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Percutaneous Herniectomy under CT and fluoroscopy guidance for lumbar radiculopathy related to disk hermiation: Treatment results and comparison between lateral and medial herniated disks. 2012

Interventional Spine

Patrick, Browaeys, MD
Laurent, Huwart, MD, PhD, Non ASSR Member
Nicolas, Amoretti, MD, Non ASSR Member

Paper/Non-Mentor

Purpose

1. To analyse the outcome of percutaneous herniectomy performed under CT and fluoroscopy guidance, in lumbar radiculopathy related to disk herniation. 2. To compare the results of percutaneous herniectomy regarding to the disk herniation localization

Methods & Materials

Prospective IRB approuved study including 200 patients (116 males & 84 females, mean age 46) betweeen January 2010 and January 2011. 46 (23%) patients had a postero-medial herniation (group 1, medial herniation). 74 patients had a foraminal herniation and 80 patients a posterolateral herniation, for a total of 154 (77%) lateral herniations (group 2, lateral herniation). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%) and L5-S1 in 72 cases (36%). Inclusion criteria were radiculopathic pain assessed both by refering physician and operatorwith disk herniation at the corresponding level confirmed by MRI, ; failure of conservative treatment and at least one corticosteroid foraminal infiltration;Huskisson Visual Analogic Scale (VAS) for pain >= 6/10. Persistance of disk hydration (hyper T2 signal) Exclusion criteria were sensitive deficit, evolving motor deficit or stable motor deficit <4/5, previous back surgery, coagulation disorder, pregnancy and current infection. Procedure was performed under local anesthesia, with CT (GE Lightview 8 rows MSCT, GE Healthcare, Milwaukee, MI, USA) and fluoroscopy (GE Stenoscope, GE Healthcare, Milwaukee, MI, USA) guidance. Herniectomy was realized with a percutaneous discectomy device (Herniatome, Gallini Medical Devices, Montova, IT). Discography was performed at the beginning of the procedure to confirm the symptomatic level. Patients were hospitalized for 2 days after the procedure. VAS for pain was evaluated prior to the herniectomy, at two days, at one month and at 6 months after the procedure. Statistical analysis was done by Pillsi-Spur, Wilks-Lambda, Hotelling-Spur and Scheffe multivariable tests for significance and the Levene test for the variances.

Results

Group 1 (patients with medial herniation) VAS prior to intervention was 7.9±2.5. VAS was 3.2±2.1 (p<0.01*) at two days, 3.9±1.2 (p<0.01*) at one month and 2.7±1.2 (p<0.01*) at 6 months. Group 2 (patients with lateral herniation) VAS prior to intervention was 8.2±3.2. VAS was 2.8±1.5 (p<0.01*) at two days, 1.5±0.9 (p<0.01*) at one month and 1.1±0.5 (p<0.01*) at 6 months. (*compared to the initial VAS) Relative VAS reduction at 6 months was of 65% in group 1 and of 81% in group 2 (p<0.01)

Conclusion

Percutaneous herniectomy under CT and fluoroscopy guidance seems to provide significant clinical amelioration, both for medial or lateral localization of the herniation. Also, this method seems to provide better results for lateral localization of the herniation. While open-sky surgery might be simply not indicated when pain is the only symptom of hernia, or sometimes controversial if attempted, percutaneous herniectomy could be a valuable alternative therapeutic procedure, with the advantage of its minimal invasiveness and the avoidance of general anesthesia.

References/Financial Disclosures

No disclosure

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