Percutaneous nucleotomy with CT and fluoroscopic guidance.
Automated percutaneous diskectomy was performed with use of computed tomographic (CT) and fluoroscopic monitoring. Degenerative disease of the intervertebral disk was treated with local administration of anesthesia and use of a nucleotome. One hundred ten patients with neurologic symptoms and morphologic changes of one segment were selected for treatment. Previous conservative therapy had been unsuccessful. Patients with completely prolapsed and sequestered fragments of herniated disks ("uncontained disk"), narrow intervertebral spaces, posterior osteophytes, diseased facet joints, and spinal stenoses were not considered candidates for percutaneous nucleotomy (PNT). After PNT, 82% of the patients had complete remission of their neurologic symptoms; Lasègue sign was negative or improved in 92%. In 18% (20 patients), the symptoms did not improve sufficiently; 11% (12 of 110) of these patients underwent surgical nucleotomy. There were no serious complications, in particular, no injuries to vital structures (nerves, thecal sac, arteries, veins), except for one case of spondylodiskitis. Guiding PNT with CT and fluoroscopy provides a safe procedure with good clinical results. The addition of CT has shortened the operation but increased over-all procedure time. In the future, a shift to outpatient treatment may offset the additional time and cost of including CT guidance.
Seibel
R M
RM
Institute of Diagnostic and Interventional Radiology, University Witten/Herdeck, Mulheim a.d. Ruhr, Germany.
Grönemeyer
D H
DH
Sörensen
R A
RA
D000328:Adult; D000368:Aged; D005471:Fluoroscopy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed