209 - Endoscopic Transforaminal Discoplasty in Disc Degeneration and Low Bac...

#209 Endoscopic Transforaminal Discoplasty in Disc Degeneration and Low Back Pain

Lumbar Therapies and Outcomes

Poster Presented by: M. Schubert

Author(s):

M. Schubert (1)
A. Helmbrecht (1)
C. Schultz (1)
C. Wagner (1)

(1) APEX SPINE Center, Spine, Munchen, Germany

Abstract

Background: Chronic mechanical back pain is believed to originate in the posterior segment of the lower lumbar discs. Annular ruptures may cause back pain when nuclear material is entrapped in the fishers. Vulnerability of the posterior annulus is believed to occur from insufficient blood supply from the endplates because of calcifications of the nutritional filter.

Purpose: To evaluate the clinical and MRI improvements of the disc degenerations after an endoscopical transforaminal decompression with endplate abrasion (discoplasty).

Study Design: A Prospective clinical study.

Patient Sample: 183 patients with discography proven disc degeneration (less than 50% disc narrowing) of one level and with primarily chronic low back pain. No younger than 18 and not older than 65 years. No previous back surgery.

Outcome Measures: The patients had a clinical evaluation 3 months after surgery and returned at two years an extensive questionnaire including VAS Scores, MacNab Score as well as a extensive satisfaction rating.

Method: Preoperative discography of at least two levels was performed to confirm one level symptoms. The procedure was performed under local and intraveneous anaesthesia. A percutaneous transforaminal approach to the posterior segment of the involved disc was performed using special reamers up to 7,5 millimetre. The disc was opened with a curette and cleaned with special forceps's. Than with a special reamer and an awl the lower endplate was perforated into the subchondral bone until abundant bleeding was visualised.

Results: On the first postoperative day there was usually a significant pain relief. At the three month follow up the MRI showed a flattening of the posterior annulus and increases water content of the treated disc. There was one postoperative discitis that healed with microsurgery. In 4 cases a reprolaps occurred. At the two year follow up 76% of the patients reported an excellent or good result, 15% a fair and 19% a unsatisfactory result. The VAS pain score improved from Average 8,8 to 2,9 points. Only two patients reported some increase of back pain. 13 patients needed reoperations mostly endoscopic redecompressions, 2 patients ended up with a fusion.

Conclusion: With a 76% success rate the endoscopic discoplasty appears a reasonable treatment for chronic low back pain with less than 50% disc narrowing.