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Lumbar Percutaneous Mechanical Disc Decompression

Abstract

Minimally invasive disc decompression procedures performed in the United States include microdiscectomy, chemonucleolysis, automated percutaneous discectomy, laser discectomy, radiofrequency Coblation® (ArthroCare Corporation, Austin, TX), hydrodiscectomy, and use of a Dekompressor® (Stryker, Kalamazoo, MI). The evidence for percutaneous discectomy procedures is lacking due to a paucity of literature, a lack of high-quality randomized controlled trials (RCTs), which show conflicting results when they are present. Thus, the evidence based on a best evidence synthesis is Level II to IV for long-term improvement, which is essentially based on small, randomized controlled trials, multiple observational studies, and consensus.

Percutaneous disc decompression is indicated in those patients with low back and/or leg pain of at least 3 months duration and a contained disc after failing to respond to conservative therapeutic interventions, including fluoroscopically guided epidural injections. This manuscript describes pathophysiological, anatomical, and technical considerations of percutaneous disc decompression utilizing multiple modalities.

Keywords

  • Disc herniation
  • Disc protrusion
  • Disc bulging
  • Percutaneous lumbar laser discectomy
  • Dekompressor
  • Hydrodiscectomy
  • Nucleoplasty

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Acknowledgments

This book chapter is modified and updated from a previous book chapter, “Percutaneous mechanical disc decompression” by David S. Kloth, MD, Vijay Singh, MD, and Laxmaiah Manchikanti, MD, in Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Manchikanti, L., Singh, V., Pasupuleti, R., Kloth, D.S., Hirsch, J.A. (2018). Lumbar Percutaneous Mechanical Disc Decompression. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_17

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