Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Patients with radiculopathy, with or without back pain, often do not respond to conservative care and may be considered for epidural steroid injection therapy or a disc decompression procedure. Plasma disc decompression (PDD) using the Coblation SpineWand device is a percutaneous, minimally invasive interventional procedure. The purpose of this study was to evaluate clinical outcomes with PDD as compared with standard care using fluoroscopy-guided transforaminal epidural steroid injection (TFESI) over the course of 2 years.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a multicenter randomized controlled clinical study. Ninety patients (18–66 years old) who had sciatica (visual analog scale score ≥50) associated with a single-level lumbar contained disc herniation were enrolled. In all cases, their condition was refractory to initial conservative care and 1 epidural steroid injection had failed. Participants were randomly assigned to receive either PDD (46 patients) or TFESI (44 patients, up to 2 injections).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The patients in the PDD Group had significantly greater reduction in leg pain scores and significantly improved Oswestry Disability Index and 36-Item Short Form Health Survey ([SF-36], physical function, bodily pain, social function, and physical components summary) scores than those in the TFESI Group. During the 2-year follow-up, 25 (56%) of the patients in the PDD Group and 11 (28%) of those in the TFESI Group remained free from having a secondary procedure following the study procedure (log-rank p = 0.02). A significantly higher percentage of patients in the PDD Group showed minimum clinically important change in scores for leg and back pain and SF-36 scores that exceeded literature-based minimum clinically important changes. Procedure-related adverse events, including injection site pain, increased leg or back pain, weakness, and lightheadedness, were observed in 5 patients in the PDD Group (7 events) and 7 in the TFESI Group (14 events).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In study patients who had radicular pain associated with a contained lumbar disc herniation, those patients treated with PDD had significantly reduced pain and better quality of life scores than those treated using repeated TFESI. In addition, significantly more PDD patients than TFESI patients avoided having to undergo a secondary procedure during the 2-year study follow-up.</jats:p></jats:sec>

Epidural Steroid Injection for Lumbar Disc Herniation in NFL Athletes

“…In the general population, back and leg pain secondary to disc hemiation is estimated to affect 10 million in the United States alone (16). The majority of episodes of acute lumbar pain resolve with conservative treatment (e.g., physical therapy, medications, and activity modifications), 60%-70% within 6 wk and 80%-90% within 12 wk (5).…”

Antimicrobial Effects of Plasma-mediated Bipolar Radiofrequency Ablation on Bacteria and Fungi Relevant for Wound Infection

“…Plasma-mediated bipolar radiofrequeney ablation (PbRf ablation), eommonly referred to as Coblation®, is a method for Volumetrie soft tissue removal, whieh is established in several surgieal fields, sueh as arthroseopy, spinal surgery, tumour reseetion, and ear, nose and throat surgery (12)(13)(14)(15). The teehnique is based on indueing a bipolar radiofrequeney eurrent between two eleetrodes in a eonduetive medium, sueh as saline, and thus ereating a physieal plasma field that is able to break moleeular bonds and dissolve tissue at relatively low temperatures (16,17).…”

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.…”

“…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. 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.…”