Oral Posters: Thoraco-lumbar Degenerative

Presented by: H-J Cho - View Audio/Video Presentation (Members Only)

Author(s):

J.-W. Hur(1), K.-S. Ryu(1), J.-S. Kim(1), J.-H. Seong(1), H.-J. Cho(1)

(1) Seoul St. Mary's Hospital, The Catholic University of Korea, Neurosurgery, Seoul, Korea, Republic of

Abstract

Percutaneous trans-sacral approach procedures such as neuroplasty using a Racz catheter or epiduroscope are frequently performed as treatment option for lumbar disc herniation (LDH) but they are limited in that they cannot completely remove the causing pathology. Recently, with the development of laser technology, trans-sacral epiduroscopic laser decompression (SELD) has been receiving attention as an alternative tool and few reports have demonstrated its effectiveness, but there are insufficient reports of results. The purpose of this study is to report preliminary clinical and radiololgic results of SELD for the treatment of LDH in a single center experience.
21 patients (M:F = 3:4) who underwent SELD for the treatment of single-level LDH were retrospectively evaluated for minimal 12 month follow-up. Their medical records including demographic data, diagnosis, complication, epiduroscopic findings and degree of symptom relief were investigated. The mean age of patients were 53.7 years and mean BMI was 23.3. All patients received same routine protocol procedures under local anesthesia by single surgeon using Ho:Yag laser.
Clinical outcome were evaluated using visual analogue scale (VAS) scores for back and leg pain and functional status was measured with Oswestry disability index (ODI). Radiologic outcome were evaluated by comparing the changes of disc size on magnetic resonance image (MRI) scans, preoperatively, postoperatively and at final follow-up.
Fifteen patients (71.4%) showed symptom relief immediate postoperatively after the procedure and 18 patients (85.7%) showed relief at final follow-up. The average VAS scores for back pain decreased from 8.2 to 3.5 at immediate postoperative and to 1.5 at final follow-up. The average VAS scores for leg pain decreased from 6.9 to 2.75 at immediate postoperative ant to 2.35 at final follow-up, respectively. Mean ODI improved from 48 to 23 postoperatively and further decreased to 14 at final follow-up. Immediate postoperative MRI showed subtle changes in most of the patients (18/21, 85.7%), however, final follow-up images revealed significant reduction of disc pathology in 80.9% (17/21 patients).
There was no procedure related complication in all patients except mild headache after the operation in two patients. One patient received microdiscectomy under general anesthesia due to recurrence of disc herniation after 3 month.
The results of this preliminary study show significant improvements of VAS score and ODI after SELD for LDH with back and leg pain at minimal 12 months follow-up. Postoperative MRI scans revealed significant decrement of the disc size and reduction of neural compression. The SELD is suggested to be an effective therapeutic modality for patients with symptomatic LDH.