Using Percutaneous Endoscopic Outside-In Technique to Treat Selected Patients with Refractory Discogenic Low Back Pain

2019 ◽  
Vol 2 (22.2) ◽  
pp. 187-198
Author(s):  
Shih-Hao Chen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Success Rate ◽  
Low Back ◽  
Transforaminal Approach ◽  
Interlaminar Approach ◽  
Discogenic Low Back Pain ◽  
Endoscopic Discectomy ◽  
Annular Tear

Background: Controversy is not uncommon in the diagnosis of discogenic low back pain (DLBP) and in the identification of the location of the pain source for the symptomatic disc in patients with DLBP. Various techniques, from minimally invasive procedures to fusion surgery, are used to treat chronic DLBP, but the clinical outcomes are variable. Percutaneous endoscopic discectomy by transforaminal or interlaminar approach is considered to be an effective method to treat DLBP, but the evidence is limited; the lack of clear evidence may be associated with patient selection and surgical technique. Objectives: The purpose of this study is to evaluate the clinical results of percutaneous endoscopic treatment for annular tear in selected patients with DLBP by using the outside-in technique. Study Design: A prospective study and retrospective observations were performed on 24 consecutive patients with a minimum 2 years of follow-up. This study was approved by the Institutional Review Board (IRB) of Buddhist Dalin Tzu-Chi General Hospital Foundation (IRB number: 10504004) and written informed consent was obtained from all patients. Setting: This research took place within an interventional pain management and spine practice. Methods: Twenty-four consecutive patients with single-level DLBP diagnosed by positive highintensity zone on magnetic resonance imaging, positive provocative discography, and block test underwent a percutaneous endoscopic procedure from January 2014 to December 2015. The transforaminal approach or interlaminar approach was selected according to the location of the annular tear. The torn lesions were visualized directly and treated by puncture and debridement of the inflammatory tissues from the outer annulus fibrosus to the inner nucleus using the outsidein technique. The Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI) score were evaluated before and after surgery. The clinical global outcomes were assessed on the basis of modified MacNab criteria. Results: These patients included 13 men and 11 women with a mean age of 43.8 years (range, 32-55 yrs). There were 15 lesion levels at L4/L5 and 9 lesion levels at L5/S1. Among them, 15 levels were accessed by transforaminal approach and 9 levels by interlaminar approach. No serious complications were observed during the follow-up periods. All except 2 patients experienced significant symptomatic and functional improvements at the 2-year follow-up with a success rate of 91.7%. Limitations: Significant limitations include nonrandom format and small sample size. Future research may focus on controlled prospective studies with larger sample sizes and long-term followup to examine the validity of this protocol. Conclusions: The percutaneous endoscopic procedure provides a safe and effective treatment for selected patients with DLBP. The outside-in technique allows the surgeons to visualize and treat the torn or inflammatory lesions directly, and the success rate is high at 2 years follow-up. Key words: Transforaminal, interlaminar, outside-in technique, endoscopic discectomy, discogenic low back pain

A RARE CASE OF A DISCAL CYST FOLLOWING PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY VIAA TRANSFORAMINALAPPROACH

2021 ◽  
pp. 23-24
Author(s):  
Srinu Gugulothu ◽  
Bhaskar Jana ◽  
Sudheer Suggala
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cystic Lesion ◽  
Low Back ◽  
Transforaminal Approach ◽  
Endoscopic Discectomy ◽  
Rare Lesion ◽  
Magnetic Resonance Imaging Mri ◽  
Endoscopic Lumbar Discectomy ◽  
Disc Level

Adiscal cyst is a rare lesion that causes low back pain and radiculopathy of the lower extremities. There are several reports of discal cysts occurring after surgery, but data are limited on their occurrence after percutaneous endoscopic discectomy (PED). A21-year-old man with disc herniation at the L4-L5 disc level underwent PED via a transforaminal approach. The immediate postoperative course was uneventful and his symptoms were relieved. Six weeks after surgery, low back pain and mild pain in the left thigh recurred. Magnetic resonance imaging (MRI) revealed a cystic lesion adjacent to the left side of the L4-L5 intervertebral disc. Conservative treatment was ineffective, so we reoperated using PED with the same approach. Pain improved and MRI revealed disappearance of the cystic lesion. When symptoms relapse after PED, it is necessary to consider the occurrence of a cyst. Endoscopic Minimally Invasive Surgery

scholarly journals Thermal Annuloplasty Using Percutaneous Endoscopic Discectomy for Elite Athletes with Discogenic Low Back Pain

2019 ◽  
Vol 59 (2) ◽  
pp. 48-53 ◽  
Author(s):  
Hiroaki MANABE ◽  
Kazuta YAMASHITA ◽  
Fumitake TEZUKA ◽  
Yoichiro TAKATA ◽  
Toshinori SAKAI ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Elite Athletes ◽  
Low Back ◽  
Discogenic Low Back Pain ◽  
Endoscopic Discectomy

scholarly journals Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial

2017 ◽  
Vol 11 (3) ◽  
pp. 380-389 ◽  
Author(s):  
Koji Akeda ◽  
Kohshi Ohishi ◽  
Koichi Masuda ◽  
Won C. Bae ◽  
Norihiko Takegami ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Platelet Rich Plasma ◽  
Low Back ◽  
Discogenic Low Back Pain ◽  
Intradiscal Injection ◽  
Autologous Platelet Rich Plasma ◽  
The Mean ◽  
Autologous Platelet

<sec><title>Study Design</title><p>Preliminary clinical trial.</p></sec><sec><title>Purpose</title><p>To determine the safety and initial efficacy of intradiscal injection of autologous platelet-rich plasma (PRP) releasate in patients with discogenic low back pain.</p></sec><sec><title>Overview of Literature</title><p>PRP, which is comprised of autologous growth factors and cytokines, has been widely used in the clinical setting for tissue regeneration and repair. PRP has been shown <italic>in vitro</italic> and <italic>in vivo</italic> to potentially stimulate intervertebral disc matrix metabolism.</p></sec><sec><title>Methods</title><p>Inclusion criteria for this study included chronic low back pain without leg pain for more than 3 months; one or more lumbar discs (L3/L4 to L5/S1) with evidence of degeneration, as indicated via magnetic resonance imaging (MRI); and at least one symptomatic disc, confirmed using standardized provocative discography. PRP releasate, isolated from clotted PRP, was injected into the center of the nucleus pulposus. Outcome measures included the use of a visual analog scale (VAS) and the Roland-Morris Disability Questionnaire (RDQ), as well as X-ray and MRI (T2-quantification).</p></sec><sec><title>Results</title><p>Data were analyzed from 14 patients (8 men and 6 women; mean age, 33.8 years). The average follow-up period was 10 months. Following treatment, no patient experienced adverse events or significant narrowing of disc height. The mean pain scores before treatment (VAS, 7.5±1.3; RDQ, 12.6±4.1) were significantly decreased at one month, and this was generally sustained throughout the observation period (6 months after treatment: VAS, 3.2±2.4, RDQ; 3.6±4.5 and 12 months: VAS, 2.9±2.8; RDQ, 2.8±3.9; <italic>p</italic>&lt;0.01, respectively). The mean T2 values did not significantly change after treatment.</p></sec><sec><title>Conclusions</title><p>We demonstrated that intradiscal injection of autologous PRP releasate in patients with low back pain was safe, with no adverse events observed during follow-up. Future randomized controlled clinical studies should be performed to systematically evaluate the effects of this therapy.</p></sec>

A Double-blind, Placebo-controlled, Dose–Response Pilot Study Evaluating Intradiscal Etanercept in Patients with Chronic Discogenic Low Back Pain or Lumbosacral Radiculopathy

2007 ◽  
Vol 107 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Steven P. Cohen ◽  
Daniel Wenzell ◽  
Robert W. Hurley ◽  
Connie Kurihara ◽  
Chester C. Buckenmaier ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Double Blind ◽  
Pain Scores ◽  
Discogenic Low Back Pain ◽  
Leukocyte Counts ◽  
Factor Α ◽  
Necrosis Factor

Abstract Background: In recent years, convincing evidence has emerged implicating tumor necrosis factor α as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-α inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. Methods: A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. Results: At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. Conclusions: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.

scholarly journals Prospective Clinical Study on Natural History of Discogenic Low Back Pain at 4 Years of Follow-up

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 525-532
Author(s):  
Baogan Peng
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Study ◽  
Natural History ◽  
Prospective Clinical Study ◽  
Low Back ◽  
Discogenic Low Back Pain ◽  
History Of ◽  
Pain Symptoms

Background: To accurately assess the effect of any therapy for treating discogenic low back pain, the natural history of such pain should be known beforehand. However, until now, no pathological characteristic could be used to predict the disease course of low back pain. Objective: To better instruct the clinical treatment of discogenic low back pain, a prospective clinical study was performed to observe the natural history of the disease. Study Design: A prospective clinical study during a 4-year follow-up period. Setting: The study was performed at a spinal center in China. Methods: A total of 279 patients with chronic low back pain were included from June 2006 through October 2007. Using discography, 156 patients (56%) were diagnosed to have discogenic back pain. A 101-point numerical rating scale (NRS) was used to assess the back pain symptoms and the Oswestry Disability Index (ODI) was used to assess lumbar function. Results: Of the 156 patients, 131 (84%) completed the study at 4-year follow-up. At the end of follow-up, 17 patients (13.0%) had their low back pain symptoms alleviated and lumbar function improved; 10 patients (7.6%) were slightly improved; 16 patients (12.2%) had their symptoms aggravated; and 88 patients (67.2%) experienced the same pain and disability as before. Although the average NRS and ODI scores obtained during the 4-year follow-up study gradually decreased, statistical significances were found in such changes (P < 0.05,and P < 0.05, respectively); however, the improvement rates of both pain (7.6%) and disability (5.2%) were very low. Limitations: The shortcoming of this study is its relatively small sample size. Conclusion: The present study indicated that the natural history of discogenic low back pain was chronic but persistent, and that the pain and disability in most patients did not improve over time. Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis.

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