RESUMEN

Introduction: A new navigable percutaneous disc decompressor (L'DISQ-C, U&I Co., Uijeongbu, Korea), introduced in 2012, is designed to allow direct access to herniated disc material. The L'DISQ device can be curved by rotating a control wheel, directed into disc herniation treats, and decompresses contained herniated discs with minimal collateral thermal damage. This study reports the case of contained central disc herniation in a 34-year-old male with a 2-year follow-up successfully treated with navigable ablation decompression treatment (L-DISQ). Case Report: A 34-year-old man presented to the outpatient department with a 6-month history of neck pain and bilateral upper limb radiation. His neck pain had increased progressively. At the time of presentation, his neck pain visual analog scale score was 7/10, and his neck disability index score was 30. The magnetic resonance images showed a single fluid-containing lesion with a hyperintense zone at the C4-5 levels with central disc herniation. The patient was successfully treated with the navigable ablation decompression treatment (L-DISQ) procedure. Conclusion: The navigable ablation decompression treatment (L-DISQ) is a valuable technique in treating contained cervical disc herniation with rapid pain relief and improvements in functional outcomes without any significant injury to surrounding structures. It is safe, precise, and effective in the treatment of symptomatic cervical disc herniations. Large, randomized, and multicenter trials are needed to explore the potential of the same technique further.

RESUMEN

BACKGROUND: The navigable percutaneous disc decompression (PDD) device L'DISQ is an effective and safe option for the treatment of lumbar discogenic pain. However, few studies have evaluated the prognostic factors of successful PDD using this device. OBJECTIVE: This study aimed to evaluate the prognostic factors associated with the successful outcome of PDD using the L'DISQ for treating lumbar discogenic pain by following up patients before and one, 2, 3, and 6 months after the procedure. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary university hospital. METHODS: A successful outcome was defined as a >= 50% reduction in the numeric rating scale scores for pain and a >= 40% reduction in the Oswestry Disability Index scores at 6 months after the procedure. Clinical parameters and patient demographics, including pain duration, history of surgery, number of treatment levels, and the radiographic findings of lumbar magnetic resonance imaging (MRI), were also examined. RESULTS: Of the 106 patients included, 80 (75.5%) had successful outcomes at 6 months. Multivariable logistic regression analysis revealed that the presence of high-intensity zones (HIZs) (P = 0.016) was an independent positive predictor of successful PDD outcomes; conversely, migration of the herniated disc (P = 0.017) and bilaterally herniated discs (P = 0.001) were negative predictors. LIMITATIONS: The limitations of this study were its retrospective design, absence of a control group, and difficulty in predicting the effect when multiple levels were involved because of the use of MRI characteristics of the disc as a predictor. CONCLUSIONS: The presence of HIZs, the absence of migration of herniated discs, and the presence of unilaterally herniated discs are positive predictors of successful outcomes of PDD using the L'DISQ.

Asunto(s)

RESUMEN

Background/aim: Minimally invasive procedures have been increasingly used for the treatment of herniated discs. Nonsurgical interventions minimize the secondary damage to other tissues and shorten the length of hospital stay by avoiding general anesthesia. Possible complications are thermal injuries, root injury, discitis, endplate damage, dural injury, meningitis, infection, increase in pain, and muscle spasm. We aimed to evaluate the efficacy of percutaneous decompression therapy by using intradiscal navigable electrodes on pain and functional movement index in patients with herniated nucleus pulposus (HNP). Materials and methods: A total of 209 patients with protrusive lumbar disc herniation underwent percutaneous ablation decompression treatment using an intradiscal routable electrode (L-Disq) in our pain clinic. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at the beginning and at the 1st, 3rd, 6th, and 12th months after treatment. Patient satisfaction was evaluated at the 12th month by a patient satisfaction scale (PSS). Results: When compared to initial values, VAS and ODI scores showed statistically significant improvement at the 1st, 3rd, 6th, and 12th months (P < 0.001). Mean VAS scores were 7.28 and 3.03 points (P < 0.001) while mean ODI scores were 32.46 and 20.48 points (P < 0.001) at the beginning and at the 12th month, respectively. Satisfaction rate of all patients was 81%. We also attempted to treat the existing annular fissure using an ablation method and we believe that treating the herniated disc together with the fissure in the same session increased our success rate. Conclusion: With clinical evidence, we suggest that L-Disq may be considered as an appropriate option with a low risk of complications in pain management in cases of lumbar disc herniation that are resistant to conservative methods.

Asunto(s)

RESUMEN

Recently, various studies evaluating percutaneous cervical nucleoplasty have reported good results. Percutaneous cervical nucleoplasty has been commonly used for treating contained herniated disc or protrusion, but a posterolateral extruded disc has not been considered to be an indication. The tip of the L'DISQ(R) wand can be curved to the desired angles by the rotation of the control wheel. Therefore, L'DISQ(R) can directly access the extruded disc. We report the application of percutaneous cervical nucleoplasty by using the L'DISQ(R) in three patients with an extruded disc. Decompression was successfully performed, and the symptoms improved immediately. In one patient, a 6-month follow-up magnetic resonance imaging study showed disappearance of the extruded cervical disc. Percutaneous cervical nucleoplasty using the L'DISQ(R) can be an effective, low complication, minimally invasive procedure for treating cervical disc herniation.

Asunto(s)