255. Percutaneous thermal disc decompression versus percutaneous disc decompression like minimally invasive outpatient procedure of low back pain treatment; single center 1-year experience

Abstract

BACKGROUND CONTEXT Chronic low back pain is one of the major social, economic, and health care worldwide disability causes. PURPOSE The aim of our work is to compare two different minimally-invasive, outpatient procedures for the treatment of contained lumbar disc protrusions using radiofrequency percutaneous targeted disc decompression (TDD) vs mechanical percutaneous disc decompression (PDD) in patients presenting contained lumbar disc herniation confirmed with MR imaging (MRI). STUDY DESIGN/SETTING Single center. PATIENT SAMPLE We enrolled 200 patients with back and leg pain due to MRI identified unilateral and contained lumbar disc protrusion, who failed conservative treatment like physical and pharmacological therapy or epidural steroid injections. OUTCOME MEASURES: METHODS Selected patients were randomized into two groups and treated with TDD (Group A) and with PDD (Group B); all procedures were performed under fluoroscopic guidance in angiography suite using a posterolateral approach ipsilateral respect to the herniation. RESULTS Group A: 100 patients received single-level treatment; 13 patients needed double-level treatment. Group B: 100 patients received single-level treatment; 21 patients needed double-level treatment. All patients were compliant with post-treatment protocol and follow-up. At 6 months follow up we observed: Group A mean improvement 3.9 on the VAS and 75% of subjective improvement; Group B mean improvement 4.1 on the VAS and 77% of subjective improvement; At 12 months follow up we observed: Group A mean improvement 3.7 on the VAS and 86% of subjective improvement; Group B mean improvement 3.9 on the VAS and 89% of subjective improvement; Post 12-months follow-up showed that 89% of patients returned to work following treatment, about 7% make a discontinued use of medical therapy and less than 4% required further pain retreatment. More than 95% of all treated patients agreed to repeat the procedure in case of the therapeutic failure at the first intervention. One case of spondylodiscitis was observed, according to previous reports. CONCLUSIONS Both approaches appear to be a safe and effective treatment for chronic low back pain due to contained lumbar disc herniations with no significant statistical difference in terms of life quality gain due to the improvement in leg and back pain, persisting for at least 1 year. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.