Percutaneous Disc Decompression Research Articles

A Case Report on Pneumocephalus That Occurred Following an Epidural Ozone Injection During Percutaneous Lumbar Disc Decompression Surgery

: Spinal decompression is a common procedure in spinal, neurosurgery, and orthopedic surgery. While there are a number of known complications associated with it, pneumocephalus (air in the brain) is generally not a recognized complication postoperatively. However, in rare cases, it can occur as a result of spinal decompression surgery. We describe a case of a 54-year-old female patient who developed pneumocephalus following percutaneous lumbar disc decompression surgery of the lumbar spine. The patient presented to the emergency department 3 hours after discharge with severe restlessness, cognitive impairment, nausea, vomiting, and lack of balance. During symptomatic treatment in the emergency department and 1 hour after taking oxygen, the patient’s vital signs improved. Before discharge, a computed tomography (CT) scan was taken again, which showed the disappearance of radiological symptoms. The patient was discharged 12 hours after hospitalization with suitable clinical conditions. Obtaining urgent imaging tests (magnetic resonance imaging [MRI] or CT) at the cranial and spinal levels, along with an electroencephalogram, allows us to diagnose the problem and determine the appropriate course of treatment, whether pharmacological or surgical.

Percutaneous Radiofrequency Disc Decompression: A Study of 27 Patients.

Percutaneous radiofrequency nucleoplasty is a true minimally invasive technique for treatment for radiculopathy caused by contained disc protrusions. This minimally invasive procedure uses controlled thermoablation for reducing the intervertebral disc and decompressing the lumbar nerve root. Material and Methods: Our study is a prospective analysis of 27 patients aged from 30 to 64 years with lumbar disc protrusion who were treated with percutaneous radiofrequency disc decompression (PRFD) between May 2018 and May 2019. Clinical follow-up was reported at 1 month, 3 months, and 6 months. The outcomes were assessed using a visual analog scale (VAS) and MacNab score. Of the 27 patients, 14 were female and 13 were male. Their mean age was 53 ± 2 years. In all 27 patients, percutaneous radiofrequency nucleotomy was performed. An excellent outcome as reflected by MacNab score was observed in 17 patients (63%), a good outcome in 8 patients (29.7%), and a poor outcome in 2 patients (7.3%). Prior to treatment, the average back and leg VAS scores were 7.95 and 7.82, respectively. At sixth month follow-up, the back and leg VAS scores were reduced to 3.17 and 3.04, respectively. Patients with a poor outcome developed early recurrent disc prolapse and required endoscopic discectomy. PRFD is a safe and effective treatment of contained disc protrusion. PRFD is a good alternative to surgery. These procedures significantly increase quality of life in patients with lumbar radiculopathy.

Which Percutaneous Lumbar Disc Decompression Technique is more suitable? Comparing Laser, Radiofrequency, and Quantum Techniques

: Percutaneous lumbar disc decompression (PLDD) has emerged as an effective and minimally invasive treatment option for lumbar disc herniation. This review aims to provide pain specialists with a comparative overview of Iran’s commonly utilized PLDD techniques: Laser, radiofrequency (RF), and quantum PLDD. The review discusses patient selection criteria, procedural characteristics, and outcomes to facilitate informed clinical decision-making.

A narrative review of percutaneous laser disc decompression - early experience in Lagos, Nigeria

Overview. Managing chronic pain arising from the degenerative disc disease of the spine has remained a huge challenge while choosing from within a vast array of treatment armamentarium ranging from the use of medications only or in combination with other physical treatment options, minimally invasive heat therapy, and operative interventions. Patients with chronic pain referred to as ‘contained disc’ in cervical, thoracic, and lumbar disc pathology have been successfully managed with percutaneous laser disc ablative therapy. This approach is only for selected patients and advantages derivable from this approach are the preservation of soft tissue anatomy, minimal post-procedure pain, less metabolic responses, and no blood loss when compared to open surgical procedures. Methodology. This is a one-year retrospective narrative study of six adult patients who presented with chronic low back pain related to the spine and had a lumbosacral spine magnetic resonance imaging (MRI) scan with findings of contained disc herniation. Patients’ brief clinical evaluation which involves biodata, history of pain, and pain scores using the visual analogue scale (VAS) pre and post-intervention and Oswestry disability index to assess disability from chronic pain. A narration of these patient’s progression to follow-up six months after the procedure was documented. Results. The results showed significant improvement in the VAS and ODI scores in five of the 6 patients, with one showing marginal improvement. Conclusion. Percutaneous lumbar disc decompression is effective in the management of chronic low back with concordant clinical and radiological evidence of contained disc pathology.

Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus

To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus. A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days. All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation. The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

Evaluation of the resection efficiency and safety of an enhanced power plasma generator using cadaveric intervertebral discs.

Plasma energy has been used to provide minimally invasive interventional treatment for spinal problems. However, this procedure has been used for limited indications mainly because of its small resection range. To overcome this problem, we designed the enhanced power plasma device. This device seeks to maximize the resection area by modifying the electrode arrangement and enhancing the maximum electric power. The purpose of this study is to assess the efficiency and safety of this newly designed plasma generator, a device for percutaneous disc decompression. We performed an intradiscal procedure on 7 fresh human cadaver lumbar spine specimens using the enhanced power plasma under C-arm fluoroscopic guidance at various voltages. As a result, the volume of the removed area was proportional to the applied magnitude of the electric power level. In particular, under the high-power level condition after 500s treatment, nearly the entire nucleus pulposus was eliminated. The generated plasma density also tends to grow along with the given electric power. The highest level of temperature rise did not exceed the level that would lead to degeneration in the collagen tissue of the intervertebral disc. Histopathologic examination also demonstrated that there was no thermal damage to the surrounding neural tissues. In conclusion, we speculate that the concepts of this newly designed enhanced plasma generator could be applied to remove huge disc materials without thermal or structural damage to the adjacent target tissues in future spine clinics.

A New Role for Epidurography: A Simple Method for Assessing the Adequacy of Decompression during Percutaneous Plasma Disc Decompression

Percutaneous plasma disc decompression (PPDD) is a minimally invasive treatment for discogenic low back pain and herniated disc-related symptoms. However, there are no known outcome predictive variables during the procedure. The purpose of this study was to evaluate and validate epidurography as an intra-procedure outcome predictor. We retrospectively enrolled 60 consecutive patients who did not respond to conventional treatments. In the next stage of treatment, PPDD was performed, and the epidurography was conducted before and after the PPDD. We analyzed the relationship between epidurographic improvement and the success rate. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure and 1 month after the procedure. The pain reduction and the success rate in the epidurographic improvement group were significantly higher than in the epidurographic non-improvement group. Both the Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups, but there was no significant difference in Oswestry Disability Index scores. This study's results showed that PPDD is an effective treatment method. We also suggested that epidurography may be a potential outcome predictor for ensuring successful outcomes and determining the endpoint of the procedure.

Transforaminal Percutaneous Endoscopic Lumbar Discectomy (TPELD) in Caudal Migrated Lumbar Disc Herniations: A Case Series and Literature Review

Background Data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely utilized in various degenerative spine pathologies, due to the presence of high-speed drills, flexible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis.

Minimally-invasive percutaneous treatments for low back pain and leg pain: a randomized controlled study of thermal disc decompression versus mechanical percutaneous disc decompression

BACKGROUND CONTEXTMinimally invasive techniques have recently been developed as alternative treatments to surgical interventions, especially for small or contained herniated disc. PURPOSEAim of our study is to assess the efficacy of the mechanical percutaneous disc decompression (PDD) in comparison with the percutaneous radiofrequency targeted disc decompression (TDD). STUDY DESIGNWe conducted a single-center noninferiority trial in which patients who had low back pain with radicular leg pain (RLP) from a contained herniated disc were randomly assigned in a 1:1 ratio to undergo either PDD or TDD. PATIENT SAMPLEFrom January 2016 to January 2017 a total of 327 patients were assessed for eligibility of whom 200 underwent randomization in the trial; 100 patients underwent the PDD and 100 underwent the TDD. OUTCOME MEASURESThe primary outcome measure was the proportion of patients who reported >50% reduction in Numeric Rating Scale (NRS) leg pain score. Secondary outcome measure included the proportion of patients who reported >30% improvement in Oswestry Disability Index (ODI) score. METHODSOutcomes of this trial were measured with the use of patient-reported data obtained from validated questionnaires to assess the low back pain with RLP before intervention and at 6 and 12 months after interventions. MRI was performed before intervention and at 6 and 12 months after interventions. In addition to NRS and ODI scores, we collected the following data: age, gender, length of hospitalizations and return to work rate. RESULTSWhen using an intention to treat analysis with those lost to follow-up and requiring a second procedure counting as failures, there were no statistically significant difference between the two treatment groups in the primary and secondary outcomes at 6 months: >50% reduction in NRS leg pain (PDD vs. TDD)=67% versus 65%; >30% ODI improvement (PDD vs. TDD)=57% versus 55%. Similarly, there were no statistically significant differences between groups in outcomes at 12 months: >50% reduction in NRS leg pain (PDD vs. TDD)=51% (95% CI 41%–60%) versus 40% (95% CI: 30%–49%); >30% ODI improvement (PDD vs. TDD)=42% (95% CI 32%–51%) versus 30% (95% CI: 21%–39%). A nonintention to treat analysis which discounted those lost to follow-up showed the only statistically significant finding was the percentage of those reporting >30% ODI at the 12 month follow-up time, favoring the PDD group: (PDD vs. TDD)=58% (95% CI 46%–69%) versus 42% (95% CI: 22%–43%). CONCLUSIONSPDD and TDD are comparable treatments for patients presenting with low back pain with RLP unresponsive to medical therapy caused by contained disc herniations.

The Importance of Sacral Neuroanatomy in Pain Syndromes and Procedures

: The neural plexus exists in different parts of the body. The sacral plexus is the lowest neural network in the body that is responsible for sensory and motor innervation to a large part of the body. The sacral plexus or sacral nerve roots may be damaged by diseases, such as disc herniation, spinal canal stenosis, and cancer or iatrogenic injuries during surgery or interventional pain procedures (open spinal surgeries, hip surgeries, percutaneous endoscopic disc decompression, trans-sacral epiduroscopic laser decompression, …). Patients with sacral nerve damage may experience a variety of symptoms, including low back pain radiating to the legs, sensory disturbance in the buttocks or legs, motor weakness in the legs, bladder or bowel dysfunction (urinary retention/incontinence, defecation’s problems), or sexual dysfunction. Therefore, complete familiarity with the anatomy of the sacral plexus is very important. In this article, we tried to review the anatomy of the sacral plexus and sensory or motor innervations of each terminal branch of the sacral plexus. Also, the clinical importance of these nerves in the development of pain syndromes and diagnostic and therapeutic methods for damage to the terminal branches of the sacral plexus were investigated.

Functional outcome of percutaneous spine endoscopic intervention in lumbar disc herniation- A retrospective analysis

Introduction: Low back pain is one of the most common musculoskeletal problems among developed and developing nations. The prolapsed intervertebral disc (PIVD) is the most common pathology associated with treatable low back pain. The management protocol for PIVD has evolved from conservative treatment to surgical and finally to minimally invasive pain and spine interventions. Aims and Objectives: The aim of study was to evaluate the functional efficacy and patient satisfaction in PIVD patients with minimally invasive percutaneous endoscopic disc decompression (PEDD). Materials and Methods: All data was obtained from pain medicine OT records of tertiary hospital regarding epidemiological data, VAS score for pain, ODI score for functional outcome and Modified Macnab's criteria for patient satisfaction(Pre-op, 1 week, 1 month, 3 months and 1 year) were tabulated and statistically analyzed using SPSS version 21. Results: There were 30 male and 26 female patients in our series with the mean age of the 42.09±10.57 years. The VAS score showed statistically significant improvement 3 months (P=0.034) and at 1 year (P=0.012) postoperative. The modified ODI score showed statistically significant improvement during 3 months (P= 0.015) and 1-year score (P=0.008). The modified MACNAB scores (P= 0.001) showed significant improvement in patient satisfaction. One patient had a recurrence and opted for conventional surgical management. Few patients had transient side effects (dysesthesia-7, mild weakness-1) which improved with conservative measures. Conclusion: We conclude that percutaneous endoscopic disc decompression for single-level lumbar disc herniation is a safe, effective and low-cost definitive treatment modality with minimal complications.

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

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.

Image-guided percutaneous mechanical disc decompression for herniated discs: a technical note.

Interventional radiology plays a key role in the treatment of symptomatic herniations of intervertebral discs. Through image-guided techniques, it is possible to use minimally invasive procedures with a percutaneous approach that are usually proposed before classic surgery. Thanks to imaging guidance, it is possible to significantly increase accuracy and decrease complication rates. The pivotal principle of these mini-invasive techniques is to remove a small amount of volume of the nucleus of the intervertebral disc which results in a significant reduction in intradiscal pressure; allowing for a consequent reduction in compression of the nervous structures that generate spinal pain. However, it must be considered that this type of treatment is only addressed to contained disc herniations previously diagnosed with a suitable neuroimaging examination. There are different types of treatment using a variety of chemical, thermal or mechanical processes that result in partial removal of the nucleus pulposus. The purpose of this technical note is to illustrate mechanical disc decompression treatment via a percutaneous approach using the DISKOM device (DISKOM percutaneous discectomy probe, Biopsybell, Mirandola, Italy). Indications, complications and various methods of use are described in relation to the different levels of the spine to be treated. (www.actabiomedica.it).

Current Concepts in Intradiscal Percutaneous Minimally Invasive Procedures for Chronic Low Back Pain.

Study Design:A systemic review of thermal annular procedures (TAPs) and percutaneous disk decompression procedures (PDDPs) for the treatment of discogenic chronic low back pain (CLBP) was conducted.Objective:The objective of this review is to evaluate and to compare the effectiveness of TAPs and PDDPs in treating discogenic CLBP and to assess the frequency of complications associated with those procedures.Materials and Methods:English-language journal articles were identified through computerized searches of the PubMed database and bibliographies of identified articles and review papers. Articles were selected for inclusion if percutaneous minimally invasive procedures were the treatment options for patients with CLBP and if follow-up outcome data included evaluations of back pain severity, functional improvement, and/or incidence of complications. For this review, 27 studies were included.Results:Intradiscal electrothermal therapy (IDET) procedure in properly selected patients may eliminate or delay the need for surgical intervention for an extended period, whereas few adverse effects have been reported. In contrast to IDET, there is far less literature on the effectiveness of radiofrequency annuloplasty and intradiscal biacuplasty procedures. Nucleoplasty is a potentially effective treatment option for patients with contained disc herniation, while the procedure is well tolerated. Increased success rates have been found for percutaneous laser disc decompression and automated percutaneous lumbar discectomy in strictly selected patients.Conclusions:These procedures can be effective and may obviate the need for surgery completely. Further prospective randomized sham-controlled trials with higher quality of evidence are necessary to confirm the efficacy of these procedures.

Therapeutic Effects and Safety of Percutaneous Disc Decompression with Coblation Nucleoplasty in Cervical Vertigo: A Retrospective Outcome Study with 74 Consecutive Patients and Minimum 1-Year Follow-Up

Background: Surgical treatment of cervical vertigo has been rarely reported. This is the first retrospective study to evaluate the clinical outcomes of percutaneous disc decompression with coblation nucleoplasty (PDCN) for treatment of cervical vertigo. Objectives: To assess the clinical outcomes of patients with cervical vertigo who failed to improve with conservative care and who were subsequently treated with PDCN. Study Design: This study used a retrospective design. Setting: The research was conducted within an interventional vertigo management and spine practice. Methods: Seventy-four consecutive patients with cervical vertigo underwent PDCN and were followed for at least one year. Outcome measures included the dizziness intensity Visual Analog Scale (VAS), dizziness frequency, the Dizziness Handicap Inventory (DHI), and neck pain intensity. Clinical efficacy was assessed by rating scale and the modified MacNab evaluation criteria. Surgical complications during the operation and follow-up were also recorded. Results: The vertigo VAS score, frequency of dizziness, DHI, and neck pain intensity were all decreased significantly from evaluation before surgery to one week after surgery and to the last follow-up, giving a mean effective rate of 94.6% one week after surgery and 90.6% at the last follow-up. Good to excellent results were attained in 85.1% of these patients one week after PDCN and in 75.7% of the sufferers at the last follow-up (P < 0.001). There were 5 patients with transient adverse effects (6.25%) reported within the first month after surgery; they all recovered after conservative treatment. No neurological complications were found and no patient went on to spinal fusion surgery thereafter. Limitations: The rate of follow-up was 70% and a placebo effect cannot be excluded. There is no gold standard for the diagnosis and treatment of cervical vertigo so far. Conclusion: The clinical outcomes of PDCN for cervical vertigo were satisfactory in both the early and late postoperative period. PDCN is an effective, low-complication, minimally invasive procedure used to treat cervical vertigo. Further prospective randomized controlled trials are essential to verify this conclusion. Key words: Cervical vertigo, percutaneous disc decompression, coblation nucleoplasty, longterm outcome, dizziness intensity, dizziness frequency, dizziness handicap inventory, clinical efficacy, surgical complication, retrospective study

03:09 PM WITHDRAWN Abstract No. 200 Percutaneous thermal disc decompression versus percutaneous disc decompression like minimally invasive outpatient procedure of low back pain treatment: single-center one-year eperience

The aim of our work is to compare two different minimally invasive, outpatient procedure for the treatment of contained lumbar disc protrusions using Percutaneous Targeted Disc Decompression (TDD) vs Percutaneous Disc Decompression (PDD) in patients presenting contained lumbar disc herniation confirmed with MR imaging. We enrolled 200 Patients with back and leg pain due to MRI identified unilateral and con-tained lumbar disc protrusion, who failed conservative treatment like physical and pharma-cological therapy or epidural steroid injections. Selected Patients were randomized into two group and treated with TDD (Group A) and with PDD (Group B); all procedures were performed under fluoroscopic guidance using a posterolateral approach contralateral or ipsilateral respect to the herniation. Group A completed a 12-minute 40° C thermal decompression protocol. Group B completed a standard mechanical decompression protocol. All group patients follow 1 month sessions of specific physical therapy. MRI and clinical follow-up measures were performed at 6 and 12 months and compared with PairTtest. Each patient has joined the procedure after written informed consent Group A: 100 pt received single-level treatment; 13 patients need for double-levels treat-ment. Group B: 100 pt received single-level treatment; 21 patients need for double-levels treat-ment. All patients were compliant with post-treatment protocol and follow-up. 6 months follow up: Group A mean improvement 3.9 on the VAS and 75% subjective improvement; Group B mean improvement 4.1 on the VAS and 77% subjective improvement; 12 months follow up: GroupA mean improvement 3.7 on the VAS and 86% subjective improvement; Group B mean improvement 3.9 on the VAS and 89% subjective improvement; Post 12 months follow up show that 89% of patients returned to work following treatment, about 7% make a discontinued use of medical therapy and only less than 4% required fur-ther pain retreatment. More than 95% of all treated patients were agree in repeating the procedure. One case of spondylodiscitis was observed. Both approaches appears to be a safe and effective treatment for chronic low back pain due to contained lumbar disc

Abstract No. 558 Percutaneous thermal disc decompression versus percutaneous disc decompression like minimally invasive outpatient procedure of low back pain treatment: single-center one-year eperience

Abstract No. 558 Percutaneous thermal disc decompression versus percutaneous disc decompression like minimally invasive outpatient procedure of low back pain treatment: single-center one-year eperience

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

Aims:Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.Methods:Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months.Results:The median visual analog scale score was 7.00±0.45 points before treatment and 2.73±0.65 points at 12 months post-procedure and were statistically significant (p<0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00±0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.Conclusion:Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

Aims: Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.Methods: Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months. Results: The median visual analog scale score was 7.00&plusmn;0.45 points before treatment and 2.73&plusmn;0.65 points at 12 months post-procedure and were statistically significant (p&lt;0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00&plusmn;0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.Conclusion: Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.

Percutaneous Coblation Nucleoplasty in Patients with Contained Lumbar Disc Prolapse : One Year Follow-Up in a Prospective Case Series

Background:clinical outcome data was analyzed for 100 patients withcontained disc herniation who underwent percutaneous discdecompression procedure using Coblation® technology,after failing to respond toconservative management. Patients and Methods: Patients presented with clinicalsymptoms of discogenic low back pain and/or leg painFollow-up data was collected up to 12 months.Patient gender distribution was 68% female, 32% male, witha mean age of 39 years.With mean duration of back pain of 8.57 ,ranging from 3 to 17 month and mean duration of leg pain of 4.36 .ranging from 2 to 10 monthaccording to visual analogue scale for pain assessment.The mean pre-procedure pain level for all patients wasReported as 7.56 for back and 7.72 for leg while average pain level was 4.86 for back and 3.42 for leg at the 12-month follow-up post procedure period. And according to Oswestry disability index for functional assessment. The mean pre procedure index was 31.48 range from 23-40. It decreased after 12 month to 13.82 range from 5-32. Results:The results of this analysis indicated that PDD usingCoblation technology, isan effective procedure for patients presenting withdiscogenic back and/or leg pain who have failed conservativetherapies.