Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report

OBJECTIVE: Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. METHODS: The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. RESULTS: The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001). CONCLUSION: PDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to compare the early course of APLD with the long term follow-up after APLD and also the long term follow up after APLD with the short term follow-up after nucleoplasty. SUMMARY OF LITERATURE REVIEW: We evaluated the postoperative clinical course of both APLD and nucleoplasty. The evaluation of the postoperative clinical course was performed by using the Oswestry Disability Index (ODI). MATERIALS AND METHODS: We studied 59 patients who underwent APLD and nucleoplasty from 1989 to 2004. We defined the 26 cases with less than 5 years follow up as the early course follow-up after APLD, the 20 cases with over 5 years follow up as the long term after APLD, and 13 cases with less than 5 years follow up as the short term follow up after nucleoplasty. We then compared three groups. We inspected the condition of the discs on MRI and the level of the operated disc. RESULTS: The most common type of disc was a protruded disc (69.4%). Its ODI was lower than that of the extruded type. 5 cases out of the total group underwent open discectomy after APLD. In our study, the extruded type patients underwent a worse clinical course than protruded type patients. The patients who under went procedures at two affected disc levels had higher ODI scores compared to patients who underwent procedures at one level. The ODI score of the early course follow-up after APLD was 12.4%, the ODI of the long term follow up was 6.9% and that of the short term follow-up after nucleoplasty was 4.6%. CONCLUSIONS: On the long term follow-up, the patients who underwent APLD had significant improvement for any of the clinical parameters, as compared with their preoperative status. The patients who underwent nucleoplasty had a better prognosis than those patient who underwent APLD with less than 5 years follow up.

Comparative Study of Microdiscectomy and Automated Percutaneous Discectomy in Lumbar Disc Herniation

Aretrospective study on operative results was carried out in a series of 164 patients who were performed by microdiscectomy and 57 patients by automated percutaneous lumbar discectomy(APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows: 1) Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade. Among 57 APLD cases, 43 were males and 14 females, mean age 32.2 years, and the highest incidence in the 3rd decade. 2) The preoperative symptoms and signs in microdiscectomy and APLD cases were lumbago(98.2% vs 98.2%), radiating pain(96.3% vs 98.2%), positive straight leg raising test(77.4% vs 70.2%), motor weakness(27.4% vs 17.5%), claudication(13.4% vs 0%) and voiding difficulty(2.4% vs 0%). 3) Number of operated levels were 226 in microdiscectomy and 74 in APLD. The most commonly operated levels in both groups were L4-5. 4) Operative results. (1) The overall success rates by Prolo's scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively. (2) In younger age group(below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy(100%, 89.9% vs 76.7%, 62.5% respectively). (3) As to protrusion and degeneration on MRI, a clinical result, from patients with mild to moderate protrusion and degeneration of discs was significantly better in microdiscectomy group, and that of mild protrusion and degeneration of discs in APLD group was significantly better. (4) The most common cause of failure was inadequately removed disc material in microdiscectomy cases and operated for sequestered discs in APLD cases. There results indicate that there were no differance in overall success rates between microdiscectomy and APLD. But it should be emphasized that clinical results may have been influenced by age, existence of compensation, and the degree of protrusion and degeneration of discs as prognostic factors. The authors believe that if the selection of operative procedure is carefully decided with details of clinical and radiologic findings of the patients, a good outcome can be expected.

A Clinical Study and Analysis of Chemonuecleolysis Versus Automated Percutaneous Lumbar Discectomy in Herniated Nucleus Pulposus of the Lumbar Spine

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.