Until recently, people who had painful sciatica from herniated (in other words, ruptured) disks in their backs have had only one choice if they needed surgery: we made a small one-inch incision, exposed the disk, and removed the herniated portion that was pressing on the nerves and causing the sciatica.
This operation works well, but it requires an overnight hospital stay, general anesthesia, and a recovery period while the incision heals. Over the past several years a lot of thought has gone into devising ways of removing a herniated disk without having to make an incision. Several different methods have been invented, and they all share the term “percutaneous discectomy”. This means that a small probe is inserted through the skin into the disk, then the disk is removed through the probe. These methods all rely on the theory that if we can remove the center of the disk, then the herniated part will fall back into the hole created, just as a house falls into a new sinkhole. There are a couple of different ways that the disk is removed: one method called “chemonucleolysis” involves injecting an enzyme into the center of the disk to dissolve it. The whole disk then shrinks. Other methods use various devices to physically remove the disk’s center, such as strong vacuums, rotating cutters, and hand instruments. A laser can also be inserted through the probe to vaporize the center of the disk.
These percutaneous methods have advantages over regular surgery: they can be done with the patient awake, under local anesthesia. They are done as day surgery with no hospital stay. The recovery period is also much shorter. Of course, there are also disadvantages: the success rate of the percutaneous methods is lower than regular surgery because we are relying on the herniated part to fall into the “sinkhole” we create. Sometimes it just won’t. The success rate of regular surgery is about 90%+, but it is only 65-70% with percutaneous methods. However, if percutaneous surgery fails, regular surgery can then be performed without compromise.
Not every herniated disk can be treated with percutaneous methods. If the herniated disk is too large or too ruptured, then it couldn’t possibly fall back into the sinkhole well enough. Percutaneous methods also won’t work if the disk is all dried out and rigid – that usually means disks in elderly people. We also can’t do much about bone spurs with percutaneous methods.