Ann Rehabil Med.  2015 Oct;39(5):735-744. 10.5535/arm.2015.39.5.735.

The Factors Associated With the Successful Outcomes of Percutaneous Disc Decompression in Patients With Lumbar Herniated Nucleus Pulposus

• Lee SH
• Jeong YJ
• Kim NH
• Park HJ
• Yoo HJ
• Jo SY

• KMID: 2148204
• DOI: http://doi.org/10.5535/arm.2015.39.5.735

Abstract

OBJECTIVE
To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP).
METHODS
We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD.
RESULTS
The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (DeltaVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (DeltaODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012).
CONCLUSION
PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP.

Keyword

Intervertebral disc displacement; Radiculopathy; Decompression; Regression analysis; Treatment outcome

MeSH Terms

Decompression*
Follow-Up Studies
Humans
Intervertebral Disc Displacement
Leg
Logistic Models
Radiculopathy
Regression Analysis
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Percutaneous disc decompression was performed using L'DISQ catheter with fluoroscopic guidance. After the injection of contrast media, the C-arm fluoroscopic view shows the tip of wand (arrows) within a posterior lumbar intervertebral disc. (A) Lateral view, (B) anteroposteior view.

• 

  Fig. 2 A computed tomographic reconstruction image of the L'DISQ wand after percutaneous disc decompression (PDD) is shown. (A) The introducer needle (black arrows) was inserted posterior to the annulus fibrosus. (B) From the axial view of computed tomographic image, the tip of the PDD wand (white arrowheads) is seen within the intervertebral disc.

• 

  Fig. 3 Changes of the visual analogue scale (VAS) after percutaneous disc decompression at 1-, 3-, 6- and 12-month of follow-up assessment. Values are presented as mean±standard deviation. *Significant differences (p<0.01) from the baseline.

• 

  Fig. 4 Changes of the Oswestry Disability Index (ODI) after the percutaneous disc decompression at 1-, 3-, 6- and 12-month of follow-up assessment. *Significant differences (p<0.01) from the baseline.

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