02 Feb Dekompressor Discectomy
A Dekompressor Discectomy is a procedure to remove the section of a herniated disc in order to decompress a nerve root being irritated and causing pain (percutaneous discectomy). It is a minimally invasive procedure and involves a small needle-like instrument guided by imaging.
Dekompressor Discectomy procedure is reserved for the treatment of a painful disc herniation that has been refractory to all medical treatments. It is typically performed on patients who have had back, buttock or leg pain for at least six weeks. This procedure is ideal if the patient is diagnosed with an isolated problem area, instead of a diffuse, multi-level pattern.
The procedure is guided by CT or fluoroscopy. The first step is to perform a discography by introducing the probe at the level of the protruded disc. A local anesthetic agent is administered and an incision of a few millimeters is made, after which coaxial trocar is inserted at the level of the herniated disc. The decompression probe is then introduced. It has a rotating tip carves away the disc tissue compressing the nerve, relieving the pressure from it and stopping the pain. After the probe and cannula are removed, the skin is covered with a small bandage. This procedure can be done on an outpatient basis and recovery is fast (one day of bed rest) and with minimal scarring. Most people return to normal activity in one to six weeks.
The early studies performed to study the overall efficacy of Dekompressor discectomy have shown that the majority of patients achieve significant improvements that were sustained for 6 or 12 months. But rigorous studies are needed to fully establish its efficacy in providing not only pain relief but also physical functioning. Having said that, the fact of the matter for patients with severe radicular pain is the lack of alternatives. As these patients have already failed conservative care, only two options remain on the table: surgery or perpetual opioids, none of which is desirable. In this context, Dekompressor discectomy offers a viable alternative worth exploring.
There are some contraindications for this procedure that one must keep in mind. They include traumatic spinal fracture, infection, tumor, pregnancy, severe co-existing medical disease. It is not suitable for conditions with pain unrelated to a herniated disc. Therefore, it is not suitable for pain caused by severe bony stenosis or severe disc degeneration. General anesthesia is contraindicated as one must be awake and alert to respond to pain stimuli.
It is also contraindicated in patients with severe and rapidly progressing neurological deficits.
There are some potential complications of this procedure and include infections, bleeding, nerve damage, worsening pain, paralysis, idiosyncratic reaction, anaphylaxis, and death.
Overall, despite its early, limited data and some contraindications and side effects, Dekompressor discectomy offers an alternative option that might be suitable and desirable for many patients. Hopefully, as further data accumulates, it will further establish the safety and efficacy is this procedure.