Percutaneous discectomy is an advanced, minimally invasive surgery for the decompressing disc space. The procedure involves removing the intervertebral disc material in the neck and back. Unlike traditional disc herniation surgical approaches, this recent technique can be done in an outpatient setting, significantly reducing post-operative morbidity. It also allows you to regain your normal work function quickly. If you are experiencing pain from your contained herniated disc, consult Dr. George Rappard, a seasoned and experienced Los Angeles surgeon. He can review your medical history and symptoms to determine whether you qualify for the treatment and advise you accordingly.
Percutaneous means through the skin. It involves a surgical procedure performed through small punctures and incisions into your skin without your physician's direct view of the anatomy they are working on. Since the medical practitioner cannot see the instruments beneath your skin, they will use an x-ray machine to see the location of the surgical tools within your body.
Using percutaneous discectomy to decompress intervertebral discs dates back to the 1960s. Although early procedures had their share of limitations, they relieved the pain for suitable patients.
Over time more innovative techniques have been developed. Modern percutaneous discectomy uses plasma technology to eliminate tissue from the disc’s tissue. During the treatment, the doctor introduces an instrument via a needle and places it into the disc’s center to remove tissues from your nucleus. Tissue removal from your nucleus decompresses the disc and relieves the pressure exerted by your disc on your surrounding nerve root reducing pain.
What to Expect During Your Percutaneous Discectomy Treatment
The procedure is straightforward.
You will receive local anesthesia, and needle insertion is simple with little pain. Then the physician will insert the needle into the disc; disc decompression takes a couple of minutes. Fluoroscopy guides the needle while a probe with a rotating tip is inserted via the needle.
When the physician turns the probe on, the rotating tip removes portions of the disc nucleus and creates a space, permitting your disc to reabsorb the herniation. Consequently, pressure on your nerves is relieved. Since only the adequate portion of your disc is removed to lower pressure in the disc, your disc becomes stable.
Typically, the process is ideal for patients who have not had success with nerve blocks, medications, and physical therapy. The patients do not qualify for surgical treatment because their disc bulge is small.
The procedure takes approximately thirty minutes and can be performed in an office-based outpatient setting. You will leave the doctor’s office with only a tiny bandage over the needle insertion area.
You can return home within three hours following the procedure. Your injection site can be tender for forty-eight hours after your treatment. You can use cold or heat packs to ease the discomfort. You should limit activity and rest for at least 24 hours following the treatment. Some doctors prescribe painkillers. Although the recovery period varies with patients, most people resume their normal activities and work in a week.
Pros of Percutaneous Discectomy
The procedure is a low-risk treatment choice for neck and back pain. It can improve mobility, reduce pain, and eliminate the need for conventional surgical methods. The therapy not only treats the symptoms but also addresses the root cause.
Unlike other treatment options, the procedure is less invasive and causes less scarring and fibrosis.
Risk and Complications
While it is a safe procedure, it has risks linked to it, like any other medical procedure. Common complications in the percutaneous discectomy include:
- Injection site tenderness
- Increased intracranial pressure
- Spinal cord compressions
- Anesthesia-related allergies
- Risk of infection
- Insignificant risk of damaging your nerves or spine
Moreover, the process may not be successful and you could still experience pain and discomfort.
Using sterile techniques and fluoroscopic guidance during the treatment can reduce the risk of these risks.
Various Conditions treated by Percutaneous Discectomy
Ideal patients for this treatment option are those suffering from chronic pain stemming from disc herniation that has not responded to traditional treatment methods like heat, ice, inflammatory medication, and physical therapy. Any skilled and seasoned doctor should recommend this option before discussing invasive surgical methods.
Percutaneous discectomy can relieve leg and back pain symptoms like:
- Pain due to a central bulge of the disc or central focal protrusion
- Reduced mobility due to degenerative diseases like osteoporosis
The procedure is common among patients with tiny contained herniations whose open surgical discectomy provides results. With contained herniation, the bulge is within the disc and below the posterior longitudinal ligament
It is also ideal for persons with huge contained herniations (non-ruptured discs) who cannot benefit from open surgery.
What is a Herniated Disk?
A herniated disk is a spine injury. You have a vertebra in your bones that stretches from your skull’s base to the tailbone. Between the vertebrae are round cushions known as disks that serve as buffers between the bones, permitting you to move and bend. When a disk leaks or tears, you suffer from the herniated disk.
While herniated discs can occur anywhere along your spine, the condition is common in the neck or lower back.
Persons between 30 and 50 are more vulnerable to this injury. Men are also twice as at risk as women.
Other risk factors include the following:
- Sitting in one position for long
- Lifting heavy substances
- Repetitive twisting motions or bending for sports, hobbies, or work
Causes and Symptoms of Herniated Disk
Your disks have a gel-like center and a firm outer layer that resembles a jelly doughnut. The outer layer can weaken over time and can crack. The herniated disk occurs when the inner jelly substance pushes via this crack, causing the leaking material to press on surrounding spinal nerves.
Factors that can cause the disk to weaken include the following:
- Excessive weight
- Sudden strain due to improper twisting or lifting
- Repetitive motions
Symptoms of herniated disk vary depending mainly on the location of the condition.
An injury in your lower back can result in sciatic nerve pain (sharp pain that starts from one of the buttocks to the foot and leg). Other symptoms include:
- Numbness or tingling in your feet or legs
- Muscle weakness
- Back pain
Symptoms of a herniated disk in the neck include the following:
- Pain between or near the shoulder blades
- Neck pain
- Pain in the shoulder, finders, hand, and arm
- Pain that intensifies when turning or bending your neck
- Tingling or numbness in the arms
How Herniated Disk is Diagnosed
Your doctor will perform a thorough examination to assess your muscle reflexes, muscle strength, sensation, and pain. The physician can also order tests like:
- Magnetic resonance imaging — For capturing accurate images of a suspected herniated disk
- Computed tomography — It shows your spine’s bone
- X-rays — Assists ruling out other causes of neck or back pain
- Electromyogram — Involves injecting dye into the spine using diagnostic imaging. The dye reveals the narrowing of your spinal cord and the location of the injury
- Myelogram — Involves placing tiny needles into different muscles to evaluate your nerve function. This test aids in determining the affected nerve.
A brief Overview of Sciatica
Sciatica is pain that affects the sciatic nerve. Usually, it affects one side of the lower body, and pain extends from the lower back through the back of the thigh and down to the leg. The pain can also extend to your toes and foot, depending on the location of the affected sciatic nerve. For some patients, sciatica pain can be disabling and severe.
Some of the symptoms of sciatica include the following:
- Lower back pain
- Pain in your leg or rear that worsen when sitting
- Hip pain
- Tingling or burning down your leg
- Difficulty moving your foot or leg, weakness, or numbness
- Shooting pain that makes it challenging to stand up
- Constant pain on one side of your rear
Typically, sciatica is caused by irritation of the roots of the lumbosacral spine and lower spine. Other causes of the pain include:
- Muscle spasms in your buttocks or back
- Degenerative disk condition
- Lumbar spinal stenosis
Factors that can increase the risk of suffering from sciatica include:
- Putting on high heels
- Not exercising regularly
- An occupation that involves driving for extended periods, carrying heavy substances, or twisting the back
- Sleeping on a mattress that is too soft or hard
You should seek immediate medical attention if you experience any of the following:
- Loss of bowel or bladder control
- Severe pain
- Blood in your pee or burning when you pee
- Weakness or numbness in your legs, pelvis, bottom, or upper thighs
- Pain that moves down the legs
- Back pain and fever
- Redness or swelling in your spine or back
How Long After Percutaneous Discectomy Can You Walk?
You can walk almost immediately after percutaneous discectomy. Walking is a gentle exercise that offers essential soft tissue and muscle stimulation. Here is everything you should know about exercising and walking after the surgery.
Assisted or Brief Walking
You can take short walks the first day after the disc removal, especially with help from your doctor, or by using a walker or cane. You should limit the walking to brief durations until you regain strength and stability.
Handling Post-Surgery Discomfort
When you start walking after the procedure, you might experience discomfort associated with the recovery. While it is normal, you should consult a doctor if the pain feels out of the ordinary or persists once you start walking.
Otherwise, you can manage post-surgery pain with the following:
- Heat therapy to facilitate the recovery process and ease soreness when you walk
- Ice applications to reduce inflammation around the surgical site
- Use of anti-inflammatory medication
Proper Lifting Techniques
You should not twist, bend, or lift anything two (2) weeks after percutaneous discectomy. It can hinder the recovery process and increase the risk of herniation.
Even after two weeks, only lift five (5) pounds or less. When lifting, do not bend at your waist or round the back. Instead, bend at your knees, with the back straight, to take pressure off the spine and lower the risk of injury.
When performing any activity, listen to your body. Increased leg or low back pain indicates that you have strained.
Smoking can hinder your recovery, inhibit bone growth, and delay healing. It also has a negative influence on disc degeneration.
Throughout the recovery process, you should maintain a healthy balance of relaxation and exercise. Psoas position maintains a proper posture while sitting. On the other hand, a “zero gravity” chair can assist you in achieving the psoas position with ease, taking pressure off the spine.
Walking and Light Stretching
You should integrate light stretching with walking within your initial weeks after percutaneous discectomy. Muscle stimulation reduces the risk of scar tissue issues. It also assists spine-supporting muscles to regain strength, taking direct pressure off the recovering spine. The light stretching and walking should involve the following:
- Walking at a steady pace for approximately 30 minutes daily
- Doing hamstring stretches targeting muscles supporting the lower back
- Gently stretching tendons and muscles along your spine’s side
Effective Ways to Sit After Percutaneous Discectomy
While your doctor will encourage you to walk and move around the day after percutaneous discectomy, you should limit your sitting to twenty minutes for the first two weeks. You can gradually increase this duration to forty minutes by week four.
One thing that can help when recovering is using a seat cushion. The cushion offers pressure support, comfort, and spinal alignment. Pressure support assists in distributing weight evenly, preventing undue strain on your back. Comfort allows you to relax and rest, which is essential for recovery. On the other hand, spinal alignment keeps your spine in its natural position, promoting healing.
Ensure you sit on a rotating chair after the procedure while working; it prevents twisting the body to reach things. Move the body as a unit when turning. You should not move with the hips and feet facing in different directions. Do not hold the receiver with the head tucked over your shoulders while speaking with the phone. Ensure you hold your phone with your elbow on the armrest or desk and keep your neck straight.
The best way to get up from your chair is to slide to the edge of the chair and lift yourself up with your hips and knees straight. Placing one foot in front of the other also helps. When getting out of a chair with an armrest, use your hands to support yourself and keep your posture straight. Avoid leaning forward or bending backward a lot.
How to Sleep Comfortably after Percutaneous Discectomy
Sleeping is an effective way the body heals, but it can be challenging to find a comfortable position after a discectomy procedure. Some sleeping positions can exacerbate your back pain.
It is advisable to sleep on your side or back as you recover. Sleeping on the belly is discouraged because the spine is not in a neutral position. Also, wear satin pajamas to bed; they allow you to change sleeping positions easily.
When sleeping on the back, elevate your head, shoulders, and upper back with a supportive pillow. Use a rolled-up towel or pillow underneath the knees to relieve any back strain. Avoid placing your arms above your head as you sleep since it creates tension in your shoulders, neck, or back.
When sleeping on your side, place a pillow between the knees to support the hips, pelvis, and spine in a neutral position. Log roll when changing positions to the other side instead of twisting the torso.
You can also use the log roll method to safely and comfortably leave your bed. The method involves side rolling your legs and body (with bent knees) over the bed’s edge and using your arms to gently press the body up as you simultaneously lower the legs to the floor. Ensure you exhale between your movement phases to relax and activate your core muscles supporting the spine.
Moreover, the mattress you sleep on after the procedure matters. You can reverse the results if you sleep on the wrong form of mattress. So, use a mattress tailored to support the spine alignment and reduce the pressure points.
Other Tips for Recovering after Percutaneous Discectomy
The additional effort you make now can make your healing process smoother and return to your everyday activities as soon as possible. You should adhere to your doctor’s guidelines alongside the following:
- Eating healthy — Since you are less active when recovering, avoid fattening or heavy, high-calorie foods. Instead, eat a balanced, low-fat diet rich in fresh fruits and vegetables.
- Incision care and bathing — Typically, surgeons recommend keeping your skin around the incision clean and dry for four days after the procedure. Avoid a tub bath until your incision has recovered. Pain in the incision area should subside as recovery progresses.
- Ask for assistance — List chores your family and friends can help you complete.
- Physical Therapy (PT) — Some patients require physical therapy. Our doctor should assess and make arrangements for the service. PT is essential to recovery since it helps you regain and build strength, physical endurance, and flexibility.
- Wear bracing — If the doctor prescribed a back brace, ensure you wear it. The brace supports and stabilizes your back or neck and limits movement of your spinal levels fused during the treatment. While some braces are corset-like supports, others are complicated and fitted to the patient’s body.
- Broad in and alighting from a motor vehicle — To leave your car, sit at the edge, lower yourself to the seat and then scoot back before slowly bringing in your legs. Follow the reverse steps to alight from the car.
What to Expect During Your Initial Percutaneous Discectomy Consultation
If your doctor has recommended percutaneous discectomy, you may have many questions. Before undergoing the process, you will have a consultation with the medical practitioner, and here is what to expect:
- Medical history review — The doctor will review your medical history before your consultation, but they will want to discuss it with you before the procedure. They will ask you about family history, allergies, previous diagnostic imaging methods, and previous spine treatments.
- Physical examination — Analyzing imaging tests and data is beneficial, and so is conducting a physical examination. The surgeon will perform manipulation and movement exercises to understand the issue. Additionally, they will check your heart rate and blood pressure.
- Percutaneous discectomy treatment explanation — After your physician understands your condition and medical history, they should tell you more about the process and what to expect. Do not hesitate to ask questions and express your concerns.
- Next steps — Your surgeon should also dedicate time to tell you about the next steps. It can involve ensuring you have clearance from your health insurance provider, scheduling your treatment, and guiding you on preparing in the days leading to the procedure.
Percutaneous Discectomy Cost
The overall cost varies depending on your health circumstances, recommendations, and insurance plan.
If not covered by insurance, percutaneous discectomy costs can range between 15,000 and $50,000, including the facility fee, anesthesiologist fee, and surgeon’s fee.
Typically, health insurance covers the procedure if ordered by your doctor. Medicare and most health insurance plans cover the treatment. If insured, assuming the deductible has been met, typical out-of-pocket costs would consist of coinsurance that ranges from 10% to 40% of the treatment, up to the annual out-of-pocket maximum.
Additional costs include:
- Many patients require up to six (6) weeks of recovery time, so you might need to factor in the time you will not be working
- A back brace that costs at least $200
- Physical therapy costs between $50 and $100 per session and can add about $1,000 to your overall cost.
- Cost of painkillers prescribed after surgery
- Cost of equipment like a walker that costs between $50 and $200
Since the operative cost can be expensive, you should discuss your financial concerns with your insurance provider and surgeon beforehand.
Find a Qualified Back and Neck Pain Surgeon Near Me
Percutaneous discectomy is a noninvasive surgical procedure that treats pain caused by a herniated disc in the back or neck. It can relieve pressure and compression of your spinal condition by removing the herniated disc portion. Your doctor could recommend the procedure if you experience pain that has not been alleviated by medication and rest or have developed progressive neurological signs like numbness and weakness.
To find out whether you would benefit from percutaneous discectomy, contact Dr. George Rappard at 424-777-7463 for an evaluation. The Los Angeles-based spine specialist takes pride in being unsurpassed in his minimally invasive surgical technique and experience. He is committed to addressing your pain symptoms and wants your return to everyday life to be seamless and fast.