The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

Abstract

Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions: Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

Comments on "The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis"

“…I read the recently published article, “The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis” by Manchikanti et al [ 1 ], with great interest. They performed a meta-analysis to evaluate the effectiveness of percutaneous epidural neurolysis or adhesiolysis in the management of chronic lumbar radiculopathy due to disc herniation by including 6 previous studies (1 randomized controlled trial and 5 retrospective single-arm studies) [ 2 - 7 ].…”

Update on Interventional Radiology of the Spine

“…In a systematic review and meta-analysis evaluating the contents of the injectate as well as the routes of administration, Manchikanti et al concluded there is level 1 evidence for transforaminal and interlaminar approaches using local anesthetic and steroids versus level 2 evidence for the use of local anesthetic alone via the same routes. 20 For caudal infiltrations, there is level 2 evidence for using local anesthetic and steroids or local anesthetics alone. 20…”

“…20 For caudal infiltrations, there is level 2 evidence for using local anesthetic and steroids or local anesthetics alone. 20…”

Efficacy and safety of Yaobitong capsule for acute lumbar disc herniation: A protocol for a multi-center randomized controlled trial

“…Lumbar disc herniation (LDH) is a frequently occurring disease in orthopedics, which seriously endangers the physical and mental health of patients. [ 1 , 2 ] Most of the protruding lumbar intervertebral discs compress the nerve roots of L5 and S1, resulting in typical symptoms of sciatica. [ 3 ] One study suggests that patients who fail to respond to conservative treatment for 6 weeks meet the surgical indications.…”