Percutaneous lumbar discectomy: a systematic review / Discectomia percutânea lombar: uma revisão sistemática

Introduction: Low back pain is a clinical condition with a multifactorial etiopathogenesis, which has a high socioeconomic impact, especially in the economically active population, as it is associated with frequent absenteeism and reduced quality of life. Through intervertebral disc degeneration, a progressive instability of the compromised region is observed, triggering a harmful positive feedback mechanism that further promotes intervertebral disc disease. Built by the interaction between the predisposing biopsychosocial components, a multidisciplinary therapeutic proposition is suggested. In persistent low back pain, treatment involves surgical procedures such as Percutaneous Lumbar Discectomy. Objectives: to evaluate the scientific evidence regarding the clinical outcomes and safety of this surgery. Method: systematic review duly registered in Prospero (CRD42022370811), based on the PICOD question, elaborated from a Boolean search in different databases for scientific articles, evaluated and selected in a paired way based on the eligibility criteria. In addition to extracting data related to the proposed objectives, the articles included were evaluated in relation to their level of evidence and strength of recommendation. Results: among the 12 articles included, it was observed that it is a clinically effective and safe procedure. In the set of evidences gathered, they are of high and moderate level of evidence with respective strength of recommendation strong/good and weak/moderate. Conclusion: Percutaneous Lumbar Discectomy promotes significant reduction of pain and increase in body functionality, in addition to preserving local musculoskeletal structures and preventing post-surgical joint instability. It is, therefore, a safe and clinically effective minimally invasive procedure for patients with herniated discs.

Introdução: a lombalgia é uma condição clínica de etiopatogenia multifatorial, que desencadeia um elevado impacto socioeconômico especialmente na população economicamente ativa, por associar-se ao absenteísmo frequente e à redução da qualidade de vida. Observa-se mediante a degeneração do disco intervertebral, uma instabilidade progressiva da região comprometida desencadeando um mecanismo de feedback positivo prejudicial que promove ainda mais a doença do disco intervertebral. Edificada pela interação entre os componentes biopsicossocial predisponentes, sugere-se uma proposição terapêutica multidisciplinar. Na dor lombar persistente o tratamento envolve procedimentos cirúrgicos como a Discectomia Percutânea Lombar. Objetivo: avaliar as evidencias científicas relativas aos desfechos clínicos e à segurança desta cirurgia. Método: revisão sistemática devidamente registrada no Prospero (CRD42022370811), fundamentada na pergunta PICOD acrônimo para Paciente, Intervenção, Comparação, Desfechos (outcomes) e Design, elaborada a partir de busca booleana em diferentes bases de dados por artigos científicos, avaliados e selecionados de forma pareado com base nos critérios de elegibilidade. Além da extração de dados relativos aos objetivos propostos, os artigos incluídos foram avaliados em relação ao respectivo nível de evidencia e força de recomendação. Resultados: dentre os 12 artigos incluídos, observou-se que se trata de um procedimento clinicamente efetivo e seguro. No conjunto de evidencias reunidas são de alto e moderado nível de evidencia com respectiva força de recomendação forte/boa e, fraca/moderada. Conclusão: a Discectomia Percutânea Lombar promove relevante redução da dor e aumento da funcionalidade corporal, além de preservar as estruturas musculoesqueléticas locais e prevenir a instabilidade articular pós-cirúrgica. Trata-se, portanto, de um procedimento minimamente invasivo seguro e clinicamente efetivo para os pacientes portadores de hérnia discal.

Provocative Discography Following Focal Selective Coagulation in a Patient with Chronic Lumbar Discogenic Pain

This is a case report of the provocative discographic findings before and after focal selective coagulation of the major annular fissure using intradiscal navigable catheter. A 46-year-old woman had a 30-month history of axial low back pain and magnetic resonance imaging findings suspicious for painful L4/5 disc. The provocative discography confirmed painful disc before coagulation. The final electrode tip position in the coagulation procedure was at the largest fissure within the outer annular margin identified through the discography. Six months after the successful coagulation therapy, inadvertently performed discography resulted in decreased pressure rise over time. Neither evoked pain nor change in the integrity of outer annulus as compared with the previous results was reported. Such an interventional method has not been reported previously, and the analytic results suggest that it may be possible to relocate the pressure of the entire nucleus pulposus only by focal selective coagulation of the fissure.

Guía de instrucción en endoscopia de columna avanzado / Instruction guide in advanced endoscopy of the Spine

La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten entrenar técnicas quirúrgicas mínimamente invasivas como la endoscopia de columna. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los participantes. Inicialmente el asistente encontrará conceptos teóricos de instrumental, equipos y la técnica quirúrgica, posteriormente en la fase práctica se aplicarán los conceptos adquiridos usando un modelo sawbone de columna lumbar y finalmente se realizará la practica en un modelo anatómico humano sobre el que se desarrollan de manera completa y guiada los diferentes procedimientos endoscópicos usados a nivel lumbar. El entrenamiento en modelos bajo un ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.

The evolution of traditional surgical techniques and training models of surgeons require changes. For this reason the centre of research and training in minimally invasive surgery (CLEMI) has developed and applied teaching models that help in the training of minimally invasive surgical techniques such as the endoscopy of the spine. CLEMI proposes a model based on simulation taught in a controlled, structured, and progressive environment that is adjusted to the individual rhythm of each of the participants. The student will initially encounter the theoretical concepts of instruments, equipment, and the surgical technique. This will be followed by a practical phase in which the acquired concepts will be applied using a sawbone model of the lumbar spine. Finally the practice will be carried out on a human anatomical model on which they develop, in a complete and guided manner, the different endoscopic procedures used at the lumbar level. Model training in a controlled environment decreases the learning period and increases student skills.

Nucleus pulposus atherectomy decompression and ozone nucleolysis combine lumbar traction in the treatment of central type lumbar disc herniation / 中国基层医药

Objective To investigate the clinic technique and effect of treating lumbar disc herniation (LDH) with decompressor and ozone injection combined lumbar traction after surgery.Methods 110 contained LDH patients were randomly divided into two group:decompressor and ozone group,decompressor and ozone combined lumbar traction after surgery group.Under the guidance of CT,fifty-five patients in group A were treated by disc decompression with Decompressor through poster olateral approach,then ozone was injected into the lumbar disc or out side the lumbar disc,and the other fifty-five patients in group B were treated by lumbar traction after surgery that disc decompression and ozone injection same as the group A in once a day and one week of treatment.The theraputic effect was evaluated by comparing VAS,effective rate of therapy before and after treatment.Results The VAS score of two groups at 1,3,7 days between pre-and post-treatment had singificantly different(t =2.159,2.163,2.169,2.167,2.173,2.192,all P ＜0.05).110 case were followed up after 6 and 12 months,The good-excellent rate of therapy in B group 12 months were better than those of A group (x2 =74.23,75.11,all P ＜ 0.05).Conclusion Decompressor combined ozone injection and lumbar traction after surgery is an effective menthod for treatment of the central type mbar disc herniation.

Effect of Percutaneous Laser Disc Decompression on Phospholipase A2 and Nerve Conduction Velocity in Rabbit with Prolapse of Intervertebral Disc / 中国康复理论与实践

@#Objective To explore the mechanism of percutaneous laser disc decompression (PLDD) for treating prolapse of intervertebral disc. Methods 15 rabbits were divided into 3 groups randomly: sham group, model group with PLDD treatment, model group without PLDD treatment. The nerve conduction velocity (NCV) of L6 nerve root and the activity of phospholipase A2 (PLA2) in the intervertebral disc of L5-6 were determined 2 weeks after the initial surgery. Results NCV in the group with PLDD was significantly faster than that in the group without PLDD (P<0.001); NCV in the group without PLDD was significantly lower than that in the sham group (P<0.001). The activity of PLA2 in the group with PLDD was significantly lower than that in the group without PLDD (P<0.001); The activity of PLA2 in the group without PLDD was significantly higher than that in the sham group (P<0.001). Conclusion The activity of PLA2 in the herniated discs is higher than that in normal discs, which result in NCV falls remarkably. The PLDD can reduces chemical factors such as PLA2.

Percutaneous Laser Disc Decompression for Treatment of Lumbar Discogenic Pain / 中国康复理论与实践

@# Objective To investigate the therapeutic effect of percutaneous laser disc decompression on lumbar discogenic pain.Methods56 patients with lumbar discogenic pain were treated with percutaneous laser disc decompression with Nd:YAG laser(wavelength 1064 nm).They were followed up for more than 3 months with Macnab criteria.ResultsAll the patients were followed up.At the end point of postoperative 3 months,32 patients had an excellent outcome,20 were good,3 patients were fair,1 patient were poor.No complication(infection and nerve injury)had been observed.ConclusionPercutaneous laser disc decompression is a safe,little invasive and effective treatment modality for lumbar discogenic pain.

Clinical Research of Percutaneous Disc Decompression for the Treatment of Lumbar Disc Herniation / 医学研究杂志

Objective To observe and compare the short time effect on lumbar disc herniation patients who were trearted by three kinds of percutaneous disc decompression. Methods In 86 cases of lumbar disc herniation patients, 19 cases were treated by Laser Disc Decompression(PLDD) , 21 cases were treated by Nucleoplasty,and 46 cases were treated by Decompressor, All patients were evaluated by visual analogue scales (VAS). Results VAS of 7d(2.01?0.864) ,30d(1.88?0.923) and pre - operation (6.40?1.162), decreased significantly(P0.05). Conclusion The three kinds of percutaneous disc decompression were effective, safe treatment for contained lumbar disc herniation.

Mid-term Efficacy of PLDD for Treatment of Lumbar Disc Herniation / 中国微创外科杂志

Objective To investigate the mid-term efficacy of percutaneous laser disc decompression(PLDD) for patients with lumbar disc herniation.Methods Between May 2001 and December 2006,a total of 122 patients with simple lumbar disc herniation underwent PLDD in our hospital.Under local anesthesia,the operaiton was performed using a laser diode with the patients in supine position.A C-arm X-ray system was employed to guide the surgery.Results The patients were followed up for 6 to 60 months(mean 36.5 months).Accroding to the MacNab Criteria,60 patients achieved excellent outcomes,39 were good,15 were fair,and 8 were poor.The rate of exellent and good outcomes was 81.1%(99/122).No patient had postoperative complications.Conclusions PLDD is effective and safe for patients with simple lumbar disc herniation.The cases recover quickly after the operation,because the procedure is minimally invasive.

Percutaneous laser disc decompression in the treatment of discogenic back pain / 中国微创外科杂志

Objective To evaluate curative effects of percutaneous laser disc decompression(PLDD) in the treatment of discogenic low back pain.Methods A total of 36 patients with discogenic low back pain was included in the study.The PLDD was performed by using the DIOMED semiconductor laser treatment,with a power of 15 W,1 s-pulse duration,1 s-interval,and an energy of radiation of 800~1 200 J.Curative outcomes were evaluated based on the Visual Analog Scale(VAS) criteria. Results The operation time was 15~60 min(mean,30 min).The pain provocation was observed in 32 patients.Follow-up examinations were conducted in the 36 patients for 6~36 months(mean,11 months).The postoperative VAS scores were improved by ≥ 3 points in 18 patients and ≥ 2 points in 14 patients.Results revealed that 32 patients(88.9%) reported a good response and 4(11.1%) reported no response. Conclusions Percutaneous laser disc decompression is a safe,effective,and minimally invasive procedure that can be used for patients with discogenic low back pain.

Some remarkable on percutaneous laser disc decompression results according to age

At the Centre of Biophysics from June 1999 to December 2003, 499 cases of herniated lumbar disc divided into age groups of 60 years old were treated by percutaneous laser. Excellent results achieved in 32.3%, good in 46.7%, medium in 18.2% and poor in 2.8%. There was not died case or severe complication. Laser technique could be used for the elderly because of the physical state, associated disease with high risks and difficulties in other surgical interventions.

The significance of the magnetic resonance image after the performance of the percutaneous laser disc decompression (PLDD)

The magnetic resonance image is compulsory indication for patients with the suspected clinical symptoms of the disc dislocation and treated by the percutaneous laser disc decompression (PLDD). The magnetic resonance image should be taken care after PLDD in the indication and implementation. The parameters of the first performance must be the same as these of the second performance. An evaluation in the results of image must be based on the principles of technique which is the reduction of the pressure but not reduction of volume of ectopia

Percutaneous laser for lumbar disc decompression

There are several advantages of percutaneous laser. Candidates for this technique are patients who have CT or MRI imaging findings showed that the spinal disc(s) were displaced but remained to be intact, with correlative pain symptoms and received conservative treatment for at least three months without success. The patients have only to suffered regional anesthesia, have not to hospitalize, free from scar, have not any spinal problem, time of immobilization and activity limitation was shorter

A Comparative Study on the Indication of Percutaneous Laser Disc Decompression / 实用放射学杂志

Objective To study the effect of selection of indications in percutaneous laser disc decompression(PLDD).Methods Lumbar disc herniation treated by PLDD with satisfactory and unsuited indications in 34 cases respectively were matched studied.Results The curative effect was 85.3% and 55.9% in satisfactory indication group and unsuited indication group respectively (?~2=5.06,P

Clinical Study of Percutaneous Laser Disc Decompression (A Report of 66 Cases) / 实用放射学杂志

Objective To study of percutaneous laser disc decompression(PLDD)in the patients of lumbar disc herniations.Methods 66 patients were treated with PLDD.The mean age of the 48 male and 18 female patients was 39.3 years old.Results 58 patients of all,or 87.9% showed excellent or good result.15 patients(78.9%)showed excellent and 2 patients(10.5%) were good,2 patients(10.6%) were fair or poor under 30 year old.15 patients(44.1%)showed excellent and 17(50.5%)patients were good,2(5.9%)patients were fair in 31~50 years old.2(15.4%) patients showed excellent and 7(53.8%)patients were good,4(29.8%)patients were fair or poor over 51 years old.Conclusion PLDD is safe and convenient method of treating lumbar disc herniations.

Percutaneous LASER Disc Decompression for Lumbar Disc Herniations: Preliminary Report

After attempts of percutaneous laser disc decompression on 14 patients of lumbar disc herniations, disappointing results were recorded as follows, 2 cases(14.2%) were considered excellent, 2 cases(14.2%) good, 2 cases(14.2%) fair and 8 cases(57.1%) poor. While successfully treated patients had minimal subligamentous extension of nucleus pulposus, failed cases had moderate to severe subligamentous extension of nucleus pulposus through the annular tearing. In preliminary conclusion of percutaneous laser disc decompression, successful result can be expected only on the minimal subligamentous extension cases, and chemonucleolysis will be better choice for the moderate to severe subligamentous extension cases.