Radicular pain ("sciatica" or "pinched nerve") from a herniated lumbar disc continues to be a difficult treatment decision for spine specialists. Although most patients improve with conservative non-invasive therapy (i.e. no surgery), numerous patients continue to experience significant pain.
Open surgical procedures are available and have good success rates. However, patients need to understand the small, but not insignificant, risk of complications such as nerve root injury, excessive scarring around nerve roots, mechanical instability, bleeding, and infection. It has therefore become increasingly important that spine specialists consider minimally invasive procedures for these patients and progress to more invasive interventions only if they become necessary.
In the past, lumbar epidural steroid injections or selective nerve root blocks have been the most effective minimally invasive tools used by spine physicians. The ability of these injections to improve symptoms of nerve root compression ("sciatica" or radiculopathy) is well established. However, for patients who continue to suffer radicular pain ("sciatica") despite traditional interventional/medical management (physical therapy, anti-inflammatory medications, narcotics, steroid injections), a major treatment gap exists between this treatment and progression to surgery.
This desire for a minimally invasive option for treatment of spine pain led to the development of numerous percutaneous techniques (non-surgical techniques using probes that are directed through the skin and muscle, down to the problem area in the spine using x-ray guidance). These procedures have demonstrated good to excellent results 70–75% of the time. For patients with a symptomatic focal disc protrusion (type of herniated disc), unresponsive to more conservative measures, percutaneous decompression has become the standard of care in interventional spine management. The implementation of this treatment option has dramatically reduced the number of patients ultimately needing lumbar surgery.
Percutaneous Discectomy (Percutaneous Disc Decompression [PDD]) is a minimally invasive procedure performed under live x-ray guidance with the goal of removing a small amount of nuclear disc material (jelly-like substance in the centre) from your herniated disc. This decreases the pressure inside the disc (like deflating a balloon), thus relieving the pressure transmitted to your nerve root. The ultimate goal is to relieve your symptoms of leg pain +/- back pain (otherwise known as "sciatica" or "radiculopathy").