Percutaneous discectomy for a herniated disc

Surgery Overview

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Percutaneous means "through the skin" or using a very small incision. Discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord.

Percutaneous discectomy is different from conventional open discectomy or microdiscectomy. There are several percutaneous procedures. All of them involve inserting small instruments between the vertebrae and into the middle of the disc. X-ray monitoring is used during surgery to guide the movement of the surgical instruments. The surgeon can remove disc tissue by cutting it out, sucking out the center of the disc, or by using lasers to burn or evaporate the disc. The disc material that has herniated is not directly removed in these operations.

This procedure is usually done in a surgery center using either local or general anesthesia.

Before surgery, your doctor will confirm that a herniated disc is causing your symptoms by using an imaging study, such as magnetic resonance imaging (MRI), computed tomography (CT scan), or myelogram.

What To Expect After Surgery

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You can expect to go home on the same day you have a routine percutaneous discectomy.

After a percutaneous discectomy, you can use prescription medicine to control pain during the recovery period.

For several weeks, avoid long periods of sitting, as well as bending, twisting, and lifting.

Why It Is Done

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Percutaneous discectomy may be done if:

• The history, physical examination, and imaging (such as MRI, CT scan, or myelogram) indicate that the disc is bulging, and the material inside the disc (nucleus) has not ruptured into the spinal canal.
• Pain and nerve damage have not improved after 4 or more weeks of nonsurgical treatment, and symptoms are severe and disabling.
• There are signs of serious nerve damage (that may be getting worse) in the leg, such as severe weakness, loss of coordination, or loss of feeling.
• Pain is severe and disabling.

Should I have surgery for a herniated disc?

This procedure should not be done if you have:

• Fragments of disc material (nucleus) in the spinal canal (as seen on CT scan or MRI).
• Narrowing of the spinal canal (spinal stenosis).

How Well It Works

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Percutaneous discectomy is less effective than traditional open discectomy surgery.¹

Risks

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During a percutaneous discectomy, the surgeon has no way of seeing the herniated disc or the compressed nerve root. And the surgery does not directly remove the disc herniation. So there is no guarantee that pressure on the nerve will be reduced or eliminated using percutaneous discectomy.

What To Think About

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Many experts consider percutaneous discectomy to be a poor alternative to standard discectomy or microdiscectomy procedures.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Deyo RA, Weinstein JN (2001). Low back pain. New England Journal of Medicine, 344(5): 363–370.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	July 21, 2008