Subchondral Marrow Changes After Laser Diskectomy in the Lumbar Spine

Cvitanic, Oliver; Schimandle, Jeffrey H.; Casper, G. David; Tirman, P. F. J.

doi:10.2214/ajr.174.5.1741363

Cited by 32 publications

(21 citation statements)

References 26 publications

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“…Grönemeyer et al reported the success rate of percutaneous laser discectomies (PLDDs) as 74% in 20 patients with HNP after a follow-up of 4 years (16). Although the results were similar to those of our present study, it has been shown that percutaneous laser nucleolysis offers an insufficient level of temperature control, which may lead to injury of adjacent tissues (17)(18)(19). This procedure comes with some disadvantages, such as moderate to severe intraoperative pain, thermal effects of the laser, postoperative back pain, spasm, and lack of visualization of the laser tip under fluoroscopy (20).…”

Section: Discussionsupporting

confidence: 87%

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

Ceylan¹

2019

Turk J Med Sci

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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.

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Section: Discussionsupporting

confidence: 87%

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

Ceylan¹

2019

Turk J Med Sci

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“…Vertebral endplate signal changes (VESC), also known as Modic changes [28], have been reported to be associated with low back pain (LBP) in people from the general [18], working [21,35], and clinical populations [2,5,6,13,43]. Seven out of ten studies included in a recent systematic review displayed significant positive associations between VESC and LBP, with odds ratios (OR) ranging from 2.0 to 20 [16].…”

Section: Introductionmentioning

confidence: 99%

Predictors of new vertebral endplate signal (Modic) changes in the general population

et al. 2009

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Vertebral endplate signal changes (VESC), also known as Modic changes, have been reported to be associated with low back pain (LBP). However, little is known about predisposing factors for the development of new VESC. The aim of this study was to investigate the predictive value of lifestyle factors and disc-related magnetic resonance imaging (MRI) findings in relation to the development of new VESC. This prospective observational study included 344 people from the Danish general population who had an MRI and completed LBP questionnaires at the age of 40 and again at 44 years. Potential predictors of new VESC were female gender, disc-related MRI findings (disc degeneration, disc bulges, disc herniation, and other endplate changes) and lifestyle factors [high physical work or leisure activity, high body mass index (BMI), and heavy smoking]. Bivariate and multivariate logistic regressions were used to identify predictors of new VESC. New VESC at the age of 44 appeared in 67 of the 344. The majority (84%) of these new signal changes were type 1 VESC and almost half (45%) were only in the endplate and did not extend into the vertebral body. In the multivariate analysis, lumbar disc levels with disc degeneration, bulges or herniations at 40 were the only predictors of new VESC at age 44. Therefore, the development of new VESC at the age of 44 appears to be based on the status and dynamics of the disc, rather than being the result of gender or lifestyle factors such as smoking and physical load.

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“…Currently, there is considerable interest in the Holmium Yttrium-Aluminum-Garnet (Ho: YAG) laser, a solid-state laser that oscillates at a mid-infrared wavelength (2.1 mm) near the high light-absorption spectrum of water. Owing to its favorable features of affecting water-containing substances and excellent conductance through an optical fiber, Ho: YAG laser has already been applied to operations or interventions in the urinary tract [1], coronary artery [2], thoracic cavity [3], lumbar disc [4], nasal cavity [5], and skin [6]. From the physical point of view, three modes of applications can be distinguished on the basis of laser-tissue interaction and the nature of the surroundings.…”

Section: Introductionmentioning

confidence: 99%

Holmium: YAG laser‐induced liquid jet knife: Possible novel method for dissection

et al. 2002

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Subchondral Marrow Changes After Laser Diskectomy in the Lumbar Spine

Abstract: Subchondral marrow abnormalities may occur in the vertebral end plates after holmium:yttrium aluminum garnet laser diskectomy. However, these changes probably do not affect surgical outcomes and appear to resolve over time.

Cited by 32 publications

References 26 publications

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

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

Predictors of new vertebral endplate signal (Modic) changes in the general population

Holmium: YAG laser‐induced liquid jet knife: Possible novel method for dissection

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