Percutaneous Discectomy -- What is It?

A discectomy is a surgical procedure in which the central portion of an intervertebral disc, the nucleus pulposus, which is causing pain by stressing the spinal cord or radiating nerves, is removed. Advances in options have produced effective alternatives to traditional discectomy procedures, i.e. microdiscectomy. A laminectomy is often involved to permit access to the intervertebral disc in a traditional discectomy.

The Intervertebral disc is the structure between the vertebrae (bones of the spine), which act as both a spacer and a shock absorber. The disc is composed of two parts: a soft gel-like middle (nucleus pulposus) surrounded by a tougher fibrous wall (annulus fibrosus).

Lumbar nerve root pain (often called Sciatica) generally goes below the knee and is felt in the area of the leg that the particular spinal nerve supplies. Sciatica is usually caused by an intervertebral disc protruding because it's tough fibrous wall weakens and is therefore no longer able to contain the gel-like substance in the centre. This material may bulge or push out through a tear in the wall (Herniation) causing pain when it touches a nerve.

There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimially invasive procedures, and invasive procedures (the latter of which may also be called open surgery).

Back pain (also known "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be radiate into the arm and hand), in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.

Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year.A.T. Patel, A.A. Ogle. "Diagnosis and Management of Acute Low Back Pain". American Academy of Family Physicians. Retrieved March 12, 2007.

The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a "slipped disc", is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are almost always posterior-ipsilateral in nature due to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression (see "chemical radiculitis" below). This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Low back pain ( or lumbago) is a common musculoskeletal disorders affecting 80% of people at some point in their life. It accounts for more sick leave and disability than any other medical condition. It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.

The causes of lower back pain are varied. A traumatic event may result in either muscular pain or a vertebral fractures. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor.

The sciatic nerve (also known as the ischiatic nerve) is a large nerve in humans and other animals. It begins in the lower back and runs through the buttock and down the lower limb. It is the longest and widest single nerve in the human body.

The sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot. It is derived from spinal nerves L4 through S3. It contains fibres from both the anterior and posterior divisions of the lumbosacral plexus.