Percutaneous navigable intradiscal decompression in treatment of lumbar disc herniation: a single-center experience

Abstract

Background/aim: Minimally invasive procedures have been increasingly used for the treatment of herniated discs. Nonsurgical interventions minimize the secondary damage to other tissues and shorten the length of hospital stay by avoiding general anesthesia. Possible complications are thermal injuries, root injury, discitis, endplate damage, dural injury, meningitis, infection, increase in pain, and muscle spasm. We aimed to evaluate the efficacy of percutaneous decompression therapy by using intradiscal navigable electrodes on pain and functional movement index in patients with herniated nucleus pulposus (HNP). Materials and methods: A total of 209 patients with protrusive lumbar disc herniation underwent percutaneous ablation decompression treatment using an intradiscal routable electrode (L-Disq) in our pain clinic. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at the beginning and at the 1st, 3rd, 6th, and 12th months after treatment. Patient satisfaction was evaluated at the 12th month by a patient satisfaction scale (PSS). Results: When compared to initial values, VAS and ODI scores showed statistically significant improvement at the 1st, 3rd, 6th, and 12th months (P < 0.001). Mean VAS scores were 7.28 and 3.03 points (P < 0.001) while mean ODI scores were 32.46 and 20.48 points (P < 0.001) at the beginning and at the 12th month, respectively. Satisfaction rate of all patients was 81%. We also attempted to treat the existing annular fissure using an ablation method and we believe that treating the herniated disc together with the fissure in the same session increased our success rate. Conclusion: With clinical evidence, we suggest that L-Disq may be considered as an appropriate option with a low risk of complications in pain management in cases of lumbar disc herniation that are resistant to conservative methods.

The Use of Dexmedetomidine in Puncture Techniques for Degenerative Diseases of the Lumbar Spine

“…In the past two decades, puncture techniques such as denervation of the facet joints 17,18 and posterolateral transforaminal endoscopic discectomy have been widely used to reduce painful vertebrogenic syndrome. 19,20 Many spinal surgeons indicate the possibility of using local anesthesia in minimally invasive spinal interventions. 20,21 But in some cases, a low individual pain threshold and psychosomatic anxiety do not allow for adequate perioperative anesthesia, requiring use of general anesthesia.…”

<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>

“…Three studies have reported the therapeutic outcomes of the navigable percutaneous disc decompression device on pain caused by lumbar spine disorders. 6,10,12 In 2011, Lee et al 6 performed percutaneous disc compression in 27 patients using the navigable percutaneous disc decompression device. They recruited patients with radicular pain whose nerve roots were compressed by a herniated disc.…”

“…At 48 weeks after the procedure, the average VAS score had changed from 7.55 at pretreatment to 3.60. In 2019, Ceylan et al 10 recruited 209 patients with HLD and a spinal canal with an axial diameter greater than 50%. The average VAS score reduced from 7.28 at pre-treatment to 3.03 at the 1-year follow-up.…”

“…6 Its effectiveness in managing radicular pain following HLD has been previously reported. 6,10 However, its effectiveness for HLD pain that is refractory to repeated ESIs and that requires open surgery has not been reported.…”

Percutaneous Laser Disc Decompression: In Low Back Pain or in Radicular Pain

“…Whether percutaneous laser disc decompression (PLDD) is an effective procedure is still controversial. While most of the studies claim that PLDD is effective (1)(2)(3)(4)(5)(6)(7), there are also studies stating that it is not effective than placebo (8)(9)(10)(11). However, the literature generally focusing only radicular pain or only discogenic pain when evaluating such patients (1,2,4,5,8,9).…”