Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel®) versus percutaneous laser disc decompression in patients with chronic radicular low back pain
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel®). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. Methods: Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel®, which had been performed in our center during 2016- 2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results: The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions: Both techniques were equivalent in pain reduction but DiscoGel® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.
Abstract
Background: Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel®). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. Methods: Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel®, which had been performed in our center during 2016- 2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results: The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions: Both techniques were equivalent in pain reduction but DiscoGel® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.
참고문헌 (32)
- Govind J, "Lumbar radicular pain", Aust Fam Physician, 33, pp.409~412 (2004)
- Rhee JM, "Radiculopathy and the herniated lumbar disc. Controversies regarding pathophysiology and management", J Bone Joint Surg Am, 88, pp.2070~2080 (2006)
- Wheeler AH, "Chronic lumbar spine and radicular pain : pathophysiology and treatment", Curr Pain Headache Rep, 6, pp.97~105 (2002)
- Buenaventura RM, "Systematic review of therapeutic lumbar transforaminal epidural steroid injections", Pain Physician, 12, pp.233~251 (2009)
- Hahne AJ, "Conservative management of lumbar disc herniation with associated radiculopathy : a systematic review", Spine (Phila Pa 1976), 35, pp.E488~504 (2010)
- Menchetti PPM, "Minimally invasive surgery of the lumbar spine", pp.83~105 (2014), Springer
- Skovrlj B, "Minimally invasive procedures on the lumbar spine", World J Clin Cases, 3, pp.1~9 (2015)
- Ren L, "Efficacy evaluation of percutaneous laser disc decompression in the treatment of lumbar disc herniation", Photomed Laser Surg, 31, pp.174~178 (2013)
- Singh V, "Percutaneous lumbar laser disc decompression : an update of current evidence", Pain Physician, 16(2 Suppl), pp.SE229~260 (2013)
- Sobieraj A, "Early results of percutaneous laser disc decompression(PLDD)as a treatment of discopathic lumbar pain", Ortop Traumatol Rehabil, 6, pp.264~269 (2004)
- Guarnieri G, "Intradiscal and intramuscular injection of Discogel®—radiopaque gelified ethanol : pathological evaluation", Neuroradiol J, 23, pp.249~252 (2010)
- Léglise A, "DiscoGel® in patients with discal lumbosciatica. Retrospective results in 25 consecutive patients", Orthop Traumatol Surg Res, 101, pp.623~626 (2015)
- Volpentesta G, "Lumbar percutaneous intradiscal injection of radiopaque gelified ethanol("Discogel")in patients with low back and radicular pain", J Pain Relief, 3, pp.145~ (2014)
- Haefeli M, "Pain assessment", Eur Spine J, 15(Suppl 1), pp.S17~24 (2006)
- Fairbank JC, "The Oswestry disability index", Spine (Phila Pa 1976), 25, pp.2940~2952 (2000)
- Zhao XL, "Treatment of lumbar intervertebral disc herniation using C-arm fluoroscopy guided target percutaneous laser disc decompression", Photomed Laser Surg, 30, pp.92~95 (2012)
- Knezevic NN, "Treatment of chronic low back pain-new approaches on the horizon", J Pain Res, 10, pp.1111~1123 (2017)
- Epstein NE, "Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?", Neurol Int, 7(Suppl 42), pp.S1080~1084 (2016)
- Ishiwata Y, "Magnetic resonance-guided percutaneous laser disk decompression for lumbar disk herniation--relationship between clinical results and location of needle tip", Surg Neurol, 68, pp.159~163 (2007)
- Haufe SM, "Percutaneous laser disc decompression for thoracic disc disease : report of 10cases", Int J Med Sci, 7, pp.155~159 (2010)
- Lee DY, "Carbon dioxide(CO2)laser-assisted microdiscectomy for extraforaminal lumbar disc herniation at the L5-S1 level", Photomed Laser Surg, 29, pp.531~535 (2011)
- Ren L, "Medium-term follow-up findings in imaging manifestation after percutaneous laser disc decompression", Photomed Laser Surg, 31, pp.247~251 (2013)
- Hashemi SM, "Effects of percutaneous laser disc decompression (PLDD) on clinical outcome of teared vs intact protruded intervertebral discs: a prospective cohort study", 2, pp.279~285 (2018)
- Brouwer PA, "Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica : a randomized controlled trial", Spine J, 15, pp.857~865 (2015)
- Asgharzadeh A, "Evaluating the safety and efficacy of discogel in the treatment of herniated lumbar disc : a systematic review", Health Tech Asmnt Act, 1, pp.e62329~ (2017)
- Theron J, "Percutaneous treatment of cervical disk hernias using gelified ethanol", AJNR Am J Neuroradiol, 31, pp.1454~1456 (2010)
- Theron J, "Percutaneous treatment of lumbar intervertebral disk hernias with radiopaque gelified ethanol : a preliminary study", J Spinal Disord Tech, 20, pp.526~532 (2007)
- Bellini M, "Percutaneous injection of radiopaque gelified ethanol for the treatment of lumbar and cervical intervertebral disk herniations : experience and clinical outcome in 80patients", AJNR Am J Neuroradiol, 36, pp.600~605 (2015)
- Klessinger S, "The frequency of resurgery after percutaneous lumbar surgery using dekompressor in a ten-year period", Minim Invasive Surg, 2018, pp.5286760~ (2018)
- Zamora T, "Effect of propionibacterium acnes (PA) injection on intervertebral disc degeneration in a rat model: does it mimic modic changes?", Orthop Traumatol Surg Res, 103, pp.795~799 (2017)
- Rao PJ, "DISC(degenerate-disc infection study with contaminant control) : pilot study of Australian cohort of patients without the contaminant control", Spine (Phila Pa 1976), 41, pp.935~939 (2016)
- Chen Z, "Modic changes and disc degeneration caused by inoculation of propionibacterium acnes inside intervertebral discs of rabbits : a pilot study", Biomed Res Int, 2016, pp.9612437~ (2016)