Percutaneous discectomy has high success rate in treating sciatica

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A minimally invasive approach to reducing pressure and inflammation in herniated discs of the lumbar spine results in good outcomes, especially for patients with sciatica, according to a presentation at the 44th annual meeting of the American Society of Neuroradiology in San Diego.

"The key to success is appropriate patient selection," said Dr. Jeffrey A. Stone, who reported his experience with this technique at the meeting. Dr. Stone is the chief of the Section of Interventional Neuroradiology at the Medical College of Georgia.

He told Reuters Health that instruments sold in the 1980s did not work very well for percutaneous discectomy, so many physicians remain skeptical. But with new devices available since 2000, the success rate has been significantly higher, and he and his associates have initiated a prospective trial to determine long-term outcomes with the procedure.

The procedure is performed by inserting a cannula into the herniation, through which a portion of the disc's nucleus can be vaporized or suctioned out.

Percutaneous discectomy is not for all patients with back pain, Dr. Stone noted. He performs a couple of tests to find out which patients are good candidates for the procedure. For example, he'll inject contrast material to see if increased pressure worsens the pain, and if the patient gets relief once the pressure is reduced.

"Or we'll do selective nerve root injection of anesthetic and steroid to the compressed nerve," he added. "If they get substantial relief those patients will do very well with percutaneous discectomy," he said. Occasionally that one treatment will be sufficient, but "most of the time the pain recurs within a couple of weeks."

In his practice,"85% (of appropriate candidates) will get significant reduction in pain," and he has patients who underwent the procedure a few years ago and "are still doing fine."

He has found that if the pain is not caused by pressure on the nerve or inflammation, those patients will probably do better with surgery.

"The disc herniation needs to be contained, to communicate with the parent disc," he said. "If it is pinched off from the disc or has become fragmented and migrated into the spinal canal," patients will require traditional surgery.

Dr. Stone noted that intradiscal electrothermal therapy (IDET), a form of annuloplasty, has been used to repair tears in the disc.

"IDET by itself has not been very successful," he noted, "particularly with radicular pain."

But he is now considering the combination of percutaneous discectomy followed by IDET to provide even better relief from symptoms.

"It would take time to complete the two procedures, but far less time than if you do microdiscectomy with surgery," he added