- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
Spinecare Topics
Surgical Interventions
Surgical Interventions
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Surgical Interventions
During the procedure, the patient is asked to describe in detail what
they are experiencing. The patient may also be asked to draw a pain
diagram identifying the distribution of pain associated with disc
assessment. If the pain is similar to their chief complaint then it is
associated with the tested disc and the pain is considered to be
concordant. After evaluation of an involved disc, the
interventionalist may inject a local anesthetic into the disc prior to
needle removal. This usually will relieve the associated pain within a
few minutes. Most frequently requested levels of discography are at
the levels of L2-L3, L3-L4, L4-L5, L5-S1 segments of the low back.
Indications for procedure and the use of discography: Discography can be a valuable tool in the evaluation of pain of discogenic origin. Discography is not simply a procedure used to determine the site of the spine that may respond to a surgical fusion. With the continuous evolution of minimally invasive interventional procedures and the growing recognition of the role of the disc and pain syndromes, the demand for the procedure or similar procedures will likely grow.
Indications for the procedure include chronic low back pain that has not responded to conservative care. The procedure should be considered for patients who have had no favorable responses to other minimally invasive procedures such as joint blocks and epidural steroid injections. In summary, it should be reserved for the patient the attending clinician believes has pain of primary disc origin reducing the quality of their life.
Automated Percutaneous Lumbar Discectomy
Automated percutaneous lumbar discectomy (APLD) was first performed approximately 20 years ago. There has been some resistance to this minimally invasive approach, although APLD has generally stood the test of time. APLD may be one of the safest surgical treatments available for the care of herniated lumbar discs. It requires the use of an operating microscope. The reduced size of the incision is associated with a low complication rate. APLD is proposed to work by causing central decompression of the nucleus pulposus or gel-like center of the disc. The reduced pressure within the disc may reduce the size of a disc herniation. Depending on the research interpreted, the success rate of APLD has been reported to range from between 40% and 90%. Other forms of percutaneous disc removal, which include laser disc decompression and bipolar percutaneous disc compression, requires otoscopy of the disc during removal.
Indications for the Procedure: Candidates include patients who have unremitting signs and/or symptoms due to disc herniation, which have not responded favorably to a course of conservative intervention. Patients who have herniations whereby the gel-like center is contained by the outer fibers of the disc or the posterior longitudinal ligament. The use of neuroimaging techniques particularly MRI is particularly helpful in evaluating whether a patient meets this criteria. Individuals who have herniations with an extrusion of the gel-like center of the disc beyond the outer boundaries of the disc are not good candidates.
Another procedure that has proven to be very sensitive for the selection of patients with APLDs, computed tomography, or CT discogram. This procedure helps to confirm the presence of complete tears of the outer fibers within the disc and can evaluate the relationship of a disc herniation with the posterior longitudinal ligament. A CT discogram can be used to evaluate the size of a tear within the intervertebral disc. Patients who are selected for this procedure should undergo a differential pain workup including facet injections to help exclude non-discogenic sources of pain at the involved spinal level.
Indications for procedure and the use of discography: Discography can be a valuable tool in the evaluation of pain of discogenic origin. Discography is not simply a procedure used to determine the site of the spine that may respond to a surgical fusion. With the continuous evolution of minimally invasive interventional procedures and the growing recognition of the role of the disc and pain syndromes, the demand for the procedure or similar procedures will likely grow.
Indications for the procedure include chronic low back pain that has not responded to conservative care. The procedure should be considered for patients who have had no favorable responses to other minimally invasive procedures such as joint blocks and epidural steroid injections. In summary, it should be reserved for the patient the attending clinician believes has pain of primary disc origin reducing the quality of their life.
Automated Percutaneous Lumbar Discectomy
Automated percutaneous lumbar discectomy (APLD) was first performed approximately 20 years ago. There has been some resistance to this minimally invasive approach, although APLD has generally stood the test of time. APLD may be one of the safest surgical treatments available for the care of herniated lumbar discs. It requires the use of an operating microscope. The reduced size of the incision is associated with a low complication rate. APLD is proposed to work by causing central decompression of the nucleus pulposus or gel-like center of the disc. The reduced pressure within the disc may reduce the size of a disc herniation. Depending on the research interpreted, the success rate of APLD has been reported to range from between 40% and 90%. Other forms of percutaneous disc removal, which include laser disc decompression and bipolar percutaneous disc compression, requires otoscopy of the disc during removal.
Indications for the Procedure: Candidates include patients who have unremitting signs and/or symptoms due to disc herniation, which have not responded favorably to a course of conservative intervention. Patients who have herniations whereby the gel-like center is contained by the outer fibers of the disc or the posterior longitudinal ligament. The use of neuroimaging techniques particularly MRI is particularly helpful in evaluating whether a patient meets this criteria. Individuals who have herniations with an extrusion of the gel-like center of the disc beyond the outer boundaries of the disc are not good candidates.
Another procedure that has proven to be very sensitive for the selection of patients with APLDs, computed tomography, or CT discogram. This procedure helps to confirm the presence of complete tears of the outer fibers within the disc and can evaluate the relationship of a disc herniation with the posterior longitudinal ligament. A CT discogram can be used to evaluate the size of a tear within the intervertebral disc. Patients who are selected for this procedure should undergo a differential pain workup including facet injections to help exclude non-discogenic sources of pain at the involved spinal level.
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