Percutaneous automated discectomy

Abstract

Herniated lumbar discs are a major health problem throughout the world. Over 200,000 back operations are performed each year in the United States alone. The traditional procedure for herniated lumbar discs, surgical removal through laminectomy, while benefiting most patients, carries the risk of soft tissue injury of both joints and neural structures and can have a prolonged recovery period following surgery. Because of the potential problem associated with surgery the trend in the treatment of this problem is moving toward the use of more conservative treatment modalities prior to resorting toward surgery. Prior to chemonucleolysis those patients who had failed conservative means such as bed rest, traction, physical therapy, and epidural steroids had laminectomy as their only alternative. Chymopapain raised the hopes of both patients and physicians that a relatively noninvasive treatment could be used instead of surgery in this patient population. The fact that 70,000 chymopapain injections were made within 6 months of introduction of its use in the United States attests to this desire on the patient’s part not to have to undergo back surgery. The use of chymopapain, however, has been greatly curtailed due to its association with major complications which include anaphylaxis, subarachnoid hemorrhage, disc space infection, and transverse myelitis with associated paraplegia.