Automated percutaneous lumbar discectomy

Abstract

Lumbar spine disc disease has traditionally been treated surgically by laminectomy and manual removal of the offending disc material. Chymopapain was extensively used to decompress the disc pressure in a relatively noninvasive manner, but has been abandoned due to serious complications, including anaphylaxis and paraplegia. Onik introduced automated percutaneous discectomy in 1985. This procedure has proved safe and efficacious for treating lumbar disc disease without complications. It is performed on an out-patient basis under local anesthesia with minimal rehabilitation time. The success rate reported in a multi-institutional study with one year follow-up is approximately 75%. The majority of failures occur in patients with free fragments or spinal stenosis — both of which can be diagnosed preoperatively with good imaging examinations. Hence, the success rate can be expected to improve if preoperative imaging is relied upon to help choose appropriate patients. Over 30,000 percutaneous discectomy procedures have been performed. The only complication reported, disc infection, developed in fewer than 0.2% of cases. Automated percutaneous discectomy has the potential to treat a vast number of patients with lumbar disc disease who otherwise would have laminectomies.