[Nucleotomy--a new method in the treatment of lumboischiadic syndrome]

Degenerative changes in the lumbosacral portion of the spine are frequently associated with the lumboischiadic syndrome (LI syndrome). Its treatment is traditionally conservative or surgical. In the seventies and eighties to these two procedures percutaneous punctures were added. The objective of the authors is to present their own experience with a new puncture method of LI syndrome--APLD (automated percutaneous lumbar discectomy).

The number of operated patients in 1991-1994 comprised 45 patients, 19 men and 28 women, mean age 40.7 years (18-64 years). APLD was performed 47 times (four times at the level of L3/4, 30 times at the level of L4/5 and 13 times at the level of L5/S1; in two subjects the operation was repeated because the first operation was not effective. APLD is a miniinvasive method made under local anaesthesia with skiascopic control, using special instruments of Surgical Dynamics, USA. Patients with the LI syndrome are selected for treatment according to strict clinical and radiological criteria, the effectiveness of treatment depends on the selection of patients. In the published group treatment was successful in 83% (17% not improved, 38% improved, 45% cured) which is consistent with the experience of others, in particular authors abroad. Only in one instance a minor peroperative complication occurred; the authors did not record any postoperative complications.

APLD is an effective and safe method of invasive treatment of prolapse of lumbar intervertebral discs in an indicated group of patients. It does not replace surgical treatment but reduces the period of conservative treatment. If this treatment is not successful after 4-6 weeks, APLD should be the method of choice. Therefore doctors who are the first to treat these patients should become familiar with the clinical indications.