Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: Early results

Abstract

BackgroundBack pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce.MethodsWe included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups – those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively.ResultsThe mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11).Conclusions and level of evidenceEarly results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement.This study presents Level IV evidence.Clinical relevanceWe feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

Efficacy of Nucleo-Annuloplasty Using Disc-Fx in Lumbar Disc Herniation

“…Results of another study indicated that although improvement seen in the degenerative disc disease was not significantly different from that of the contained lumbar disc herniation subgroup, the contained group required re-intervention within 1 year of the procedure [10].…”

“…The patients with a focal disc prolapse may have had a preexisting thinning of the annulus fibrosus; creation of a 2.7-mm annulotomy near the weakened area may have predisposed them to recurrent disc prolapse [10]. Carragee et al [15] studied clinical outcomes after lumbar discectomy for treatment of sciatica and demonstrated that patients with lumbar disc herniation's containing no fragments experienced poorer treatment outcomes than did those with other types of herniation's, with 38% having recurrent or persistent sciatica.…”

“…The other concluded that the level of evidence that nucleoplasty improves radicular pain due to contained disc herniation is limited to fair [7]. A device called the L' disQ is effective for treatment of lumbar disc herniation, discogenic pain, and symptomatic lumbar disc disease [8][9][10]. The Disc-FX system combines percutaneous manual discectomy using forceps, nuclear ablation, and annular modification using radiofrequency equipment.…”

“…The Disc-FX system combines percutaneous manual discectomy using forceps, nuclear ablation, and annular modification using radiofrequency equipment. Two previous articles have reported its efficacy for contained lumbar disc herniation [10,11]. Sequestration or extruded disc herniation does not include.…”

Complications of Non-Endoscopic Discectomy: A Retrospective Study of Twenty-One Years

“…5 The effectiveness of both LS and RF has been reported in several studies, with improvement rates of above 70%. 7,8,11,[13][14][15][16][17][18][19][20][21] Nevertheless, their safety margin and degree of complications continue to create extensive controversies between different surgeons. The purpose of the study was to report and compare the number and grade of major complications present in non-endoscopic thermal discectomy and nucleoplasty, in the treatment of discogenic axial lumbar pain using LS and RF technologies.…”