Percutaneous microdiscectomy versus epidural injection for management of chronic spinal pain.

Abstract

In this study we present the efficacy of aspiration of disc material employing the Stryker Disc Dekompressor during percutaneous microdiscectomy for the treatment of chronic spinal and radicular pain due to contained lumber disc herniation and compare the short-term outcome in such patients with those who received lumber epidural injection. A total of 50 patients with chronic lumber discogenic pain and radiculopathy were enrolled in this study and were randomized into two groups. Group 1 (n=26) underwent first time, single-level lumber discectomy at either L3-4, L4-5, or L5-S1 using the Stryker Disc Dekompressor for aspiration of disc material and Group 2 (n=24) received epidural steroid/local anesthetic injection. Data on patient demographics, operative time, length of hospitalization, incidence of postoperative complications, analgesic usage and postoperative complications were obtained. For short-term evaluation of the outcome in the two patient groups, the Visual Analogue Scale (VAS) from 0-10 for back pain and radicular pain were obtained preoperatively, 24 hr and 1-6 wk postoperatively. Also, the straight leg raising test (SLRT) was performed and recorded. A significant decrease in the radicular pain scores and an increase in SLRT degrees with a decrease in the back pain scores was seen in the disc Dekompressor group with minimal incidence of postoperative complications. In the epidural injection group, the back pain scores were significantly decreased postoperatively while the radicular pain and the SLRT degrees were insignificantly changed 24 hr postoperatively and at wk 6. We conclud that when standardized patient selection criteria are used, the disc DeKompressor is a safe and more effective treatment for radicular pain of discogenic origin than epidural injection with steroid/local anesthetic. Back pain of discogenic origin was more effectively treated with the epidural steroid/local anesthetic injection. Treatment of patients with radicular pain associated with contained disc herniation using the Dekompressor can be a safe and more effective procedure.