Minimally invasive treatment of a herniated disc through a needle (Percutaneous Automated Mechanical Nucleotomy)
Lumbar disc herniation is a common spinal pathology which may cause lower back pain and discomfort and sometimes leg pain (AKA sciatica).
In severe cases, there is a complete rupture of the disc fibers (the annulus) and extrusion of the inner part of the disc (the nucleus) along with compression of the nerve roots.
When this happens, most patients will need an open surgical treatment with either a micro-discectomy or endoscopic discectomy. These procedure being minimally invasive, however, they require general anesthesia and most of the time one day of hospitalization.
Fortunately, for many patients, the disc prolapse is not complete, there are fibers which are still containing the nucleus of the disc, and this is what we call a prolapse or a “contained disc herniation”.
In these cases, a minimally invasive procedure called “Percutaneous Nucleotomy” may be carried on through a needle without making an opening in the skin (In medical terms called a percutaneous procedure).
The affected disc is accessed with a needle through a safe window or safe “triangle”. Fluoroscopy guidance is used (the x-ray performed during a procedure in the operative theater).
The next step is to remove the herniated part of the inner component of the disc (Nucleotomy). This will decrease the pressure inside the disc and relieve the compression on the neighboring nerve root responsible for the leg pain.
There are many ways to perform the nucleotomy. The laser may be used (called PLDD), Coablation “decomposing” (nucleoplasty) or injecting substances which may make the nucleus shrink. However, one of the best ways to perform the nucleotomy , is the automated mechanical nucleotomy in which, parts of the nucleus are mechanically detached via a shaver mounted at the tip of the needle and sucked out through a cannula.
The Percutaneous Automated Mechanical Nucleotomy is my procedure of choice to treat a contained disc herniation in patients who failed the conservative treatment with medications, infiltrations and physiotherapy. It has a high success rate in relieving the symptoms, and in particular the leg pain. It has the advantage of being a minimally invasive procedure which doesn’t require general anesthesia and hospitalization.