Akifumi Kanai1. 1. Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan. kanaiakifumi@aol.com
Abstract
OBJECTIVE: Available percutaneous procedures for lumbar disk herniation are not sufficiently effective for large herniations. Percutaneous intradiscal high-pressure injection of saline (IDHP) is designed to tear the thinned posterior longitudinal ligament (PLL), leading to significant reduction in mechanical compression of nerves by the herniation. We evaluated the effectiveness of this new therapy for patients with refractory lumbar herniation. DESIGN: We studied 25 patients with lumbar disk herniation-associated radiculopathy refractory to nonsurgical treatments. Under fluoroscopy in the lateral position, a Tuohy needle was advanced into the herniated disk. Following intradiscal anesthesia, a control glass syringe with Luer lock was attached to the needle for high-pressure intradiscal injection of saline. Pain was scored with a visual analog scale (VAS), and physical activity was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: Tearing of the PLL was confirmed by a sudden loss of resistance to injection and leakage of contrast medium out of the disk into the epidural space. No adverse events were noted during and after IDHP apart from mild lumbago that disappeared within a week. IDHP resulted in tearing of extruded and sequestered herniated disks and PLL in 20 (80%) patients, and significant improvement of VAS and JOA scores throughout the 6-month observation period. The mean procedural time was 18 min. MRI confirmed the disappearance of herniated material after tearing. IDHP was unsuccessful in five patients. CONCLUSIONS: IDHP leads to prompt relief of pain, with good outcome in patients with lumbar disk large herniation resistant to medical treatment.
OBJECTIVE: Available percutaneous procedures for lumbar disk herniation are not sufficiently effective for large herniations. Percutaneous intradiscal high-pressure injection of saline (IDHP) is designed to tear the thinned posterior longitudinal ligament (PLL), leading to significant reduction in mechanical compression of nerves by the herniation. We evaluated the effectiveness of this new therapy for patients with refractory lumbar herniation. DESIGN: We studied 25 patients with lumbar disk herniation-associated radiculopathy refractory to nonsurgical treatments. Under fluoroscopy in the lateral position, a Tuohy needle was advanced into the herniated disk. Following intradiscal anesthesia, a control glass syringe with Luer lock was attached to the needle for high-pressure intradiscal injection of saline. Pain was scored with a visual analog scale (VAS), and physical activity was assessed using the Japanese Orthopaedic Association (JOA) score. RESULTS: Tearing of the PLL was confirmed by a sudden loss of resistance to injection and leakage of contrast medium out of the disk into the epidural space. No adverse events were noted during and after IDHP apart from mild lumbago that disappeared within a week. IDHP resulted in tearing of extruded and sequestered herniated disks and PLL in 20 (80%) patients, and significant improvement of VAS and JOA scores throughout the 6-month observation period. The mean procedural time was 18 min. MRI confirmed the disappearance of herniated material after tearing. IDHP was unsuccessful in five patients. CONCLUSIONS: IDHP leads to prompt relief of pain, with good outcome in patients with lumbar disk large herniation resistant to medical treatment.