Perineural Release with or Without Balloon Decompression for the Treatment of Lumbosacral Discogenic Syndromes in Professional Athletes.

Abstract

Background: Lumbosacral discogenic syndrome (LSDS) is a common cause of low back pain (LBP) and lower limb pain (LLP) in athletes, often resulting in impaired sporting performance and delayed return to sport (RTS). Evidence regarding minimally invasive interventions, such as epidural perineural release (PNR), remains limited in athletic populations. Aim: This study aimed to compare outcomes following PNR with versus without balloon decompression neuroplasty in athletes with LSDS. Methods: We conducted a retrospective review of PNR performed between 2019 and 2024 for the treatment of LSDS among professional athletes. Demographic, clinical, and outcome data were collected from medical records and follow-up assessments. Pain intensity was assessed using the Numerical Rating Scale (NRS), while patient-reported outcomes were evaluated using the EuroQoL-5D (EQ-5D). Additional outcomes included pain-free walking, standing, and sitting durations, and self-reported health scores. Results: A total of 33 patients who had one intervention were included. Significant improvements were observed in all pain, functional, and quality-of-life outcomes following treatment (all p < 0.001). Maximum, minimum, and average pain intensity decreased from 7.5 ± 1.7 to 2.8 ± 2.2, 3.8 ± 2.3 to 0.3 ± 0.7, and 5.6 ± 1.7 to 1.5 ± 1.2, respectively. All EQ-5D domains and quality of sleep also improved significantly (all p < 0.001). Pain-free walking, standing, and sitting durations increased significantly, from 24.8 ± 23.2 to 49.7 ± 26.7 min, 18.4 ± 20.0 to 44.1 ± 23.1 min, and 25.5 ± 23.7 to 44.6 ± 24.9 min, respectively (all p < 0.001). Self-reported health scores improved from 51.9 ± 22.6 to 83.0 ± 14.3 (p < 0.001). Conclusions: Epidural perineural release, with or without balloon decompression neuroplasty, was associated by significant improvements in pain, functional capacity, and quality of life among athletes with LSDS refractory to conservative management. These findings suggest that PNR may be a promising minimally invasive treatment option; however, controlled prospective studies are required to establish its effectiveness and determine the additional benefit of balloon decompression.