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An experimental study comparing percutaneous discectomy with chemonucleolysis

R Gunzburg1, R D Fraser, R Moore

  • 1Royal Adelaide Hospital, South Australia.

Spine
|February 1, 1993
PubMed
Summary
This summary is machine-generated.

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Automated Nucleotome discectomy in sheep showed minimal disc changes, similar to simple annulus perforation. Annular perforation, not nuclear excision, likely explains any therapeutic effect, with chemonucleolysis causing significant disc alteration.

Area of Science:

  • Spinal Surgery
  • Biomedical Engineering
  • Comparative Pathology

Background:

  • Percutaneous discectomy aims to treat discogenic pain.
  • The Automated Nucleotome is a device used for discectomy.
  • Understanding the tissue response to discectomy is crucial for evaluating its efficacy.

Purpose of the Study:

  • To evaluate the macroscopic and microscopic intervertebral disc response to Automated Nucleotome discectomy.
  • To compare the effects of Automated Nucleotome discectomy with simple annular trephining and chemonucleolysis.
  • To determine the contribution of annular perforation versus nuclear excision in the Automated Nucleotome procedure.

Main Methods:

  • Eight adult sheep underwent lumbar discectomy using the Automated Nucleotome (trephine or probe) or simple trephining.

Related Experiment Videos

  • Four additional sheep received chemonucleolysis.
  • Discs were analyzed radiographically, macroscopically, and microscopically after 6 weeks.

    • Main Results:

    • Automated Nucleotome discectomy and simple trephining resulted in nearly identical radiographic and macroscopic changes.
    • Microscopic examination showed similarities between trephining and Automated Nucleotome groups.
    • Chemonucleolysis led to significant disc volume reduction, unlike the other procedures.
    • Discs treated with Automated Nucleotome or trephining did not differ macroscopically from control levels.

    Conclusions:

    • The therapeutic effect of Automated Nucleotome discectomy may primarily stem from annular perforation.
    • Removal of nuclear material with the Automated Nucleotome probe appears to contribute minimally to claimed benefits.
    • Chemonucleolysis induces substantial intervertebral disc alterations compared to mechanical discectomy methods.