CT-Guided Percutaneous Laser Disc Decompression for Lumbar Discogenic Radiculopathy-Performance of a Novel Combi-Therapy.

Abstract

On the basis of reported immediate and short-term excruciating pain by patients in the post-procedural period of computed tomography (CT)-guided percutaneous laser disc decompression (PLDD) in our clinic, we present our initial clinical experience with a novel combi-therapy using a combination of CT-guided PLDD and CT-guided epidural nerve blocks, which proved effective in managing the pain. A total of 100 patients who met the criteria for PLDD, underwent treatment for lumbar discogenic radiculopathy between 2014 and 2017. Fifty-five percent of the patients were males and 45% were females with a mean age of 46.25 years. Ninety-five patients underwent one level PLDD and five patients two-level PLDD procedures. CT-guided epidural nerve block with a combination of Bupivacaine, Lignocaine, and Kenalog was used in a 3× procedure separated by a 1-week interval. The first nerve block was given the same day, immediately after the PLDD procedure. The visual analogue scale (VAS) for pain was used during the pre-procedure and post-procedure periods. Among the patients who underwent one level PLDD, 88 had L4-L5 levels, 5 had L5-S1 levels and 2 had L3-L4 levels. L4-L5 and L5-S1 levels were the most common two-level PLDD locations in seven patients. Five patients in our study subsequently underwent open surgical treatment. All patients reported immediate pain relief, which was sustained after the procedure. The average pre-procedure VAS score was 7.6 (range from 5 to 8.2) and the VAS score immediately after the procedure was on average 0.5 (ranging from 0 to 2). Findings from this initial experience using a combi-therapy of CT-guided PLDD and CT-guided epidural nerve block have shown the benefits of this novel approach, offering significant immediate pain relief in the post-procedural phase, favorable outcomes in the short to mid-term and a significantly reduced rate of re-surgery (7%) compared with the use of only CT-guided PLDD. Lasers Surg Med 00:1-5, 2019. © 2019 Wiley Periodicals, Inc.