Percutaneous Discectomy, Disc Nucleoplasty, Perc-Disc Decompression surgery: Suspicious by any name
Patients injured by work accident or in a car crash often receive spinal trauma to the neck or low back which causes symptoms which may or may not require subsequent treatment. There is a corresponding loss of income and productivity if care requires a patient to stay off work. Such treatment may include prescriptions for pain relievers, muscle relaxants and for other medicines as well as physical therapy and rest and relaxation off work.
However, a relatively new but expensive care approach twist with accompanying costly new surgical instrumentation has evolved with questionable effectiveness and utility and with early questions raised about financial and not simply medically driven reasons for its use and misuse. Minimally-invasive spinal surgery which normally requires no hospitalization may benefit the patient and which always benefits the surgeon who chooses this care modality is currently under close scrutiny by a host of reviewers in the insurance, justice and professional sectors.
Perc-Disc surgery, also sometimes called called Percutaneous Discectomy, Percutaneous Disc Decompression, Neucleoplasty or Disc-Nucleoplasty is performed generally now by a wide range of professionals to include traditional orthopedic surgeons, neurosurgeons and now, anesthesiologists, physiatrists and pain medicine physicians.
Sadly, many practitioners are becoming more focused on over-utilizing these minimally-invasive surgical techniques to increase their practice revenue than on relying on established protocols and more traditional procedures or even on less care appropriate for the patient or the symptoms.
Reoperations utilizing the same expensive Nucleoplasty surgical procedures only increase the level of suspicion. However, the entire idea of undergoing a less invasive procedure to immediately fix an injury has wide-patient acceptability.
Initial studies by Chen* in 2003 published in SPINE on a small (4 patients) group of patients with pain from acute focal disc protrusions who were subjected to Neucloplasty offered reports of rapid and prolonged pain relief, and at best, suggested more scientific follow-up. Utilizing this study as part of a marketing effort directed to the medical profession, purveyors and practitioners alike are too rapidly drawing conclusions that support more use of Perc-Disc–type surgery when more appropriate and less costly pain management procedures currently exist.
Sadly, there are insurance and job issues for the patient to face in the future once such surgery on his spine is performed. The uninformed patient, believing his physician and sometimes too his attorney, has no idea of what the future really holds for him and for his family medically or financially once these non-invasive procedures are performed, whether for the wrong or right reasons.
*Y. Chen, S. Lee, D. Chen, “Intradiscal Pressure Study of Percutaneous Disc Decompression with Neucloplasty in Human Cadavers”, SPINE Vol 28, No 7, pp 661-665. 2003
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