Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases

Abstract

ObjectiveThis is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy.MethodsForty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria.ResultsThis study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy.ConclusionPDCT is a safe and efficient treatment modality in a selective patient with HLD.

Evaluation of Long-term Clinical Results of Percutaneous Plasma Disk Coagulation Treatment in Lumbar and Cervical Disk Herniation

“…Various classifications are used to evaluate pain and operative success in these patients such as VAS, Oswestry, and SF-36. 1,5,17 In the VAS evaluation of the patients who underwent plasma disk coagulation, it has been observed that improvement is more rapid than in conservative treatment. 1 All of our patients previously had 1 course of physiotherapy and experienced no significant radiculopathic decrease.…”

“…Although microdiscectomy is the best surgical method, complications have been reported at a rate of 2% to 14%; these typically include instability, facet distortion, and spinal injuries in spinal ligaments, spinal muscles, and during laminectomy. 1 In lumbar steroid injections and foraminal injections, the pain stops at first, but long-term results are reported to be poor. 11 Other methods are nucleoplasty, intradiscal electrothermal therapy, chemonucleosis, and the latest one, percutaneous laser disk decompression.…”

“…4,5 Minimally invasive methods are also used in DH, one of which is the percutaneous laser disk coagulation method, in which a sufficient amount of energy is administered to the lesion area without harming the adjacent soft and neural tissues. 1,6,7 In our study, we evaluated the early-period and late-period visual analogue scale (VAS) scores of 70 patients who had Macnab grade 1-2-3 LDH and CDH in the lumbar 4-5 and cervical 5-6 levels. It was found through VAS scores that percutaneous plasma disk coagulation (D30) treatment in patients with Macnab grade 1-2-3 and Pfirrmann grade 1-2-3 degeneration was more significant in CDHs.…”

“…The first approach to lumbar disk herniation (LDH) and cervical disk herniation (CDH) is conservative, involving analgesics, nonsteroid anti-inflammatory medications, physiotherapy, and rehabilitation. [1][2][3] Although the best method of surgical treatment is microdiscectomy, minimally invasive methods are also used. 1 Microscopic discectomy is the gold standard in the treatment of LDH and CDH that show clinical findings through radiculopathy.…”

“…[1][2][3] Although the best method of surgical treatment is microdiscectomy, minimally invasive methods are also used. 1 Microscopic discectomy is the gold standard in the treatment of LDH and CDH that show clinical findings through radiculopathy. However, with this method, muscle dissection and bone excision are required, after which low back pain, neck pain, infection, instability, and cardiac and neurological findings are sometimes observed.…”