NEW YORK, May 5 (Reuters) 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 Diego.
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 Georgia.
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.
REUTERS CH ND0938