ABSTRACT
OBJECTIVE: The purpose of this study was to describe the long-term effect of image-guided percutaneous laser disk decompression (PLDD). BACKGROUND DATA: PLDD has been reported to be an alternative method to treat herniated lumbar disks. It has proved to be effective on a short-term basis. Although the procedure has been used for several years, few articles report on the long-term effect of the intervention. MATERIALS AND METHODS: Two hundred patients, who were treated with image-guided PLDD for herniated lumbar disks, were observed over a period of 4 +/- 1.3 years. Treatments were carried out under CT/fluoroscopy guidance with local anesthesia on an outpatient basis with an Nd:YAG laser of 1064 nm. RESULTS: At follow-up, back pain was eliminated or reduced in 73% of the patients. Regarding sensorimotor impairment, PLDD did have a positive effect on 74% of the patients. In the majority of patients, the number of sick days and consumption of pain medication was reduced. In one patient, diskitis occurred as a complication of PLDD; 74% of the patients said they were satisfied with the outcome of the therapy; and 81.5% of the patients would have required another PLDD in cases of disk herniation. CONCLUSION: From our clinical results, we conclude that image-guided PLDD is an effective and secure method to treat contained herniated lumbar disks. Advantages of the procedure include the minimally invasive approach on an out-patient basis and the low complication rate.
Subject(s)
Diskectomy, Percutaneous , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae , Adult , Aged , Aged, 80 and over , Decompression, Surgical , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/complications , Laser Therapy/methods , Low Back Pain/etiology , Male , Middle Aged , Peripheral Nervous System Diseases/etiology , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks.
Subject(s)
Denervation/methods , Low Back Pain/surgery , Sacroiliac Joint/innervation , Tomography, X-Ray Computed , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Sacroiliac Joint/diagnostic imagingABSTRACT
PURPOSE: The objective of this study was to evaluate the clinical outcome of CT-guided radiofrequency- (RF-)thermocoagulation of cervical zygapophysial joints for chronic non radicular cervical pain syndrome using an improved posterior approach. METHODS: 169 patients were treated with CT-guided pericapsular drug instillation of steroids and local anaesthesia on the symptomatic and adjoining segments. 46 patients experienced an only short term pain relief after repeated CT-guided blocks and were therefore treated with CT-guided RF-neurolysis. For the microtherapeutic procedure the patients were placed on the CT-table in prone-position. A 23-gauge isolated aspiration canula (Leibinger) was placed vertically, under CT-guidance lateral to the zygapophysial joint to coagulate the capsular nerve endings. The probe was then repositioned to coagulate the medial and lateral branches of the corresponding segment-nerves' dorsal branches. The thermocoagulation was applied 3-4 times with 90 s. duration and a coagulation temperature of 70 degrees C. The coagulation-probe was drawn back 3-5 mm each time. No sedation or general anaesthesia was required. The treatments were carried out on out patient basis in local anaesthesia. Statistical data on pain sensation was acquired with the help of a standardized visual analogue pain scale (VAS) and by a questionnaire on treatment satisfaction and every day activities. Patients were examined and questioned on the 2nd, 7th, 30th and 90th day after the operation. RESULTS: After 90 days, 26 (56,5%) patients had experienced a definite pain reduction of >75% (VAS). 13 (28,3%) patients obtained alleviation of <50% (VAS), within the first three postoperative months. Seven (15,2%) patients reported <25% (VAS) pain relief. No intra- and postoperative complications were reported. CONCLUSIONS: CT-guided radiofrequency thermocoagulation is an effective, precise and secure, minimally invasive treatment for non radicular cervical pain that is caused by zygapophysial joint arthropathy, when CT-guided, lateral drug instillation does not cause a lasting improvement.