Minimally Invasive Treatment of Herniated Discs: How to Remove the Disc with Physical Tools

Lumbar disc prolapse, protrusion, and extrusion are the most common causes of back and nerve root pain. The primary modality of treatment continues to be either open or microdiscectomy. Although open surgery is effective, it has well-known disadvantages, including epidural scarring, damage to bone, denervation of paraspinal muscles with consequent lumbar instability, long postoperative inactivity, and the not infrequent “failed back surgery syndrome.” For these reasons, there has been, since more than half a century now, an ongoing search for less invasive methods of treatment. Percutaneous discectomy techniques attempt nerve root decompression indirectly by decreasing the central disc pressure. Different minimally invasive percutaneous decompression techniques have been proposed, and most of them are still part of the surgical armamentarium. Many are mechanical or entail use of physical energies, such as radiofrequency waves or laser. The most effective, most utilized, and safest among them are described in this chapter.