Minimally Invasive Percutaneous Hydrodiscectomy : Preliminary Report

Objective: The standard of care for surgical treatment of degenerative disc disease (DDD) is open microdiscectomy, but various minimally invasive procedures have been introduced to treat DDD. For example, there are many techniques such as endoscopic discectomy (with or without laser), intradiscal electrothermal therapy (IDET), nucleoplasty, automated percutaneous discectomy (APLD), etc. Among them, some surgical techniques are still used and others have disappeared as a result of their respective advantages and disadvantages. This paper will report the feasibility of percutaneous hydrodiscectomy Methods: A total of 13 patients who underwent hydrodiscectomy from November 2007 to March 2008 at 3 university hospitals and 2 general hospitals, respectively, were evaluated. Preoperative symptoms were low back pain with radiculopathy in 12 cases and back pain only in one case. All of the patients had soft disc herniation. Patients who had a sequestered disc fragment and instability in preoperative dynamic roentgenogram were excluded. Results: There were 13 patients: 10 male and 3 female patients. Mean age was 38.1 years old. The mean duration of the symptoms and conservative treatment period were 18.7±18.3 months and 4.7±1.98 months, respectively. Mean follow-up period was 5.5±1.3 months. Preoperative back and leg visual analogue scale (VAS) scores were 6.2±1.9 and 8.5±1.1, respectively. Postoperative back and leg VAS scores were decreased to 3±1.4 (p<0.05) and 2.7±1.0 (p<0.05), respectively. Preoperative ODI score was 48±19.1% and postoperative ODI score was decreased to 23± 22.1% (p<0.05). Using Odom’s criteria there were 5 patients (38.5%) with excellent results; 7 cases with good results (53.8%); and one patient with a poor result (7.7%). Conclusion: Percutaneous hydrodiscectomy could be a good alternative procedure in surgical treatment of lumber disc degenerative disease. The present series demonstrates promising early clinical results, but more long term follow-up and additional cases are needed to confirm these initial results.