ATRAUMATIC CT-CONTROLLED PERCUTANEOUS LASER NUCLEOTOMY

The main aim of percutaneous nucleotomy techniques is to reduce the vo lume and pressure of the affected disc while leaving all other structu res unaffected. Previously percutaneous discectomies were performed un der fluoroscopic guidance with or without endoscopy. In this paper we describe the combination of CT-scanning and fluoroscopy for guidance o f nucleotomes, lasers, microendoscopes and other microinstruments. The results of percutaneous laser nucleotomy performed on 116 out-patient s with chronic back pain are reported. Immediate pain relief was obtai ned in 92% of the patients, and improvement of neurological deficits i n 59%. After 6 weeks, 87% of patients were back at work. At follow-up, 1-17 months later, overall improvement of pain symptoms of 50-100% wa s present in 81% of the patients; the results were better in patients with longer follow-up times. Spondylodiscitis occurred in one patient and a second herniation with re-operation in five patients. These resu lts show that effective treatment of disc herniation is possible on an out-patient basis. The integration of knowledge from the fields of in terventional radiology and minimally invasive surgery will lead to inc reased use of microtherapy. This kind of therapy can become an importa nt factor in cost reduction in health care systems worldwide.