1. 2006;9;139-146Percutaneous Lumbar Disc Decompression
   A Focused Review
   Vijay Singh, MD, and Richard Derby, MD.

Chronic low back pain is a major social, economic, and healthcare issue in the United States. Various techniques are utilized in managing discogenic pain, with or without disc herniation. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression, and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s.

Technical advances in the use of intradiscal therapies led to the development of intradiscal electrothermal annuloplasty (IDET®), DISC Nucleoplasty™, and DeKompressor®, along with laser-assisted, endoscopic, and Nucleotome® disc decompressions. The indications for percutaneous lumbar disc decompression include low back and lower extremity pain caused by a symptomatic disc.

Internal disc disruptions and disc herniations are common causes of low back and/or lower extremity pain which may become chronic, if not diagnosed and treated. Annular tears lead to migration of the nuclear material and deranged internal architecture. In the chronically damaged intervertebral disc, leakage of nuclear material from annular tears can initiate, promote, and continue the inflammatory process and delay or stop recovery of vital remaining intradiscal tissue.

The most often stated goal of central nuclear decompression is to lower the pressure in the nucleus and to allow room for the herniated fragment to implode inward.

Provocative discography prior to percutaneous lumbar disc decompression is recommended. Percutaneous disc decompression may result in a small number of complications but occasionally, these could be serious.

Key Words: Internal disc disruption, disc herniation, discogenic pain, percutaneous lumbar disc decompression, IDET, nucleoplasty, LASE, decompressor, nucleotome