<p>The Successful Treatment of Herniated Lumbar Discs That are Refractory to Repeated Epidural Steroid Injection by Using a Navigable Percutaneous Disc Decompression Device: A Case Series</p>

Abstract

In most cases, lumbosacral radicular pain caused by herniated lumbar discs (HLDs) can be controlled with epidural steroid injections (ESIs). However, when the HLDs are large, the pain may not respond to ESIs. A navigable, percutaneous, disc decompression device has recently been developed to manage radicular pain that is secondary to HLD, which allows the wand tip to approach the herniated disc by rotating a control wheel. We performed a percutaneous disc decompression using the navigable percutaneous disc decompression device in two patients with a large HLD that did not respond to repeated ESIs. Patients and Methods: Patients A and B are presented with scores of 7 and 8 on the numeric rating scale (NRS), respectively. Both had lumbosacral radicular pain due to right central HLDs at L4-5 and L5-S1, despite repeated ESIs. Percutaneous disc decompression was performed under C-arm fluoroscopy. The wand was inserted through the introducer needle. Using the control wheel, we placed the needle tip on the posterolateral portion of the herniated disc. The radiofrequency current was applied to the herniated portion of the disc. The procedural time was 20-30 minutes. Results: Neither of the patients reported adverse post-procedural effects. At their 1-week follow-up, patient A and B's NRS pain scores had reduced to 2 and 1, respectively. At their 2-year follow-up, patient A had mild pain (NRS 1), and patient B reported no pain. Conclusion: The navigable percutaneous disc decompression device may be effective for pain alleviation in patients with lumbosacral radicular pain that is refractory to repeated ESIs.

Use of Navigable Ablation Decompression Treatment (L-DISQ) for Contained Cervical Disc Herniation – Technical Note and Literature Review

“…Over the last five to six decades, spine surgeons have strived to find less invasive procedures for treating patients with CDH, a midterm alternative treatment between conservative management and spine surgery. Various interventional techniques were used with variable success, which include chemonucleolysis, ozone, automated percutaneous lumbar discectomy, intradiscal laser discectomy, intradiscal electrothermal therapy, and percutaneous nucleoplasty [ 6 - 10 ]. Percutaneous procedures gathered all the interest due to their advantages, such as the lesser threat of secondary tissue damage, operability with local anesthesia, avoidance of the risks associated with general anesthesia, benefits in patients with severe co-morbidities, and earlier discharge.…”

Percutaneous lumbar discectomy: a systematic review

“…nucleus pulposus, followed by reduced pressure on the nerve root and associated with reduced pain [34][35][36] . This surgical procedure is very useful for controlling lumbosacral pain in cases of disc herniation unresponsive to epidural injections of steroidal drugs 37 , especially in cases where there is no migration of herniated discs and the presence of unilateral disc herniation 38 . As observed in some studies [39][40][41][42][43][44][45][46][47][48][49][50] , in which a relevant clinical improvement of patients was pointed out, especially in relation to pain and also to body functionality.…”