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Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: early results.

Kumar N, Kumar A, Siddharth M S, Sambhav P S, Tan J - Int J Spine Surg (2014)

Bottom Line: Significant improvement was seen in all outcome measures.We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD.However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

View Article: PubMed Central - PubMed

Affiliation: University Spine Centre, National University Hospital, Singapore.

ABSTRACT

Background: Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce.

Methods: We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups - those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively.

Results: The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11).

Conclusions and level of evidence: Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence.

Clinical relevance: We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

No MeSH data available.


Related in: MedlinePlus

1A shows the position of the Disc-FX cannula relative to the focal disc relapse. 1B shows the possibility of a recurrent disc prolapse through the annulotomy rent.
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Figure 0001: 1A shows the position of the Disc-FX cannula relative to the focal disc relapse. 1B shows the possibility of a recurrent disc prolapse through the annulotomy rent.

Mentions: Six out of the twelve patients in the CLDH group had a re-intervention within one year of the primary procedure. On analysing the preoperative MRI scans of these patients, the morphology of the disc prolapse could be categorised into either a focal disc prolapse with thinning of the annulus fibrosus or a generalised disc bulge with no annular thinning. We noted that all four patients who did poorly after their Disc-FX procedure and required a formal micro-discectomy had a focal disc prolapse on their preoperative MRI scans. The one patient who responded to a lysis block after inadequate relief from the Disc-FX had a generalised disc bulge. There appears to be a trend suggesting that this procedure may be less effective in patients with a focal disc prolapse than in those with a generalised disc bulge. It is possible that these patients already have thinning of their annulus fibrosus and creation of a further 2.7mm annulotomy close to this site of weakness predisposes them to a recurrent prolapse(Figure 1).


Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: early results.

Kumar N, Kumar A, Siddharth M S, Sambhav P S, Tan J - Int J Spine Surg (2014)

1A shows the position of the Disc-FX cannula relative to the focal disc relapse. 1B shows the possibility of a recurrent disc prolapse through the annulotomy rent.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325482&req=5

Figure 0001: 1A shows the position of the Disc-FX cannula relative to the focal disc relapse. 1B shows the possibility of a recurrent disc prolapse through the annulotomy rent.
Mentions: Six out of the twelve patients in the CLDH group had a re-intervention within one year of the primary procedure. On analysing the preoperative MRI scans of these patients, the morphology of the disc prolapse could be categorised into either a focal disc prolapse with thinning of the annulus fibrosus or a generalised disc bulge with no annular thinning. We noted that all four patients who did poorly after their Disc-FX procedure and required a formal micro-discectomy had a focal disc prolapse on their preoperative MRI scans. The one patient who responded to a lysis block after inadequate relief from the Disc-FX had a generalised disc bulge. There appears to be a trend suggesting that this procedure may be less effective in patients with a focal disc prolapse than in those with a generalised disc bulge. It is possible that these patients already have thinning of their annulus fibrosus and creation of a further 2.7mm annulotomy close to this site of weakness predisposes them to a recurrent prolapse(Figure 1).

Bottom Line: Significant improvement was seen in all outcome measures.We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD.However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

View Article: PubMed Central - PubMed

Affiliation: University Spine Centre, National University Hospital, Singapore.

ABSTRACT

Background: Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is scarce.

Methods: We included 24 consecutive patients who underwent the Disc-FX for back pain due to lumbar disc pathology non-responsive to non-operative treatment for a period of at least 6 months. Based on Magnetic Resonance Imaging (MRI) these patients fell into 2 groups - those with degenerative disc disease (DDD) (n = 12) and those with a contained lumbar disc herniation (CLDH)(n = 12). They were evaluated using the Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preoperatively and postoperatively.

Results: The mean age was 37.9 years (21-53 years). There were 17 males and 7 females. One patient in each subgroup was excluded from the final evaluation. Significant improvement was seen in all outcome measures. The overall rate of reintervention for persistent symptoms was 18.18% (4/22); in the CLDH subgroup, it was 36.36% (4/11).

Conclusions and level of evidence: Early results after the Disc-FX procedure suggest that it s a reasonable treatment option for patients with back pain due to lumbar disc disease, especially for those with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. This study presents Level IV evidence.

Clinical relevance: We feel that our study establishes Disc-FX as a modality of treating symptomatic lumbar disc disease due to DDD. However, longer term prospective studies are needed to prove this and to evaluate its role in the treatment of patients with CLDH.

No MeSH data available.


Related in: MedlinePlus