By Antonio Solini M.D. (auth.), Gary Onik M.D. (eds.)
Percutaneous nuclectomy in accordance with the Onik strategy is an avantgarde strategy used to take away the intervertebral disc through percutaneous entry and with closed surgical procedure. The instrumentation and the approach are easy. the most characteristic is the smaller diameter of the probe (2mm) which fragments and aspires the small chips of pulpy nucleus. It reduces the danger of discitic infections (occurring in a variety of chances with all equipment of percutaneous discectomy) as the gap within the anulus, being small, closes spontaneously after the probe is got rid of. in addition postoperative acute lumbar ache has been stated to ensue much less usually. this technique is performed less than neighborhood anesthesia, with radioscopic and intraoperative discographic tracking. via consulting this atlas orthopaedists, neurosurgeons and neuroradiologists may well examine this system simply, simply because each element is obviously provided and illustrated with various colored photographs.
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Extra resources for Atlas of Automated Percutaneous Lumbar Discectomy (A.P.L.D.): According to the Onik Method
Example text
Correlations between myelography and magnetic resonance tomography Disc herniation at L3-L 4 • Myelography (E) lacks visualization of the nerve root at L4 left. Magnetic resonance tomography (F) shows that disc herniation at L 3- L4 is still apparently contained. DIAGNOSTIC EXAMINATIONS 65 66 DIAGNOSTIC EXAMINATIONS Intraoperative discography Intraoperative discography is a final and discriminating test: it is carried out just before discectomy, and allows us to continue or end the procedure. It is the purpose of discography to: evaluate the integrity of the anulus fibrosus; - reproduce the nerve root pain; - carry out a discometry.
In cases such as these discectomy is not contraindicated.
Observe the decreased diameter in A-P (A) and in L-L (B) of the vertebral canal. Can percutaneous discectomy be carried out? Although it is not included in the list of indications used by the Pittsburgh School, in agreement with the French School, it is our belief that percutaneous discectomy may be performed in cases such as these, and that it may constitute a first choice of treatment. Arthrosis (C, D) In addition to the arthrosic impressions (E), myelography shows a large disc herniation at L5-S 1 to the left (F).