Percutaneous Discectomy Over Age Sixty (Nucleotome With Laser Enhancement)
Source: Spine Disorders 1994 Annual Meeting
Publisher: The Joint Section on Spine and Peripheral Nerves
Major subject: Spine and Peripheral Nerve
Publication type: Poster
Date of publication: Feb 1994
Percutaneous discectomy is an established alternative to open surgery (e.g., laminectomy, microdiscectomy) for contained herniated lumbar discs. Over the past 3 years, 419 percutaneous discectomies performed by this author were analyzed. Thirty patients ranged from age 61 to 82, and form the basis of this study, which was to determine the effectiveness of the percutaneous discectomy procedure in the older patient, and compare success rates of the nucleotome alone versus the use of nucleotome with laser. The 2.5 mm diameter nucleotome and 1.7 mm Holmium laser were used,
All patients studied had symptoms of several months to many years in duration, and had failed conservative care; all had sciatica and other findings indicating lumbar disc rupture, i.e., straight leg raising, motor, sensory or reflex abnormalities. All patients had positive MRI or CT demonstrating contained disc rupture. Many had EMG confirmations as well. There were no intraoperative or postoperative complications.
The patients were followed postoperatively from 3 months to 3 years. To be termed "successful," patients met all 4 of the following criteria:
1. Completed a postoperative evaluation form indicating satisfaction with the results, and rated the result as "successful" or"total cure"
2. Reported an increase in functional capability.
3. Resolution of positive straight leg raising.
4. Taking no pain medication.
An overall 87% success rate was found with the use of nucleotorne only. The success rate with the laser nucleotorne combination in the over-60 age group was 93%. Of note, 4 patients who had initially failed with the nucleotome procedure alone achieved success with the Holmium laser combination. Probably due to tougher tissue found in older patients, which does not aspirate as well as the softer tissue of younger patients, the use of the Holmium laser appear's to provide an even higher success rate than that of the nucleotome alone for older patients.
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