Puncture Lumbar Hydrodiscectomy and Pilot Experience of Its Application

I.A. Borshenko, S.L. Migachev, A.V. Baskov, A.I. Drakin, V.A. Baskov, O.N. Uchurov

”Orthospine” Clinic, Russian Medical Academy of Postgraduate Education, Moscow, Russia
Central Clinical Hospital N1 of the Russian Railways Open Joint-Stock Company, Moscow, Russia

 

The study goal has been carrying out primary analysis of puncture lumbar hydrodiscectomy, used for treatment of a disc-radicle conflict, and determining indications, contraindications and ways of further use of this method.

Material and Methods. Results of puncture lumbar hydrodiscectomy, performed in 16 cases with signs of a persistent disc-radicle conflict, were analyzed. The Hydrocision (Billerica, MA, USA) and SpineJet-TM Micro apparatus were used. The main indications for a procedure were as follows: presence of chronic radicular pain, resistant to conservative therapy of 4-6 weeks and conditioned by verified disc protrusion or its small extrusion, which caused compression of a root or its dislocation (1) and/or chronic discogenic pain, resistant to conventional conservative therapy of 4-6 weeks and being the result of degenerative lesion of an intervertebral disc and its protrusion formation (2). The procedure was performed under local anesthesia and ataralgesia. A mean follow-up period was 5 months. Life quality was estimated with the help of SF36 and Macnab Questionnaires and the Visual-Analog Scale (VAS).

Results. According to the Macnab Scale positive results (good and excellent) were watched in 88% of cases. The analysis on the basis of the SF36 Questionnaire and Visual-Analog Scale was indicative of statistically significant improvement of such indices as a total score of life quality (Z, p<0.05, p=0.011719), reduced intensity of radicular pain (VAS, pain in a leg) (Z, p<0.05, p=0.017961), reduced intensity of discogenic pain (VAS, pain in a back) (Z, p<0.05, p=0.011719). Improvement of indices took place within the first postoperative hours and progressed during the nearest month.

Conclusion. Puncture hydrodiscectomy is a new minimum-invasive method. The difference between this method and existing puncture interventions lies in removal of hernial protrusion, which is atraumatic for both tissue of an intervertebral disc and neural structures. Puncture hydrodiscectomy is an effective means of arresting discogenic and radicular pain, caused by disc prolapse. Possibility of outpatient treatment of discogenic and radicular pain makes puncture hydrodiscectomy an important modality.