Elsevier

Clinical Imaging

Volume 30, Issue 4, July–August 2006, Pages 242-244
Clinical Imaging

Original contribution
Clinical follow-up of 50 patients treated by percutaneous lumbar discectomy

https://doi.org/10.1016/j.clinimag.2006.01.019Get rights and content

Abstract

A series of 50 patients presenting with lumbar discogenic disease, and treated by percutaneous discectomy using the Dekompressor system (Stryker, Kalamazoo, MI, USA), were followed for more than 6 months, by analyzing the evolution of the painful symptomatology with the visual analog scale (VAS) system. All patients had been under treatment with analgesic or anti-inflammatory agents. The intensity of the pain was measured 2, 7, 30, and 180 days after the percutaneous discectomy. An improvement in the painful symptomatology of less than 30%, observed in 11 cases and in 1 case of epidural pathology, was considered an unsuccessful result. A decrease of the pain of more than 70% was observed in 72% of cases, either with the end of the symptoms of pain as noted in 79.5% of patients or with a marked reduction of the medical treatments obtained in 21.5%. The results obtained were already almost definitive at the seventh day of follow-up, and further controls rarely demonstrated an improvement in the pain. The location of the herniated disc is a parameter which appears to be very important in the efficacy of percutaneous discectomy. We noted an improvement of more than 70% in 79% of the posterolateral foraminal or extraforaminal hernias, although these favorable results were observed only in 50% of the posteromedian hernias.

Introduction

Medical therapy is the initial treatment of symptoms due to lumbar sciatica, mainly with the use of anti-inflammatory or analgesic agents. In case of no response to these treatments, besides the classical surgical intervention, which does not always result in the disappearance of the symptoms [1], [2], new therapeutic options based on interventional radiology have been proposed [3], [4], [5], [6], [7], [8]. After the first communication by Kenneth and Robert [9], who executed a percutaneous discectomy by decompression, we reported on the efficacy of the technique, which we performed in 10 patients but under computed tomography (CT)- and fluoroscopic guidance [10]. We present now the results obtained by our procedure on the control of the symptoms of pain, which we observed in 50 patients who were followed-up for more than 6 months.

Section snippets

Patients and method

The report is based on the results obtained in 50 patients who presented with sciatica pain secondary to a herniated disc and in whom the medical therapies had been unsuccessful. Twenty-five men and 25 women, of a median age of 52 years (age range, between 22 and 81 years), were subjected to percutaneous discectomy.

The criteria of inclusion in our study were the following: lumbar sciatica of disco-radicular origin secondary to a herniated disc, documented by magnetic resonance imaging, which

Results

In 11 patients, it was felt that the results were not satisfactory because the decrease in the VAS was less than 30% in 10 patients and because of the development in 1 patient of an epidural process which was treated surgically by laminectomy, without any particular consequence. Furthermore, 5 of 11 patients were operated on but only in two was the result satisfactory.

Of the 39 patients, the benefits obtained allowed the suspension of the medical therapies given before the procedure in 31

Discussion

Thanks to the minimal aggressive type of technique, this percutaneous procedure, which uses a fine needle introduced in situ under the almost perfect CT- and fluoroscopic guidance, should be considered as an alternative treatment to surgery. Our series was voluntarily limited by precise clinical factors, comparable to those of other series based on different techniques [1], [2], [3], [4], [5], [6], [7], albeit with the advantage of not excluding the possibility of an eventual surgical

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