Minimally invasive approach can take the pain out of herniated disks

Much like the aging face, the taut disks that cushion the spinal column, enabling us to twist and bend, become less elastic over time.

The loss can mean gelatinous disk innards start bulging out, pressing on nearby nerves and causing pain in the lower back and legs, says Dr. Jeffrey A. Stone, chief of the Section of Interventional Neuroradiology at the Medical College of Georgia.

"What happens is over time, just because we stand upright and put a lot of abuse on our spines, the disks go through the aging process. So as you get 35 or 40, simple trauma, even a twisting motion like tennis or golf, sometimes will stretch it and sometimes you will get a tear in the disk's outer covering called the annulus," says Dr. Stone, who likens that cover to a leather sack.

"The tear itself can be painful," he says. Worse, the gelatinous nucleus can shift, resulting in bulges, or even break free and migrate into the spinal canal.

The good news is that today many painful bulges can be treated without even an incision, says Dr. Stone, who will give an update on percutaneous diskectomy May 2 during the 44th annual meeting of the American Society of Neuroradiology in San Diego.

This latest approach to treating disk herniation uses X-ray to guide insertion of a needle through skin and muscle directly into the offending disk and eliminate the portion of the bulging nucleus that is causing pain, Dr. Stone says. Patients receive local pain relief at the injection site and enough anesthesia to relax but remain awake so they can report any pain they experience. After accessing the disk, the puncturing stylet is removed so the needle then functions as a cannula through which devices are inserted to vaporize or suction out excess gelatinous substance. "The goal is to reduce the pressure and inflammatory factors in the disk with a minimal amount of removal," says Dr. Stone.

"As we remove nucleus, the pressure inside goes down so the

Contact: Toni Baker
Medical College of Georgia

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