May 4, 2006

Herniated discs can be fixed without invasive surgery

By Karla Gale

NEW YORK (Reuters Health) - The pressure and inflammation
caused by a herniated disc in the lower back (lumbar spine) can
be relieved using an approach that is less invasive than is
traditional surgery. This procedure is especially useful for
patients with sciatica, according to a presentation at the 44th
annual meeting of the American Society of Neuroradiology in San

Sciatica is caused by pressure or injury to the sciatic
nerve, located in the back of the leg. Symptoms include pain,
numbness or weakness in the leg. A herniated disc is a frequent
cause of this condition. While open surgery has been
traditional used to correct this condition, an approach that
requires a smaller incision -- "percutaneous discectomy"-- is
now possible.

"The key to success is appropriate patient selection," said
Dr. Jeffrey A. Stone, who reported his experience with this
technique at the meeting. Stone is the chief of the Section of
Interventional Neuroradiology at the Medical College of

Instruments sold in the 1980s did not work very well for
percutaneous discectomy, so many physicians remain skeptical,
he told Reuters Health. But with new devices, available since
2000, the success rate has been significantly higher, and his
team initiated a study to determine the long-term outcomes of
patients who undergo this procedure.

The procedure is performed by inserting a thin tube into
the herniation, through which a portion of the disc's nucleus
can be vaporized or suctioned out.

However, percutaneous discectomy is not for all patients
with back pain, Stone noted. He performs a couple of tests to
find out which patients are good candidates for the procedure.
For example, he'll inject contrast material to see if increased
pressure worsens the pain, and if the patient gets relief once
the pressure is reduced.

Another test is injecting an anesthetic and steroid drug
into the compressed nerve, he added. "If they get substantial
relief -- those patients will do very well with percutaneous
discectomy," he said. Occasionally that one treatment will be
sufficient, but "most of the time the pain recurs within a
couple of weeks."

In his practice,"85 percent (of appropriate candidates)
will get significant reduction in pain," and he has patients
who underwent the procedure a few years ago and "are still
doing fine."

If the pain is not caused by pressure on the nerve or
inflammation, he has found that those patients will probably do
better with surgery. Also, if the disc herniation is pinched
off from the adjacent disc or has become fragmented and
migrated into the spinal canal, the patient will require
traditional surgery.

He is now considering combining percutaneous discectomy
with electrothermal therapy to repair disc tears and provide
even better relief of symptoms. It would take time to complete
the two procedures," but less time than more invasive surgery,
he added.