[Percutaneous nucleotomy-diskectomy techniques. Automated and manual techniques. Indications and results]

The authors review the percutaneous techniques: automated (Nucleotome) manual, with and without motorization ("shavers") with and without discoscopy. These techniques are indicated in less than 15% of cases of disc herniations; but, if the proper indications are respected, a rate of success between 75 and 85% can be expected. The guidelines of the indications are the following: contained disc herniation (longitudinal ligament not ruptured), subacute clinical course, no lateral spinal stenosis, age under 45.... Although the percutaneous techniques are simple and safe, they must be always preceded by a medical treatment during at least 6 weeks. The pre-operative imaging is of paramount value to assess the wholeness of posterior longitudinal ligament: computerized discography (C.T.-scan+discography), M.R.I., disco-manometry.... The authors advocate for percutaneous discectomy versus chemonucleolysis, but surgical approach by micro-technique remains indicated in most cases of lumbar herniated discs, especially in cases of ruptured discs (extruded or uncontained herniations), acute clinical course, spinal canal stenosis, age more than 45, or particular anatomical situations (such as deep-seated lumbosacral space or post-operative fibrosis).