Chapter 27 : “Percutaneous Discectomy”
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Lumbar discogenic pain may arise from any spinal structure, but primarily comes from the nucleus pulposus, annulus, facets, and adjacent spinal nerves. Studies of disc herniation has demonstrated that the annulus fibrosus is the site of primary pathologic change. The pathogenesis of degenerative disc disease starts from inside the disc outwards. Annular tears are associated with degenerative disc changes and contribute to the development of abnormal annular bulges that progress to protrusion when more severe 3 .
The largest disc bulging indexes were always associated with annular tears, and when bulges become herniations, the size of the tears affect the long term outcome of surgical discectomy. Larger annular tears are more susceptible to disc herniation, and large herniations are more susceptible to re-herniation. There is a need, therefore, to visually demonstrate annular tears, establish correlation with back pain, and prevent progression of these annular defects associated with intractable symptoms 3-7 . Endoscopically visualized percutaneous discectomy, when utilized appropriately, may fill help evolve the surgical treatment of disc herniation and discogenic pain.