Contained Herniated Lumbar Disc: CT- and Fluoroscopy-Guided Automated Percutaneous Discectomy—A Revival

Abstract

The combination of a new device and dual guidance (computed tomography [CT] and fluoroscopy) is similar to other percutaneous devices in achieving a mechanical decompression of the disc. The difference, however, is that the target of the decompression with the current technique is the herniated disc itself. The goal of this combined technique is to create a space, an “olive” around the probe, allowing a decrease in pressure inside the hernia. Percutaneous discectomy under combined CT and fluoroscopic guidance is a minimally invasive spine surgery that should be considered as an alternative to surgery in properly selected patients.

Keywords

percutaneous - discectomy - computed tomography - disc herniation - fluoroscopy - spine - interventional radiology

• References

• 1 Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health 1983; 73 (04) 389-395
• 2 Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004; 29 (01) 79-86
• 3 Ramirez LF, Thisted R. Using a national health care data base to determine surgical complications in community hospitals: lumbar discectomy as an example. Neurosurgery 1989; 25 (02) 218-225
• 4 Stolke D, Sollmann WP, Seifert V. Intra- and postoperative complications in lumbar disc surgery. Spine 1989; 14 (01) 56-59
• 5 Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years' experience. Clin Orthop Relat Res 1989; (238) 9-23
• 6 Onik G, Helms CA. Automated percutaneous lumbar diskectomy. AJR Am J Roentgenol 1991; 156 (03) 531-538
• 7 Mixter W, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934; 211: 210-215
• 8 Liu WG, Wu XT, Guo JH, Zhuang SY, Teng GJ. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol 2010; 33 (04) 780-786
• 9 Manchikanti L, Singh V, Falco FJ. , et al. An updated review of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. Pain Physician 2013; 16 (2, Suppl): SE151-SE184
• 10 Hirsch JA, Singh V, Falco FJE, Benyamin RM, Manchikanti L. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician 2009; 12 (03) 601-620
• 11 Harris RP, Helfand M, Woolf SH. , et al; Methods Work Group, Third US Preventive Services Task Force. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 2001; 20 (3, Suppl): 21-35
• 12 Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 2014; (09) CD010328
• 13 Hermantin FU, Peters T, Quartararo L, Kambin P. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 1999; 81 (07) 958-965
• 14 Huang TJ, Hsu RW, Li YY, Cheng CC. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 2005; 23 (02) 406-411
• 15 Teli M, Lovi A, Brayda-Bruno M. , et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 2010; 19 (03) 443-450
• 16 Arts M, Brand R, van der Kallen B, Lycklama à Nijeholt G, Peul W. Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial. Eur Spine J 2011; 20 (01) 51-57
• 17 Amoretti N, Hauger O, Marcy PY. , et al. Percutaneous discectomy on lumbar radiculopathy related to disk herniation: why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol 2012; 81 (06) 1259-1264
• 18 Amoretti N, Huwart L, Marcy PY. , et al. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs. Skeletal Radiol 2013; 42 (01) 49-53
• 19 Marks RA. Transcutaneous lumbar diskectomy for internal disk derangement: a new indication. South Med J 2000; 93 (09) 885-890
• 20 Liu WG, Wu XT, Guo JH, Zhuang SY, Teng GJ. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol 2010; 33 (04) 780-786
• 21 Bonaldi G. Automated percutaneous lumbar discectomy: technique, indications and clinical follow-up in over 1000 patients. Neuroradiology 2003; 45 (10) 735-743