Abstract
Percutaneous epidural neuroplasty (PEN) is an effective and safe procedure for herniated lumbar disc (HLD). Although PEN has an advantage of adhesiolysis, this procedure cannot decompress the protruded disc. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative methodology. This study evaluated the clinical efficacy and safety of SELD compared to PEN, as well as the change in protruded disc volume after SELD through pre- and postoperative magnetic resonance imaging (MRI), in patients with HLD. Thirty consecutive patients underwent SELD (SELD group), and 45 patients underwent PEN (PEN group). The Visual Analog Scale (VAS) for leg pain; Oswestry Disability Index (ODI); 12-Item Short-Form Health Survey (SF-12); preoperative and postoperative 4-, 12-, and 24-week Macnab criteria; and preoperative and 24-week postoperative lumbar spinal MRIs after SELD were obtained. There was no significant difference in age, sex, duration of symptoms, and the distributions of disc level between the two groups (all P > 0.05). Between the SELD and PEN groups, preoperative VAS, ODI, and SF-12 scores had no significant differences. However, the VAS, ODI, and SF-12 scores improved significantly after the procedures by postoperative week 24 in each group (all P < 0.05). Furthermore, improvements of VAS, ODI, SF-12, and success rate of Macnab criteria in the SELD group were better than those in the PEN group (all P < 0.05). The protruded disc volume after SELD decreased significantly (P=0.034). All clinical and functional outcomes of patients undergoing SELD and PEN for HLD improved following the procedures. Notably, SELD was superior to PEN regarding the degree of improvement in clinical and functional outcomes. Therefore, we suggest that SELD can be used as an effective alternative to PEN to provide improved clinical and functional outcomes in patients with HLD.
Highlights
Percutaneous epidural neuroplasty (PEN) is a minimally invasive therapy for spinal diseases [1,2,3,4]
The few studies that have investigated this procedure involving a sacral hiatus approach have only reported on clinical outcomes [10,11,12,13]. erefore, the goal of this study is to evaluate the clinical efficacy and safety of sacral epiduroscopic laser decompression (SELD) compared to PEN, as well as the change in disc volume after SELD through preand postoperative magnetic resonance imaging (MRI)
Its advantages extend beyond adhesiolysis to include drug delivery to areas of pathology that occur in diseases such as herniated lumbar disc (HLD) or stenosis [1, 2]
Summary
Percutaneous epidural neuroplasty (PEN) is a minimally invasive therapy for spinal diseases [1,2,3,4]. It was originally developed to treat postoperative adhesion, PEN has been used for targeted drug delivery, epidural scarring, and neural decompression [1, 4]. The procedure has shown good clinical outcomes as a herniated lumbar disc (HLD) treatment when compared to physiotherapy [3]. To alleviate radicular or lower back pain in patients with HLD, PEN can ameliorate aberrant adhesion and deliver drugs to areas with pathology, including the nerve root and disc [4, 5]. A disadvantage of the PEN procedure is that it cannot decompress the herniated disc. Percutaneous lumbar laser ablation is an alternative solution that addresses this problem [6]
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