Catheter Virtual Lumbar Discectomy (Early and 5 Year Follow-up Results) A New Minimally Invasive Alternative, on an Outpatient Bases

Abstract

Background: After at least six weeks of conservative management of lumbar disc disease patients, some will require additional treatment. Surgeries available do not offer clear, safe options free of complications in all cases. Moreover, some reported postoperative complications are more difficult to treat than the original illness. I am offering a new modified intervention for such cases. Objectives: The purpose of this study was to assess the safety and effectiveness of epidural cocktail instillation for lumbar degenerative diseases, confirm its indications, and evaluate the clinical outcomes of patients. Study Design: Patients were prospectively selected to receive catheter virtual discectomy (CVD) in a prospective, randomized, blinded, crossover cohort study. Setting: The enrollment took place from January 2007 through February 2012 in major tertiary Hospitals in Cairo, including Cairo University Hospitals, Naser Institute Hospital, and Al-Helal Hospital. Material & Methods: A total of 100 patients underwent epidural cocktail injections for lumbar degenerative indications by one neurological spine surgeon. The mean follow-up was 48 months. Outcomes Assessment: After one week, one month and every 3 month thereafter, for the first year, then yearly, the pain was assessed using visual analogue score (VAS). Any decrease in VAS of more than two scales was defined as a significant VAS improvement. Patients were screened for any major or minor complications. The patients were then followed for three up to five years to determine the outcome of treatment. Follow-up images were taken to assess results and determine any injection-related issues. Results The most prevalent diagnoses were disc bulges, especially in young ages. The mean severity of LBP decreased by 80% at 3-month follow-up, and 60% at 1-year follow-up. The results of pain relief were best at early follow-up visits. Forty two patients (70%) stated that they would undergo this procedure again. The late 5 year follow up, if not superimposed by an additional new insult, and after exclusion of the 14 patients who did not complete the study, had a stationary clinical course. Limitations: Fourteen patients did not complete the study, with reasons ranging from loss to follow-up (not returning) to pursuing exclusion criteria items. Eighty six patients were included in the final analysis. Conclusion Despite the supposed argue, the current study provides evidence that immediate pain relief and increase in function can be provided by the epidural cocktail injections with a very low rate of morbidity. The follow-up images showed, in addition to the clinical improvement, definite structural decrease of the disc bulges in a way as if discectomy was done without any surgical or interventional intervention. That is why the name catheter virtual discectomy (CVD) was introduced.