Abstract ID: A38
Abstract Title: Thermal Percutaneous Disc Decompression: A Novel Minimally Invasive Treatment for Contained Lumbar Disc Herniations
Authors: Cano W1, Levinstein G2
Performance Spine & Sports Physicians, P.C. Pottstown PA USA1, Performance Spine & Sports Physicians, P.C. Pottstown PA USA2
Poster Type: Poster
ABSTRACT BODY
Leg pain secondary to contained herniated disc and associated radiculitis is a primary cause of disability and health care expenditure in the USA. Traditionally, contained herniated discs have been treated through an open discectomy after conservative management has failed. Thermal Percutaneous Disc Decompression (TPDD) is a novel minimally invasive treatment for contained herniated discs. TPPD decompresses the disc herniation by applying thermal energy to the base of the disc protrusion. Although the mechanism of action is not completely understood, TPPD appears to work by modulating the annular collagen fibers, contracting the protrusion away from the irritated nerve root and destroying intradiscal pain fibers.
We performed a retrospective chart review of 25 patients with single-level contained herniated lumbar discs and ipsilateral leg pain who had undergone TPPD between July 2003 and July 2005. Other inclusion criteria included duration of pain greater than 6 months and failure of more conservative treatment. 14 cases involved the L5-S1 disc, 10 the L4-5 disc and 1 the L3-4 disc. All TPPD were performed under fluoroscopy by the same interventionally-trained physiatrist (WGC) at Pottstown Memorial Medical Center, Pottstown, PA using a Smith&Nephew 20S unit and Decompression Catheter. In all cases, a P90 protocol (90 degrees Celsius over 12 minutes) was completed. Follow-up was performed at 2 and 6 weeks post-procedure and 6 and 12 months post-procedure. Outcome measures were as follows: 1) resolution or significant (>50%) improvement of leg pain; 2) reduced medication intake; 3) improved functional status (i.e. ability to exercise); 4) need for further treatment including epidural steroid injections or eventual discectomy; and 5) whether they were satisfied with their procedural result. Of the 25 patients, 20 (80%) reported complete or significant resolution of leg pain at 2 months post-procedure. At 6-month follow-up, 17 (68%) patients continued to have complete or significant resolution of leg pain. At 12 month follow-up, outcomes were as follows: 15 patients (60%) continued to have complete or significant resolution of leg pain; there was a reduction in analgesic intake in 14 patients (56%); 13 patients (52%) had improved functional status; 4 patients (16%) went on to have further treatment including epidural steroid injections with one patient (4%) requiring a discectomy; and 22 patients (88%) reported being satisfied or very satisfied with the procedure although not all of these patients had had significant improvement of leg pain. There were no procedure-related complications.
Our results support the use of TPPD as a minimally invasive treatment for contained disc herniation and lower limb radicular pain. In the current case series, TPPD resulted in significant improvement of leg pain and functionality. Reduced medication intake and avoidance of surgery was also demonstrated. We suggest that TPPD could be offered to patients suffering from lower limb pain secondary to contained herniated lumbar disc after more conservative management has failed as a minimally invasive alternative to surgery. Prospective, multicenter studies with larger number of patients are needed to further validate this treatment option.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A38