title: Percutaneous Disc Decompression for Lumbar Radicular Pain: A Review Article.
abstract: BACKGROUND
  Open discectomy remains the standard of treatment for patients with lumbar radicular pain secondary to a prolapsed intervertebral disc. Open discectomy performed in patients with small, contained herniations may result in poor outcomes. The various techniques of percutaneous disc decompression (PDD) have been developed to address this population.
  
  
  METHODS
  A literature search was conducted on articles, which address PDD for lumbar radicular pain. Published techniques include chymopapain chemonucleolysis, percutaneous laser disc decompression (PLDD), automated percutaneous lumbar discectomy (APLD), Dekompressor, nucleoplasty, and targeted disc decompression (TDD). In addition, the rationale of provocative discography, selective nerve root injections, and intra-op discograms before performing PDD is discussed in detail.
  
  
  RESULTS
  Dekompressor and nucleoplasty have the best level of evidence with a score of 2B+. The chymopapain chemonucleolysis has the most publications, but it is also accompanied by the most significant adverse complications and so it is scored as a 2B+/-. The other techniques are supported mainly by observational studies and thus their scores range between 0 and 2B+/-. There is no supporting evidence for provocative discography in patients with lumbar radicular pain. The evidence for a positive selective nerve root injection as an inclusion criteria or the need for an intra-op discogram shows mixed results.
  
  
  CONCLUSIONS
  Nucleoplasty and Dekompressor have a weak positive recommendation for the treatment of patients with lumbar radicular pain. There is no role for provocative discography in this group of patients, although the evidence for a selective nerve root injection or an intra-op discogram is inconclusive.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore City, Singapore.
authors.forename: Damian
authors.initials: D
authors.lastname: Ong
authors.affiliation: Specialist Pain International Clinic, Singapore City, Singapore.
authors.forename: Nicholas H L
authors.initials: NH
authors.lastname: Chua
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore City, Singapore.|Specialist Pain International Clinic, Singapore City, Singapore.|Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
mesh_terms: D001416:Back Pain / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement; D008159:Lumbar Vertebrae / Q000601:surgery; D008161:Lumbosacral Region
keywords: chemonucleolysis; disc decompression; percutaneous lumbar discectomy; review; sciatica; targeted disc decompression