Authors' objectives:

To determine the availability and quality of evidence concerning the effectiveness of percutaneous discectomy for disc herniation.

Authors' results and conclusions: Percutaneous discectomy procedures are minimally invasive surgeries that act as alternatives to conventional discectomy. Procedures include manual discectomy, automated discectony, laser discectomy, and nucleoplasty. Many studies have been conducted on the array of percutaneous discectomy procedures. The quality of the studies ranged from randomized trials to case series studies. Most of the studies were small, case series studies without comparison groups. As a result, these studies did not conclusively show treatment efficacy. Two randomized trials of manual percutaneous discectomy have indicated that the percutaneous groups experienced shorter disability duration. The first randomized trial comparing arthroscopic to open discectomy showed comparable clinical results between treatment groups at mean 31 months. The second study comparing percutaneous to microdiscectomy also showed comparable clinical results at 2-year follow-up. While the results were promising, these two trials do not show that manual percutaneous discectomy is more efficacious than the gold standard conventional discectomy. APLD has also been compared to alternative treatments. In one trial against chemonucleolysis, chemonucleolysis patients experienced better outcomes at both 6 months and 1 year. A second study showed comparable results between chemonucleolysis and APLD patients. When APLD was compared to microdiscectomy, researchers halted study recruitment due to poor outcomes experienced by the APLD group. A small study examining APLD against conventional discectomy showed comparable results between the two groups, but the study did not have adequate power to detect significant findings. Although the studies were all small trials, they generally found that chemonucleolysis and microdiscectomy resulted in better patient outcomes. No randomized trials have been conducted to study the efficacy of either percutaneous laser discectomy or nucleoplasty. One study of laser discectomy included a historical comparison group of patients who underwent open discectomy. The authors note that the comparison group generally showed stronger results, but the laser group would have had a higher success rate if compensation patients had been excluded from the study. Because only case series studies have been conducted to examine the efficacy of these two procedures, they are considered investigational.

Authors' recommendations: Evidence for percutaneous discectomies does not clearly show that any of the procedures effectively treat disc herniation.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.lni.wa.gov/ClaimsIns/Files/OMD/PercutaneousDiscectomy20040224.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Washington State Department of Labor and Industries (WSDLI)

Contact Address: Box 44321, 7273 Linderson Way SW, Olympia, WA, USA 98504-4321. Tel: 1(360)902-5227

Contact Name: mojo235@LNI.wa.gov

Contact Email: mojo235@LNI.wa.gov

Copyright: Washington State Department of Labor and Industries