TECHNICALS OF PERCUTANEOUS LUMBAR DISKECTOMY - AUTOMATIC AND MANUAL TECHNIQUES - INDICATIONS AND RESULTS

The authors review the percutaneous techniques: automated (Nucleotome) manual, with and without motorization (<<shavers>>) with and without discoscopy. These techniques are indicated in less than 15 % of cases of disc herniations ; but, if the proper indications are respected, a rate of success between 75 and 85 % can be expected. The guidelines of the indications are the following: contained disc herniation (longitu dinal ligament not ruptured), subacute clinical course, no lateral spi nal stenosis, age under 45... Although the percutaneous techniques are simple and safe, they must be always preceded by a medical treatment durign at least 6 weeks. The pre-operative imaging is of paramount val ue to assess the wholeness of posterior longitudinal ligament: compute rized discography (C.T.-scan + discographie), M.R.I., disco-manometry. .. The authors advocate for percunaneous discectomy versus chemonucleo lysis, but surgical approach by micro-technique remains indicated in m ost cases of lumbar herniated discs, especially in cases of ruptured d iscs (extruded or uncontained herniations), acute clinical course, spi nal canal stenosis, age more than 45, or particular anatomical situati ons (such as deep-seated lumbosacral space or post-operative fibrosis) .