Original contributionClinical follow-up of 50 patients treated by percutaneous lumbar discectomy
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
References (11)
- et al.
Percutaneous spinal interventions
Neurosurg Clin N Am
(2005) - et al.
Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports
Clin Imaging
(2005) Measurement of pain
Lancet
(1974)- et al.
Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals
Neurosurgery
(1989) - et al.
Intra- and post-operative complications in lumbar disc surgery
Spine
(1989)