A New and Superior Technique for Removal of Herniated Lumbar Disc: Endoscope and Nucleotome Combination

Source: Spine Disorders 1995 Annual Meeting

Publisher: The Joint Section on Spine and Peripheral Nerves

Major subject: Spine and Peripheral Nerve

Publication type: Paper

Date of publication: Feb 1995

Abstract:
After performing over one thousand percutaneous discectomies since 1987 using various techniques and equipment, this author has developed a new and superior technique for combining the standard nucleotome with an innovative, highly effective working channel endoscope. Since November ’93, thirty-two patients have had percutaneous lumbar discectomies with local anesthesia performed with a newly developed endoscope, consisting of a 2.8 mm plastic tube with a 6 thousand pixel fiberoptic scope in the wall, passing through a 4.2 mm outer diameter metal cannula. A forceps, suction, dissector and 2.5 mm nucleotome fit through the working channel providing not only internal decompression, but also removal of extruded or separated fragments located outside the disc space. The combination internal-external disc access provides an excellent comprehensive new approach. All patients had sciatica for several months to many years and failed conservative care. All patients had positive MRI or CT scans and lumbar disc rupture findings (straight leg raising, motor, sensory, or reflex abnormalities). “Successful” patients continued to meet all these criteria: 1. Completed post-operative evaluation form, rating result “Successful” or “total cure.” 2. Reported increase in functional capability. 3. Positive straight leg raising resolved. 4. Taking no pain medication. The 32 endoscopic cases had a 91% success rate with no complications. This new endoscope allows inclusion of patients not previously candidates for percutaneous surgery. The automated percutaneous lumbar discectomy procedure has traditionally been an internal decompression which allows subsequent receding of prolapsed disc, not a direct removal of ruptured disc material. This new technique and equipment permits direct removal of ruptured disc as well as internal decompression. As equipment is improving for working through small cannulas and more fully eradicating the pathology while also eliminating the access damage inherent to traditional spine surgery, percutaneous techniques are rising rapidly along the effectiveness scale while remaining the safest approach.