Percutaneous Discectomy for Spinal Disc Decompression

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Percutaneous Discectomy for Spinal Disc
Decompression
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Spinal Pain

• Up to 65 million low back pain sufferers in US
  (Wall Street Journal)
• Back pain 1 reason for healthcare expenditures
• U.S. back pain costs are 3 times greater than
  cardiac services costs each year
• 20 of U.S. working population experiences back
  pain every year
• By age of 50, 97 of people have degenerated
  lumbar discs
• No effective drug treatment alternatives to
  problems
• 540,000 total U.S. discectomy procedures per year

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Percutaneous Disc Therapy Products

• Intradiscal RF Annuloplasty
• Oratec - IDET
• Radionics - discTrode
• Percutaneous Disc Decompression
• Clarus - LASE
• Arthrocare - SpineWand
• Pain Concepts - Dekompressor

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Percutaneous Disc Decompression

• Chymopapain Injections
• 1964 Smith reported enzymatic dissolution of
  nucleus pulposus in humans.
• Percutaneous Nucleotomy
• l975 Hijikata first described in with good to
  excellent results in 68 of patients.
• Percutaneous Lumbar Discectomy
• 1985 Onik et al. introduced a nucleotome for
  percutaneous discectomy.
• Laser Disckectomy
• 1987 Choy and Ascher first used lasers to
  evaporate the nucleus pulposus.
• Nucleoplasty
• 2000 Arthrocare introduces an RF ablation device
  to vaporize the nucleus pulposus.
• Percutaneous Lumbar Discectomy
• 2002 Pain Concepts introduces a 1.5 mm probe for
  percutaneous discectomy.

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U.S. Minimally Invasive Discectomy Procedures
Source Health Research International
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Percutaneous Laser Disc Decompression

• High temperatures result in vaporization,
  ablation, carbonization, and charring
• Over 10,000 LASE procedures have been done
• Minimum 6 mm incision required
• Capital equipment about 100,000
• Procedure kit about 1,500
• Being used in thoracic and cervical cases

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Percutaneous Nucleoplasty

• FDA clearance in December 1999
• RF energy process designed to vaporize the disc
  nucleus
• RF Generator required
• Over 7,000 cases performed

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Percutaneous Lumbar Discectomy

• Hundreds of thousands of cases performed
• Fluoroscopic guided procedure for removal of disc
  nucleus using a cutting device
• Success rates reported similar to microdiscectomy
  in the 75 to 85 range

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Dekompressor percutaneous discectomy probe

• Least invasive method available to remove nucleus
  pulposus
• Nucleus tissue removed through a 1.5 mm cannula
  (17 gauge)
• No need for endoscopic equipment or heat
• No capital equipment required
• Battery operated, single use, disposable
• Simple and quick (lt30 minutes) outpatient
  procedure
• Early assessment of procedure success
• No annular defect created
• FDA and European Approvals (CE Mark)

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DEKOMPRESSOR percutaneous discectomy probe
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Sample of Nucleus Tissue Removed
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Cannula Introduction Sites at 11 days
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Percutaneous Discectomy Clinical Rationale

• Discectomy procedures demonstrate success of
  nucleus removal
• relieves pain in over 70 of cases
• Symptom recurrence rates post discectomy are low
• Extrapedicular approach minimizes permanent
  structural changes
• avoids entry into spinal canal
• laminectomy not required
• Percutaneous approach may lower surgical
  complication rates
• Amount of nucleus pulposus removal needed patient
  dependent
• small changes in disc volume can result in a
  large changes in disc pressure
• surgeons rarely remove more than 30 of the
  nucleus
• successful outcome of disc surgery reported to be
  independent of the amount of disc material
  removed

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Percutaneous Discectomy Reimbursement

• Existing Medicare Reimbursement Code 62287
• Aspiration or decompression procedure,
  percutaneous, of nucleus pulposus of
  intervertebral disk, any method, single or
  multiple levels, lumbar