Automated percutaneous lumbar discectomy
AKA nucleoplasty. Utilizes a nucleotome 1). to remove disc material from the center of the intervertebral disc space. 1 year success rate of 37%.
Complications include cauda equina syndrome from improper nucleotome placement. 2)
In another study, nucleoplasty (with or without IDET) for HLD showed only a modest reduction in pain at 9 months 3).
Percutaneous disc nucleoplasty (PDN) is a Minimally Invasive Spine Surgery technique. A portion of the nucleus tissue is ablated using the Coblation technique. Re-surgery is an important factor for the clinical outcome. However, the rate of subsequent surgery after PDN is still unknown. The aim of Klessinger et al., was to investigate the frequency of an additional open surgery after PDN in a retrospective of more than ten years.
Retrospective observational study. Consecutive patients who underwent PDN between 2005 and 2006 were included. Patient's satisfaction was evaluated using MacNab's outcome criteria. The patient data (age and gender), the MRI findings (annular fissure or contained herniation) and the follow-up time was evaluated. A distinction was made between patients with only lumbago and patients with radiating pain. The focus of this study was to evaluate the necessity of an additional surgery at the same level. The period of time between the PDN and re-surgery was analyzed.
In total, 203 patients were included in this study. All patients were seen one month after PDN. The follow-up time was longer than five years in 41 patients (20.2%), and longer than 10 years in 16 patients (7.9%). The short-term success rate was 63.5%; however, 18.7% of all patients had to undergo an additional surgery at the index level. Half of these additional surgeries were performed during the first three months after PDN. If only a poor pain reduction was achieved, re-surgery was significantly more frequent compared to patients with substantial pain relief. An initial surgery at the L4-5 level was associated more often with an additional surgery compared to an initial surgery at the L5-S1 level.
The present study is the first study to report the frequency of re-surgery after PDN. At first sight, the fact that 63.5% of patients are satisfied seems to be a good result. However, this short-term result was significantly worsened due to a re-surgery rate at the index level of 18.7%. Moreover, it is possible that nucleoplasty has adverse effects resulting from the puncture and progressive degeneration. Therefore, indications for nucleoplasty should be critically reconsidered 4).
In 2009, Hirsch et al. published the results of their systematic review into the evidence-based efficacy of automated percutaneous lumbar discectomy (APLD) as a treatment intervention for contained disc herniation. Only the most scientific, evidence-based research papers were allowed entry into this “study of studies,” which makes its conclusions quite powerful.
A systematic review shows limited evidence for automated percutaneous mechanical lumbar discectomy. Automated percutaneous mechanical lumbar discectomy may provide appropriate relief in properly selected patients with contained lumbar disc herniation 5).
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