A comparison of the effects of automated percutaneous diskectomy and conventional diskectomy on intradiscal pressure, disk geometry, and stiffness.
Diskectomy, chemonucleolysis, percutaneous diskectomy, and laser ablation are used to treat patients with sciatica. The effects of percutaneous diskectomy on the intradiscal pressure of the human disk are not known. Our aims were to determine (a) whether removal of nucleus through automated percutaneous diskectomy significantly reduces intradiscal pressure without altering the disk geometry and stiffness, and if so, how much nucleus removal is required to achieve these goals; and (b) whether the effects of conventional diskectomy on these same parameters are equivalent to removal of nucleus through automated percutaneous diskectomy. Cyclic compressive loads of 20-900 N were applied to lumbar disks. Conventional diskectomy or automated percutaneous diskectomy (performed for 40 min with biomechanical measurements made four times at 10-min intervals) was then performed under zero load and the specimens retested under the same cyclic compressive loading. There were significant (p < 0.01) decreases in intradiscal pressure (by 7% under 900 N) after 10 min of automated percutaneous lumbar diskectomy. There were no further significant decreases in pressure during the next 30 min of percutaneous diskectomy. There were also significant decreases in pressure due to a puncture hole made with the Nucleotome trephine alone, without removal of disk material, and there was no difference in pressure after trephining alone and after percutaneous diskectomy. Decreases in disk height were significant, ranging from 5% at 10 min to 7% at 40 min of treatment. There were equivalent decreases in intradiscal pressure and disk height due to removal of similar amounts of nucleus during conventional diskectomy and during 40 min of percutaneous diskectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Shea
M
M
Department of Orthopaedic Surgery, Charles A. Dana Research Institute, Beth Israel Hospital, Boston, MA 02215.
Takeuchi
T Y
TY
Wittenberg
R H
RH
White
A A
AA
Hayes
W C
WC
D000328:Adult; D001331:Automation; D001696:Biomechanical Phenomena; D017586:Diskectomy; D017587:Diskectomy, Percutaneous / Q000379:methods; D004548:Elasticity; D006801:Humans; D007403:Intervertebral Disc / Q000502:physiology / Q000601:surgery*; D008875:Middle Aged; D009929:Organ Size; D011312:Pressure; D016474:Weight-Bearing