Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy: four year prospective study results

Abstract

BackgroundPatients with radiculopathy caused by contained disc herniations are less likely to have good outcomes following discectomy surgery than patients with disc herniations that are not contained. The author presents his 4-year results from a prospective trial regarding the efficacy and safety of a tubular transforaminal radiofrequency-assisted manual decompression and annulus modulation of contained disc herniations in 58 patients.MethodsFifty-eight patients with lumbar radiculopathy due to a contained disc herniation were enrolled in a prospective clinical study. Visual analog scores (VAS) for back pain and leg pain, quality of life assessment, Macnab criteria, and SF-12 were collected from patients before treatment, at 2-years and 4-years post-treatment.ResultsAt 4 years, results were obtained from 47 (81%) of patients. Compared to mean pre- treatment assessments, mean 4-year VAS for back pain improved from 8.6 to 2.3 points, and mean VAS for leg pain improved from 7.8 to 2.3. Eighty-three percent of respondents reported that they were “satisfied” or “very satisifed” with their quality of life at 4-years as per SF-12. At 4 years, recurrence was noted in 3 (6.4%) of respondents and no complications were reported.ConclusionsThe 2-year and 4-year study results are nearly identical, suggesting durable benefit out to 4 years. These results also suggest that in carefully selected patients with sustained contained disc herniations who have failed conservative treatments, manual decompression combined with radiofrequency-assisted decompression and annulus modulation are very likely to have good outcomes 4 years post-treatment.

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

“…In a previous study, patients with sustained, contained disc herniation's whose pain had not responded to conservative treatment were very likely to have good outcomes 4 years after manual decompression combined with radiofrequency-assisted decompression and annulus modulation [11].…”

“…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

“…Across the sample, 849 discs (discography-positive) were treated, showing a rate of 1.32 interventions per patient. The most affected levels were L4-L5 (329) and L5-S1 (296), comprising up to 73.7% of the total intervened discs; followed by L3-L4 (154), L2-L3 (53), and lastly, L1-L2 (17).…”

“…16 In contrast, the RF results differed (1.7%) due to factors such as the lower temperatures reached by the technology, the advanced learning curve stage, and the higher number of medical records that met the inclusion criteria and were comparable with the percentages reported in the literature. 7,[17][18][19] Regarding the type of complication, for laser, the literature reports spondylodiscitis as the most common, with an occurrence ranging from 0.24% to 1.2%. 15,16,24 In contrast, this series shows radiculitis as the principal complication.…”

“…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.…”