Lumbar disc herniation treatment with microdiscectomy versus intradiscal oxygen- ozone injections. Alexandre A, Alexandre AM*, Paradiso R European Neurosurgical.

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Presentation transcript:

Lumbar disc herniation treatment with microdiscectomy versus intradiscal oxygen- ozone injections. Alexandre A, Alexandre AM*, Paradiso R European Neurosurgical Institute (EU.N.I.). Treviso *Institute of Radiology - Catholic University of Sacred Heart. Rome XIX Symposium Neuroradiologicum The World Congress of Neuroradiology Bologna 2010, 4-9 October

Lumbar herniation level microdiscectomy discolysis L1-L2 1(0,33%) 3(1%) L2-L3 4(1.33%) 3(1%) L3-L4 28(9.33%) 36(12%) L4-L5 159(53%)165(55%) L5-S1 108(36%) 93(31%) EU.N.I.

microdiscectomy discolysis Contained 197 (65,6%) 200 (66.6%) extruded 93 (31%) 82 (27,3%) Migrated 10 (3,3%) 18 (6%) EU.N.I. kind of herniation

Pain Regression upon controls Controls Microdiscectomy Discolysis 4-6 months 292 / 300 (97.3%) 280 (93,3%) 1 year 275 (91,6%) 276 (92 %) 3 years 250 (83,3%) 2 (87,3%) EU.N.I. VAS Regression > 4

Pain Regression/ level, at 1 year Microdiscectomy Discolysis L1-L2 1 (100%) 3 (100%) L2-L3 3 (50%) 3 (100%) L3-L4 24 (82.1%)33 (91,6%) L4-L5 143 / 159(89.9%) 150 / 165 (90.90%) L5-S1 104 / 108 (96.2%) 88 / 93 (94.6%) VAS Regression > 4 EU.N.I.

Pain regression / kind Hernia Microdiscectomy Discolysis Contained 163/197 (82,74%) 172/200 (86%) Extruded 85 / 93 (91,39%) 76 / 82 (92.6%) Migrated 9 / 10 (90%) 15 / 18 (83.33%) Regression VAS > 4 EU.N.I.

Pain regression/Localisation Intraforaminal microdiscectomy discolysis 22 (91,6%) 22 (84,6%) Regression VAS > 4 EU.N.I.

Sensory disfunction regression at 3 years Microdiscectomy Discolysis complete 82.5 % 83.2 % Partial 12.4 % 9.4 % Insignificant 5.1% 2.4 % EU.N.I.

Motor Deficit regression at 3 years Microdiscectomy Discolysis complete 86.6% 85.7% partial 9.8 % 8.3% Insignificant 3.6% 6 % EU.N.I.

Results Complications observed in the two series of case records related to the procedure:  4 fistulas of cerebrospinal fluid and 1 bacterial discitis in Microdiscectomy  2 chemical discitis in Discolysis

Conclusion Results are overall better for percutaneous Discolysis in contained herniations, with broken annulus, under or extraligamentosus. On the other hand, results are totally better in cases of big extruded or migrated herniations, particular if pain was intolerable or there were important motor deficits.

Conclusion Microdiscectomy has a documented morbidity and mortality. A failure of Microdiscectomy is a FBSS (severe chronic postoperative pain, which is usually resistant to physiotherapy an pharmacological treatment). A Failure of Discolysis can't cause a FBSS, and rarely engenders new iatrogenic problems.

Conclusion Except than these considerations results are essentially equivalent with time considering both pain control and management of neurological deficits.