Percutaneous Lumbar Discectomy (PLD)

Patient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study

Clinical question

What capabilities does percutaneous lumbar discectomy have in reducing pain and increasing functional capacities for patients with symptomatic lumbar disc herniation?

Take away point

87% of employed patients were able to return to work during the follow-up, with a median time of 8 days post procedure.

Reference

Ranc, P.-A., Rudel, A., Bentellis, I., Prestat, A., Elbaze, S., Sala, V., Torre, F., Pavan, L.-J., Uri, I. F., & Amoretti, N. (2024). Patient-reported outcomes and return to work after CT-guided percutaneous lumbar discectomy: A prospective study. Journal of Vascular and Interventional Radiology, 35(3), 390–397. https://doi.org/10.1016/j.jvir.2023.12.007

https://www.jvir.org/article/S1051-0443(23)00896-5/fulltext

Study design

Prospective, observational, descriptive

Funding Source

None

Setting

Academic single center, Pasteur 2 Hospital University Medical Center (Nice, France)

Figure

Evolution of the Oswestry disability index (ODI) during the first 6 months

Summary

The purpose of this study was to understand the effectiveness of percutaneous lumbar discectomy under combined CT and fluoroscopic guidance, specifically its effects on pain relief, the length of recovery through hospital stays and/or time taken to return to work. Evaluation of patient-reported outcomes based on validated functional disability indices was also performed.

This study had 87 patients, 57 of which were employed with a median age of 56. The criteria were lumbar radicular pain visualized on magnetic resonance, failure of conservative treatment, and failure or recurrence after a peri-radicular nerve block. Patients were excluded if they had lumbar stenosis, neurologic deficits, or history of previous surgical discectomy at site of pain.

An initial planning CT was obtained to determine the access and approach for the procedure. Transdural or juxtadural access were preferred for central canal zone or subarticular zone hernias, and posterolateral or lateral approaches for herniation of foraminal and extraforaminal topography. 20-gauge guide needle was introduced to the herniated disc with contrast confirmation of its position. The Herniatome decompression probe was utilized for fragmentation and aspiration. Technical success was defined by correct targeting and tactile feedback.

The data gathered included pain measurements with visual analog scale, duration of the symptoms up to 1 year before treatment, the treated lumbar level, and topography of the herniated disc. The Oswestry disability index was obtained by questionnaire to evaluate the degree of functional disability. The participants were followed-up at 1-month interval with a lumbar MRI to evaluate any complications, then at 3 and 6 months through a blinded observer call.

The median Oswestry disability index decreased from 44 to 20 in 1 month, to 12 within 3 months, and to 7 at 6 months showing a significant increase in functionality (P < .001). At the end of follow-up, for 85% of the patients a decrease in visual analog scale score of >50% was found. With regard to the length of hospital stay, 96.5% were discharged on the same day of procedure, with the remaining patients being discharged the next day. Of the 57 actively working patients, 50 (88%) returned to work after a median time of 8 days. There were no major adverse events.

These results were consistent with those of the study by Liu et al, which evaluated the evolution of Oswestry disability index as well as differences in patients treated with endoscopic discectomy vs. percutaneous discectomy. McCormick et al also showed a 30% decrease in Oswestry indices with a different decompression probe. Ultimately, this study showed a significant decrease in the Oswestry disability index and an improvement in functional capacities after CT-guided percutaneous lumbar discectomy, leading to a faster return to work time which translates to higher patient satisfaction and decreased socioeconomic burden.

Commentary

In light of the increased incidence of younger adults developing disc herniation, this study highlights the medical and economic benefits of minimally invasive techniques in patients with refractory herniated disc syndromes. The effectiveness profile of percutaneous lumbar discectomy was comparable to previously published retrospective studies. But the current prospective study enabled evaluation of the socioeconomic impact. The methods of study were adequate in providing both qualitative and quantitative analyses. Nonetheless, as the authors rightly noted, a control group to analyze the differences compared to surgical or conservative methods would provide more real-world implications. It is clear from the data though that percutaneous lumbar discectomy has clinical and economic significance as illustrated by the median visual analog score decrease of 6 and median return-to-work time of 8 days. Minimally invasive percutaneous approaches are powerful and cost-effective additions to the refractory herniated disc management toolkit.

Post Author

Christopher Loiselle, MS, OMSIV
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
@Caloiselle