title: Restriction of indication for automated percutaneous lumbar discectomy based on computed tomographic discography.
abstract: This report details the authors' early experience using the automated percutaneous lumbar discectomy (APLD) procedure, developed by Onik et al., in 97 patients with a disc protrusion. In the evaluation of a herniated disc, we used computed tomography (CT) discography. According to the distribution of the dye inside the disc, five different disc types can be differentiated. With a follow-up after 3-7 months, the short-term outcomes of the first 40 APLD-treated patients varied, depending on the shape of the protruded nuclear material. Patients with a broad dye base on CT discography had better short-term outcomes than patients with a narrow dye base. In the next 57 patients we treated with APLD, this tendency was confirmed. The success rate of a consecutive group of patients with a disc protrusion with a broad dye base, treated with APLD, was 80%. In comparison, the patients with a disc protrusion with a narrow dye base had an overall success rate of only 53%. The difference is statistically significant (P < 0.05). The message of this report is that APLD is a useful invasive treatment for patients with a disc protrusion. The outcome depends, however, on the shape of the protruded nuclear material as shown by CT discography, which makes this examination as a conditio sine qua non before treating patients with a disc protrusion with APLD.
authors.affiliation: Orthopädische Klinik Westfälischen Wilhelms-Universität, Münster, Germany.
authors.forename: W H
authors.initials: WH
authors.lastname: Castro
authors.forename: J
authors.initials: J
authors.lastname: Jerosch
authors.forename: R
authors.initials: R
authors.lastname: Hepp
authors.forename: K P
authors.initials: KP
authors.lastname: Schulitz
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome