Automated Percutaneous Lumbar Discectomy Versus Chemonucleolysis in the Treatment of Sciatica

Revel, Michel; Payán, C.; Vallée, C.; Laredo, Jean‐Denis; Lassale, B; Roux, C.; Carter, H; Salomon, Catherine; Delmas, E.; Roucoules, J.

doi:10.1097/00007632-199301000-00001

Cited by 151 publications

(84 citation statements)

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“…2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc. 1,11,12,23,30,37,44,50 To assess the risk of bias for each study, 3 reviewers (M.F.S., J.J.X., and E.Y.T.) independently investigated the individual studies and used The Cochrane Collaboration's tool for assessing risk of bias.…”

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

117

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

117

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“…The other trial (N=71) reported only 29% satisfactory results for automated percutaneous discectomy compared with 80% for microdiscectomy [16]. One other trial (N=141) found automated percutaneous discectomy to be inferior to chemonucleolysis on patient rating of improvement and second procedures after 6 months [75].…”

Section: Chemonucleolysis Vs Placebomentioning

confidence: 99%

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

et al. 2005

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“…(JBSA 2011;24(1): [23][24][25][26][27] injections. These injections targeted facet joints via medial branch blocks, intervertebral discs via provocation discography, and sacroiliac joints (SIJs) via intra-articular injections.…”

Section: Low Back Painmentioning

confidence: 99%

“…[22][23][24] Chemonucleolysis using chymopapain has moderate success rate (approximately 66% at one year). 25,26 It has also the chances of anaphylaxis following intradiscal chymopapain injection. Injection of ozone for discogenic radiculopathy (low back pain with radiation to legs) has developed as an alternative to chemonucleolysis and disc surgery popularly called ozone therapy for slip disc.…”

Section: Ozone Disc Nucleolysis and Epidural Steroidmentioning

confidence: 99%

Interventional pain management procedure for treating low back pain: anaesthesiologists should come forward

Sardar

Sultana

Das³

et al. 2014

j Bangladesh Soc Anaesthesiologists

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Automated Percutaneous Lumbar Discectomy Versus Chemonucleolysis in the Treatment of Sciatica

Cited by 151 publications

References 0 publications

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

Interventional pain management procedure for treating low back pain: anaesthesiologists should come forward

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