Automated percutaneous lumbar discectomy in patients suffering from prolapsed intervertebral disc: a prospective study

Abstract

Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD), being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as ‘automated’ since it involves a mechanical probe, working by a ‘suction and cutting action for removal of the nucleus pulposus.

Methodology: After meeting the inclusion criteria, minimal invasive procedure – APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance.

Result: Based on patient satisfaction, 72 (60%) patients had excellent pain relief (75 – 100%), 34 (28.3%) had good pain relief (51–74%) whereas 14 (11.7%) patients had poor pain relief. Two (1.6%) patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae.

Conclusion: Percutaneous decompression (APLD) techniques for intervertebral disc herniation are safe and cost-effective techniques with significant and long lasting results concerning pain reduction and mobility improvement. They can be proposed as initial treatment or attractive alternatives prior to major surgery.

Citation: Paswan AK, Gupta S, Prakash S, Dubey RK, Khuba S, Rastogi V. Automated percutaneous lumbar discectomy in patients suffering from prolapsed intervertebral disc: a prospective study. Anaesth Pain & Intensive Care 2016;20(4):429-435