scholarly journals An Update of the Systematic Assessment of Mechanical Lumbar Disc Decompression with Nucleoplasty

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE25-SE54 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Disc Herniation ◽  
Observational Studies ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Low Back ◽  
Level Of Evidence ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques are also utilized, including nucleoplasty, automated percutaneous discectomy and laser discectomy. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature of mechanical lumbar disc decompression with nucleoplasty. Objective: To determine the effectiveness and update the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: The available literature on mechanical lumbar disc decompression with nucleoplasty was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, reduction in opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was defined as greater than one year. Results: For this systematic review, 37 studies were considered for inclusion. Of these, there was one randomized trial and 14 observational studies meeting inclusion criteria for methodological quality assessment. Based on USPSTF criteria, the level of evidence for nucleoplasty is limited to fair in managing radicular pain due to contained disc herniation. Limitations: A paucity of literature with randomized trials. Conclusion: This systematic review illustrates limited to fair evidence for nucleoplasty in managing radicular pain due to contained disc herniation. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, Coblation technology, nucleotomy

scholarly journals A Systematic Review of Mechanical Lumbar Disc Decompression with Nucleoplasty

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 561-572
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Disc Prolapse ◽  
Level Of Evidence ◽  
Level Ii ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including nucleoplasty, automated percutaneous discectomy, and laser discectomy have been described. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature. Objective: To determine the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: A comprehensive evaluation of the literature relating to mechanical lumbar disc decompression with nucleoplasty was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). A literature search was conducted using only English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross-references from reviews and systematic reviews. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Results: Based on USPSTF criteria the level of evidence for nucleoplasty is Level II-3 in managing predominantly lower extremity pain due to contained disc herniation. Limitations: Paucity of literature, both observational and randomized. Conclusion: This systematic review illustrates Level II-3 evidence for mechanical lumbar percutaneous disc decompression with nucleoplasty in treatment of leg pain. However, there is no evidence available in managing axial low back pain. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, coblation technology, nucleotomy

scholarly journals Systematic Review of the Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

2009 ◽  
Vol 1;12 (1;1) ◽  
pp. 207-232 ◽  
Author(s):  
Standiford Helm II
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Observational Studies ◽  
Low Back ◽  
Level Of Evidence ◽  
Level Ii ◽  
Discogenic Low Back Pain ◽  
One Year

Background: Chronic discogenic low back pain is a common problem with significant personal and societal costs. Thermal annular procedures (TAPs) have been developed in an effort to provide a minimally invasive treatment for this disorder. Multiple techniques utilized are intradiscal electrothermal therapy (IDET), radiofrequency annuloplasty, and intradiscal biacuplasty (IDB). However, these treatments continue to be controversial, coupled with a paucity of evidence. Study Design: A systematic review of the literature evaluating the efficacy or effectiveness of TAPs. Objective: To determine the effectiveness of TAPs in reducing low back pain in patients with intradiscal disorders. Methods: A comprehensive evaluation of the literature relating to TAPs was performed. The literature was evaluated according to Cochrane Review criteria for randomized controlled trials (RCTs) and according to the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Data sources included relevant literature of the English language identified through searches of PubMed, EMBASE, the Cochrane Library, and the Database of Reviews of Effectiveness (DARE). Outcome Measures: Short-term effectiveness was defined as one-year or less and long-term effectiveness was defined as greater than one-year. Results: Systematic review of IDET identified 2 RCTs and 16 observational studies with an indicated evidence of Level II-2. Systematic review of radiofrequency annuloplasty identified no RCTs but 2 observational studies with an uncertain evidence of Level II-3. Systematic review of IDB identified one pilot study. The level of evidence is lacking with Level III. Limitations: The limitations of this review include paucity of the literature and lack of evidence with internal validity and generalizability. Conclusion: IDET offers functionally significant relief in approximately one-half of appropriately chosen chronic discogenic low back pain patients. There is minimal evidence supporting the use of radiofrequency annuloplasty and IDB. Key words: Chronic low back pain, degenerative disc disease, internal disc disruption, intervertebral disc, thermal annular procedures, intradiscal electrothermal therapy, radiofrequency ablation, intradiscal biacuplasty, radiofrequency annuloplasty

scholarly journals Percutaneous Lumbar Laser Disc Decompression: An Update of Current Evidence

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE229-SE260
Author(s):  
Vijay Singh
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Outcome Measures ◽  
Disc Herniation ◽  
Current Evidence ◽  
Low Back ◽  
Level Of Evidence ◽  
Laser Disc ◽  
One Year

Background: Since the descriptions by Mixter and Barr of surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common practice. Disc herniations are often classified as being contained or non-contained. The results of open surgical discectomy for contained disc herniation have been poor. Consequently, several less invasive techniques have been developed including percutaneous lumbar laser disc decompression. Study Design: A systematic review of the literature of percutaneous lumbar laser disc decompression. Objective: The objective of this systematic review is to evaluate and update the clinical effectiveness of percutaneous lumbar laser discectomy in managing radicular pain secondary to contained disc herniation. Methods: The available literature on lumbar laser disc decompression in managing chronic low back and lower extremity pain was reviewed. Quality assessment and clinical relevance of randomized trials were graded according to the Cochrane Musculoskeletal Review Group criteria for interventional techniques, and observational studies according to the Newcastle-Ottawa Scale criteria. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return-to-work. Short-term effectiveness was defined as effectiveness lasting one year or less, whereas, long-term effectiveness was defined as benefit persisting for greater than one year. Results: Based on USPSTF criteria, the indicated level of evidence for percutaneous lumbar laser disc decompression is limited for short- and long-term relief. Limitations: Although laser discectomy has been utilized for many years, there is a paucity of randomized clinical trials. Conclusion: This systematic review shows limited evidence for percutaneous lumbar laser disc decompression. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, percutaneous lumbar laser discectomy, laser assisted spinal endoscopy

scholarly journals Percutaneous Lumbar Mechanical Disc Decompression Utilizing Dekompressor®: An Update of Current Evidence

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE1-SE24 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Lumbar Disc ◽  
Psychological Status ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Low Back ◽  
Level Of Evidence ◽  
Disc Protrusion ◽  
One Year

Background: The primary goal of the surgical treatment of nerve root compression from a disc protrusion continues to be the relief of compression by removing the herniated nuclear material with open discectomy. However, poor results have been reported for contained disc herniations with open surgical interventions. In recent years, a number of minimally invasive nuclear decompression techniques for lumbar disc prolapse, protrusion, and/or herniation have been introduced, including the Dekompressor®. The efficacy of several alternative techniques, including the Dekompressor, automated percutaneous discectomy, and laser discectomy, has been described, but is not convincing. There is a continued paucity of evidence for all decompression techniques. Objective: The objective of this systematic review is to evaluate and update the literature describing the clinical effectiveness of Dekompressor, a high rotation per minute (RPM) device used in mechanical lumbar disc decompression. Study Design: A systematic review of the literature focusing on mechanical disc decompression with Dekompressor. Methods: The available literature on the use of percutaneous disc decompression (PDD) with Dekompressor to manage chronic low back and lower extremity pain was reviewed using the Cochrane Musculoskeletal Review Group criteria for randomized trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the US Preventive Services Task Force (USPSTF) system for grading the quality of evidence. Data sources included relevant literature identified through PubMed and EMBASE from 1966 through September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief was the primary outcome measure. Secondary outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less. Long-term effectiveness was defined as greater than one year. Results: Only 5 studies were considered for inclusion. Of those, only 3 of them met inclusion criteria. Based on USPSTF criteria, the level of evidence for PDD with Dekompressor is limited. Limitations: Paucity of high quality literature. Conclusion: This systematic review found limited evidence for PDD with Dekompressor. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, disc protrusion, disc extrusion, radiculitis, Dekompressor.

scholarly journals Systematic Review of Percutaneous Lumbar Mechanical Disc Decompression Utilizing Dekompressor

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 589-599 ◽  
Author(s):  
Vijay Singh
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Systematic Reviews ◽  
Literature Search ◽  
Lumbar Disc ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Disc Protrusion ◽  
One Year

Background: In recent years, a number of minimally invasive nuclear decompression techniques for lumbar disc prolapse, protrusion, and/or herniation have been introduced, including the Dekompressor® a device utilizing an Archimedes screw. The primary goal of the surgical treatment of nerve root compression from a disc protrusion continues to be the relief of compression by removing the herniated nuclear material with open discectomy. However, poor results have been reported for contained disc herniations with open surgical interventions. The results with several alternative techniques including the Dekompressor, automated percutaneous discectomy, and laser discectomy have been described, but are not convincing. There is a paucity of evidence for all decompression techniques. Study Design: A systematic review of the mechanical disc decompression with Dekompressor literature. Objective: The objective of this systematic review is to evaluate the clinical effectiveness of the Dekompressor, a high rotation per minute device utilizing an Archimedes screw, used in mechanical lumbar disc decompression. Methods: The literature search was conducted utilizing a comprehensive strategy for mechanical disc decompression utilizing the Dekompressor. A literature search was conducted using only English language literature in a comprehensive search of databases including PubMed, EMBASE, the Cochrane Library, along with systematic reviews, and cross-references from reviews, systematic reviews, and individual articles. The quality of the manuscripts included was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and for observational studies with the criteria developed by the Agency for Healthcare Research and Quality (AHRQ). The level of evidence developed by the United States Preventive Services Task Force (USPSTF) was utilized in this review. The evidence was classified as Level I, II, or III with 3 subcategories in Level II for a total of 5 levels of evidence. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Results: Based on USPSTF criteria the indicated level of evidence for the mechanical high RPM device or Dekompressor is Level III for short- and long-term relief. Limitations: Lack of literature, both randomized and observational. Conclusion: This systematic review illustrates Level III evidence for mechanical percutaneous disc decompression procedures with the high RPM device or Dekompressor. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, disc protrusion, disc extrusion, radiculitis, and mechanical high RPM device, Dekompressor

scholarly journals Percutaneous Lumbar Laser Disc Decompression: A Systematic Review of Current Evidence

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 573-588
Author(s):  
Vijay Singh
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Outcome Measures ◽  
Disc Herniation ◽  
Systematic Reviews ◽  
Level Of Evidence ◽  
Laser Disc ◽  
Level Ii ◽  
One Year

Background: Since the descriptions by Mixter and Barr of open surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common practice. Disc herniations have been reported as being contained and non-contained. The results of open surgical discectomy for contained disc herniation have been poor. Consequently, several alternative techniques have been developed which are minimally invasive including percutaneous laser disc decompression. Study Design: A systematic review of the literature. Objective: The objective of this systematic review is to evaluate the clinical effectiveness of percutaneous laser discectomy in managing radicular pain secondary to contained disc herniation. Methods: A comprehensive evaluation of the literature relating to mechanical disc decompression was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. A literature search was conducted by using only the English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross references from reviews and systematic reviews. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Results: Based on USPSTF criteria the indicated level of evidence for percutaneous lumbar laser discectomy (PLLD) is II-2 for short- and long-term relief. Limitations: Even though laser discectomy has been in utilization for a number of years and numerous procedures have been performed there continues to be a paucity of literature of randomized clinical trials. Conclusion: This systematic review illustrates Level II-2 evidence for percutaneous laser disc decompression which is equivalent to automated percutaneous lumbar disc decompression. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, percutaneous lumbar laser discectomy, laser assisted spinal endoscopy

scholarly journals Automated Percutaneous Lumbar Discectomy for the Contained Herniated Lumbar Disc: A Systematic Assessment of Evidence

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 601-620 ◽  
Author(s):  
Joshua Hirsch
Keyword(s):  
Systematic Review ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Disc Prolapse ◽  
Level Ii ◽  
Lumbar Disc Prolapse ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The typical rationale for traditional surgery is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients will recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including automated percutaneous lumbar discectomy (APLD) have been described. However, there is a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. Study Design: A systematic review of the literature. Objective: To determine the effectiveness of APLD. Methods: A comprehensive evaluation of the literature relating to automated lumbar disc decompression was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. A literature search was conducted of English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross references from reviews and systematic reviews. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one-year or less, whereas, long-term effectiveness was defined as greater than one-year. Results: Based on USPSTF criteria, the indicated evidence for APLD is Level II-2 for short- and long-term relief. Limitations: Paucity of RCTs in the literature. Conclusion: This systematic review indicated Level II-2 evidence for APLD. APLD may provide appropriate relief in properly selected patients with contained lumbar disc prolapse. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, automated percutaneous lumbar discectomy, internal disc disruption, radiculitis.

scholarly journals An Updated Review of Automated Percutaneous Mechanical Lumbar Discectomy for the Contained Herniated Lumbar Disc

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE151-SE184
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Observational Studies ◽  
Randomized Trials ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Disc Prolapse ◽  
Herniated Lumbar Disc ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion are the most common causes of nerve root pain and surgical interventions, and yet they account for less than 5% of all low back problems. The typical rationale for traditional surgery is that it is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients do recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques, including automated percutaneous mechanical lumbar discectomy, have been described. There is, however, a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. Study Design: A systematic review of the literature of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. Objective: To evaluate and update the effectiveness of automated percutaneous mechanical lumbar discectomy. Methods: The available literature on automated percutaneous mechanical lumbar discectomy in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria, as utilized for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor, based on the quality of evidence scale developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was defined as greater than one year. Results: Nineteen studies were included; none of the randomized trials and 19 observational studies met inclusion criteria for methodological quality assessment. Overall, 5,515 patients were studied with 4,412 patients (80%) showing positive results lasting one year or longer. Based on USPSTF criteria, the indicated evidence for automated percutaneous mechanical lumbar discectomy is limited for short- and long-term relief. Limitations: A paucity of randomized controlled trials in the literature describing automated percutaneous mechanical disc decompression. Conclusion: This systematic review shows limited evidence for automated percutaneous mechanical lumbar discectomy. Automated percutaneous mechanical lumbar discectomy may provide appropriate relief in properly selected patients with contained lumbar disc herniation. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, automated percutaneous mechanical lumbar discectomy, internal disc disruption, radiculitis.

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