaluate 2 years' experience with percutaneous automated nucleotomy. Adult patients with small to medium sized disk hernias corresponding to clinical symptoms, and without evidence of free fragments or stenosis were treated on an outpatient basis. All patients had sciatica and conservative treatment had failed for at least 3 months. Using the Nucleotome R system, access to the disk was achieved in all but 6 of 172 disks in 152 patients. Degenerative disk disease or pain was the reason for technical failures. Four other procedures were discontinued because of pain and moderate hemorrhage. Except for one case of diskitis, no serious complications occurred. Of the patients in a prospective study, 63 had a follow-up period of 4 months or more. The overall clinical success rate was 62%, and was not significantly influenced by patient sex or age, duration of symptoms, level treated, disk degeneration or amount of nucleus material removed. The results are promising; however, this study indicates a need for refined patient selection in order to decrease the number of failures.