Clinical Outcomes of Patients Treated with Percutaneous Hydrodiscectomy for Radiculopathy Secondary to Lumbar Herniated Nucleus Pulposus

Abstract

Introduction: Acute herniated nucleus pulposus (HNP) in the lumbar spine is a common source of back and leg pain. Conservative treatment includes activity modification, medications and epidural steroid injection. Most patients improve with conservative treatment. Patients that fail to improve are referred for surgical decompression. A new minimally invasive procedure, percutaneous hydrodiscectomy, mechanically cuts and removes disc material using a high-velocity, non-thermal saline fluid jet through a 3.8mm cannulated system. The procedure is performed under local anesthesia with sedation with minimal tissue trauma, blood loss or complication. The purpose of this study is to evaluate the clinical outcomes of percutaneous hydrodiscectomy in treating patients with radiculopathy secondary to lumbar HNP. Methods: A multi-center retrospective review was conducted on consecutive patients with lumbar HNP confirmed by MRI, who failed to improve with conservative management and were to be referred for decompressive surgery, but underwent percutaneous lumbar hydrodiscectomy at one or two levels. Patients with free fragment herniation, central stenosis or bone impingement were excluded.Results: A total of 50 patients (60% male) with a mean age of 52.6 years underwent percutaneous hydrodiscectomy at six centers between August 2008 and May 2012 with no intra-operative complications. A total of 63 lumbar levels were treated; 37 single-level and 13 two-level. One patient reported mild pain over the incision that resolved. There was one level that could