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Minimally invasive procedures to treat herniated disk
By Mayo Clinic staffIn an effort to avoid surgery and possible surgical complications and to limit recovery time, some surgeons use minimally invasive techniques:
Chemonucleolysis
In chemonucleolysis, an enzyme (chymopapain) derived from the tropical papaya tree is injected into the disk. Chymopapain dissolves the protruding disk, which can reduce pressure on the nearby nerve and, in some cases, eliminate pain. Other enzymes besides chymopapain also can be used for this procedure.
Chemonucleolysis generally isn't used in the United States — due to the risk of neurological complications and allergic reactions to the enzyme. However, these complications may be avoided if your doctor takes a thorough medical history, conducts sensitivity testing and uses proper surgical techniques. Severe muscle spasms used to be common in people who received chemonucleolysis, possibly as a result of the enzyme spreading beyond the disk. Decreased dosages and the use of corticosteroids can reduce the chance of muscle spasms.
What to expect. Chemonucleolysis can be performed with general or local anesthesia, and you'll also receive corticosteroids through a vein in your arm (intravenously, called an IV). The surgeon inserts a large needle into your back and slowly injects chymopapain for a few minutes. You may notice immediate pain relief after the procedure and can usually be discharged within 24 hours. Your doctor may suggest that you take pain medications, such as ibuprofen (Advil, Motrin, others), as needed during the week or so after the procedure.
Healing may take six to 12 weeks, but you can resume activities as soon as you're able to tolerate them. Your doctor may recommend that you begin walking or swimming to aid your rehabilitation. You may be able to return to light or sedentary work within two to four weeks. Heavier work can be resumed in six to 12 weeks.
Interpreting results. Chemonucleolysis is usually less effective than surgery, with a success rate of 70 percent to 80 percent. Chemonucleolysis may offer some pain relief, and — in properly selected people — it may be an effective treatment for those who want to avoid surgery. Trying chemonucleolysis first won't affect subsequent surgical outcomes.
Endoscopic procedures
A mechanical device that fits into a large needle is inserted into your back to remove parts of your disk from between vertebrae. One type of endoscopic procedure is endoscopic diskectomy, also called percutaneous arthroscopic diskectomy.
What to expect. In this procedure your surgeon inserts a thin tube through a small incision in your back. This allows your surgeon to use small cameras and tools — such as a suction or laser probe or forceps — to remove damaged parts of the disk. Endoscopic procedures typically are performed on an outpatient basis. You may receive local or general anesthesia. Because the surgeon conducts the procedure using small cameras, bone doesn't need to be removed to see and treat the disk. A small bandage is used to close the incision.
The surgeon is unable to see the nerve root because the small incision provides a limited range of vision. That means your surgeon may not be able to tell if the correct part of the disk has been removed or be able to identify and remove disk fragments that have entered the spinal canal.
Interpreting results. Endoscopic procedures usually are less effective than standard diskectomy or microdiskectomy and are still in the developmental stage. Success rates are wide ranging. You'll need to weigh whether you're willing to chance a lower effectiveness rate in return for the minimal invasiveness of these procedures.
Open decompression for herniated disk Surgery for herniated disk
