ABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the efficacy of a transforaminal suprapedicular approach, semi-rigid flexible curved probe, and 3-dimensional reconstruction computed tomography (3D-CT) with discogram in the endoscopic treatment of non-contained lumbar disc herniations. METHODS: The subjects were 153 patients with difficult, non-contained lumbar disc herniations undergoing endoscopic treatment. The types of herniation were as follows : extraforaminal, 17 patients; foraminal, 21 patients; high grade migration, 59 patients; and high canal compromise, 56 patients. To overcome the difficulties in endoscopic treatment, the anatomic structures were analyzed by 3D reconstruction CT and the high grade disc was extracted using a semi-rigid flexible curved probe and a transforaminal suprapedicular approach. RESULTS: The mean follow-up was 18.3 months. The mean visual analogue scale (VAS) of the patients prior to surgery was 9.48, and the mean postoperative VAS was 1.63. According to Macnab's criteria, 145 patients had excellent and good results, and thus satisfactory results were obtained in 94.77% cases. CONCLUSION: In a posterolateral endoscopic lumbar discectomy, the difficult, non-contained disc is considered to be the most important factor impeding the success of surgery. By applying a semi-rigid flexible curved probe and using a transforaminal suprapedicular approach, good surgical results can be obtained, even in high grade, non-contained disc herniations.
Subject(s)
Humans , Diskectomy , Diskectomy, Percutaneous , Follow-Up StudiesABSTRACT
OBJECTIVE: The aim of this study is to evaluate the feasibility, safety and effectiveness of radiofrequency neurotomy(RFN) for remnant pain after vertebroplasty for the treatment of severe compression fracture. METHODS: 25 patients with remnant pain after vertebroplasty for one level severe compression fracture were treated by RFN. The severe compression fractures were defined to the vertebrae which less than 50% of their original heights have collapsed. Pain relief was evaluated at 2 weeks, 6 weeks and 3 months after the procedure using a visual analog scale(VAS). RESULTS: Successful outcome was determined if pain reduction exceeded 50% on the VAS at 6 weeks. Six of the 25 patients did not respond favorably to RFN (pain reduction less than 50%), and nineteen patients showed successful responses. Mean VAS score was decreased from 5.48 to 2.96 at 6 weeks. CONCLUSION: The radiofrequency neurotomy may be both feasible and useful treatment for the remnant pain after vertebroplasty. However long-term follow up is needed to confirm the effectiveness.