The Successful Treatment of Herniated Lumbar Discs That are Refractory to Repeated Epidural Steroid Injection by Using a Navigable Percutaneous Disc Decompression Device: A Case Series

Abstract

Min Young Lee,1 Mathieu Boudier-Revéret,2 Hee Kyung Cho,3 Min Cheol Chang1 1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada; 3Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang Email [email protected]: In most cases, lumbosacral radicular pain caused by herniated lumbar discs (HLDs) can be controlled with epidural steroid injections (ESIs). However, when the HLDs are large, the pain may not respond to ESIs. A navigable, percutaneous, disc decompression device has recently been developed to manage radicular pain that is secondary to HLD, which allows the wand tip to approach the herniated disc by rotating a control wheel. We performed a percutaneous disc decompression using the navigable percutaneous disc decompression device in two patients with a large HLD that did not respond to repeated ESIs.Patients and Methods: Patients A and B are presented with scores of 7 and 8 on the numeric rating scale (NRS), respectively. Both had lumbosacral radicular pain due to right central HLDs at L4-5 and L5-S1, despite repeated ESIs. Percutaneous disc decompression was performed under C-arm fluoroscopy. The wand was inserted through the introducer needle. Using the control wheel, we placed the needle tip on the posterolateral portion of the herniated disc. The radiofrequency current was applied to the herniated portion of the disc. The procedural time was 20– 30 minutes.Results: Neither of the patients reported adverse post-procedural effects. At their 1-week follow-up, patient A and B’s NRS pain scores had reduced to 2 and 1, respectively. At their 2-year follow-up, patient A had mild pain (NRS 1), and patient B reported no pain.Conclusion: The navigable percutaneous disc decompression device may be effective for pain alleviation in patients with lumbosacral radicular pain that is refractory to repeated ESIs.Keywords: lumbosacral radicular pain, disc decompression, herniated lumbar disc

Keywords

• lumbosacral radicular pain
• disc decompression
• herniated lumbar disc