Percutaneous Disc Decompression/ Discectomy - A Case Report
The authors present a case report on a percutaneous disc decompression/discectomy using a newly available device (DekompressorTM). The procedure was performed in the outpatient treatment of symptomatic spinal claudication, secondary to acute central disc protrusion and pre-existing congenital stenosis, in a 22-year old male patient.
The amount of space available for neural elements within the lumbar spinal canal and foramina is determined by spinal developmental variations and degenerative responses. The morphogenesis of the lumbar vertebrae begins after the seventh week of gestation, when a pair of chondrification centers forms in each vertebral arch.1,2,3 Ossification and bony union of the centrum, with its neural arch, define the dimensions of the neural canal and foramina and are not completed until several years after birth.4 If the paired dorsolateral ossification centers of one or more lumbar vertebrae stop growing prematurely, the lumbar spinal canal may become stenotic even in an otherwise normally developed person.5
The vertebrae of patients with congenital lumbar stenosis are characterized by short and thick pedicles. The transverse inter-pediculate diameter may also be smaller than the normal distance of 25mm.6 Although primary lumbar stenosis is the sole cause of entrapment radiculopathy in only 2% of patients with sciatica at presentation, it is a contributing factor associated with superimposed disc herniation or spondylosis in 30% of these patients.7
Approximately 1% of Americans per year will suffer significant low back pain associated with “sciatica.” These symptoms are most often attributable to disc protrusions.8 The vast majority (75-80%) of these will respond to time and conservative treatment.9 Patients with persistent pain unresponsive to conservative therapy often pursue surgical options. Most of these disk displacements occur through the lateral fibers of the posterior longitudinal ligament, whereas only a small percentage occur through the strong midline fibers.10 While the overall success rate for surgical discectomy for radiculopathy is 75-80 percent,11 those patients with central disc protrusions have much poorer outcomes, ranging from 41-68 percent.12,10 When combined with the challenges of congenital spinal stenosis, the probability of an optimum surgical outcome is even less.
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