774 - Pop Goes the Nucleus: Contemporary Techniques in Percutaneous Disc Decompression

Learning Objectives:

1. Describe the full spectrum of contemporary percutaneous disc decompression techniques for cervical and lumbar disc herniation, including novel and emerging modalities.


2. Summarize evidence-based indications, efficacy, and safety profiles of mechanical, thermal, plasma-based, and image-guided decompression approaches.


3. Discuss patient selection criteria and procedural nuances that optimize clinical outcomes.

Background: Minimally invasive percutaneous disc decompression is a validated alternative to open surgery for contained disc herniations refractory to conservative management while alleviating dependence on opioids for pain control. Techniques include mechanical (e.g., Dekompressor device), thermal (e.g., nucleoplasty via radiofrequency ablation, percutaneous laser disc decompression [PLDD]), plasma-based (e.g., percutaneous intervertebral disc coagulation therapy [PDCT]), and chemical approaches. Novel methods such as combi-therapy—computed tomography (CT)-guided PLDD with CT-guided epidural nerve block—demonstrate improved immediate pain control and reduced reoperation rates. Percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis, targeting ligamentum flavum hypertrophy, is emerging as a minimally invasive option for neurogenic claudication.

Clinical Findings/Procedure Details: Meta-analyses and randomized trials show significant pain reduction and functional improvement after percutaneous decompression, with success rates of 67–75% at 6–12 months and sustained benefit at 24 months. Mechanical and thermal modalities yield comparable outcomes, with median disc area reductions up to 52% on magnetic resonance imaging post-PLDD. Plasma-based techniques and targeted decompression show technical success rates >95%, with marked improvements in Visual Analogue Scale and Oswestry Disability Index scores. Ultrasound guidance and intra-procedural epidurography enhance safety and adequacy. Combi-therapy offers immediate and sustained pain relief, with lower re-surgery rates than PLDD alone. Complication rates remain low (< 0.5%), with discitis and device-related events most common.

Conclusion and/or Teaching Points: Here, we aim to comprehensively review the latest techniques in PDD. Contemporary percutaneous disc decompression offers effective, safe, and reproducible options for patients with contained disc herniations or lumbar spinal stenosis unresponsive to conservative therapy. Novel techniques such as combi-therapy and PILD expand the therapeutic landscape and warrant further research.