Factors Predicting the Clinical Outcome After Trans-sacral Epiduroscopic Laser Decompression for Lumbar Disc Herniation

Abstract

Objective: Previous literatures have demonstrated widely variable clinical results after transsacral epiduroscopic laser decompression (SELD) and the factors predicting outcomes are not yet established. Therefore, we analyzed the clinical outcome and associated predictive factors of SELD in patients with lumbar disc herniation. Methods: Between 2015 and 2018, 82 patients who underwent single-level SELD and followed up at least 6 months were enrolled. The overall success rate (excellent or good results at final follow-up) was 58.5% according to Odom's criteria. Based on this result, patients were divided to 2 groups: a favorable group (n = 48) and an unfavorable group (n = 34). A retrospective review of the baseline characteristics and clinical outcome were conducted to reveal the predictive factors. Results: As expected, improvement of pain and patient satisfaction, was more favorable in the favorable group (p < 0.05). Moreover, the rate of additional procedure was lower in the favorable group (4.2%, 2 of 48 patients) than in the unfavorable group (35.3%, 12 of 34 patients) (p = 0.011). Among the various baseline characteristics, the only significant predictive factor for favorable outcome was the presence of a high-intensity zone (HIZ) on preoperative magnetic resonance imaging (50.0% [24 of 48 patients] in the favorable group vs. 11.8% [4 of 34 patients] in the unfavorable group; odds ratio, 15.67; p = 0.024). Conclusion:Although SELD for lumbar disc herniation resulted in a less favorable clinical outcome than that reported in previous studies, in patients with a HIZ, SELD can be an effective minimally invasive surgery to relieve low back pain and/or leg pain.

Narrative Review of Pathophysiology and Endoscopic Management of Basivertebral and Sinuvertebral Neuropathy for Chronic Back Pain

“…53 MRI of lumbar spine may showed various grade of degeneration of lumbar intervertebral disc, presence of hyperintenisty zone suggestive of annular tear and Modic changes. 71,80,113 .…”

“…19 Discogram confirmed degenerative disc disease treatment options varies 13 from injection of anesthetic(4% xylocaine or 0.75%) bupivacaine mixed with contrast during discogram to relieve pain and provide a short to medium term therapeutic relief of chronic back pain. 89 .Other commercially available electrothermal based intervention are intradiscal electrothermal annuloplasty (IDET), disc fx 59 and transforaminal epidurosopic laser ablation of sinuvertebral nerve, transpedicular intraosseous probe insertion (figure 4A) 31,113 and epiduroscopic basivertebral nerve laser ablation with good clinical outcomes. 8,51 .…”

Shape-memory collagen scaffold combined with hyaluronic acid for repairing intervertebral disc

“…The etiology and pathogenesis of chronic LBP are complex and multifaceted. The various factors responsible for IVDD such as aging, cell loss, extracellular matrix (ECM) anabolism, and catabolic imbalance result in the breakdown of the disc tissue microenvironment, which can lead to more severe conditions such as disc herniation, disc bulging, and spinal stenosis [ 2 – 6 ].…”

Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system

“…Lumbar disc herniation (LDH) is one of the most common causes of low back and leg pain; surgery for LDH is recommended in fewer than 10% of patients, when the pain is medically intractable for at least 4-6 weeks or a neurological deficit such as weakness accompanies the condition [1]. In recent years, minimally invasive surgery, including full-endoscopic lumbar discectomy (FELD), has emerged as a surgical option of interest for both patients and surgeons [2][3][4][5][6][7]. The top 100 most-cited publications on spinal endoscopic surgery are from the USA (49), Germany (19), Republic of Korea (ROK) (15), Japan (6), China (5), Italy (2), Australia (1), France (1), Canada (1) and the Netherlands (1) [3].…”