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Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study

  • Spinal Neuroradiology
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Abstract

Purpose

To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment.

Methods

A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure.

Results

Technical success rate was 100% with a mean intervention duration of 30 min (15–45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers.

Conclusion

APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.

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Abbreviations

APLD:

Automated percutaneous lumbar discectomy

CT:

Computed tomography

VAS:

Visual analog scale

MRI:

Magnetic resonance imaging

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Author information

Authors and Affiliations

  1. Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France

    Nicolas Amoretti, Diego Palominos, Pauline Foti, Alexandre Rudel & Giacomo Gallo

  2. Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK

    Danoob Dalili

  3. School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK

    Danoob Dalili

  4. Department of Radiology, Hôpital Tenon AP-HP, Paris, France

    Francois Cornelis

  5. Department of Radiology, Centre Hospitalier Universitaire de Lausanne, Lausanne, France

    Nicolas Theumann

  6. Department of Radiology, Micro Invasive Intervention, Valencia Hospital Universitario y Politecnico la Fe, Valencia, Spain

    Manuel Cifrian-Perez

  7. Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France

    Hauger Olivier

Authors
  1. Nicolas Amoretti
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  2. Danoob Dalili
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  3. Diego Palominos
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  4. Francois Cornelis
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  5. Nicolas Theumann
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  6. Manuel Cifrian-Perez
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  7. Pauline Foti
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  8. Alexandre Rudel
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  9. Hauger Olivier
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  10. Giacomo Gallo
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Corresponding author

Correspondence to Nicolas Amoretti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclosure paragraph

1. The scientific guarantor of this publication is Nicolas Amoretti.

2. Pauline Foti kindly provided statistical advice for this manuscript.

3. Methodology:

• Prospective

• Observational

• Multicentric

Additional information

Publisher’s note

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Key points

1. APLD can successfully and safely treat lumbar disc herniation in a reproducible way.

2. APLD can treat different types of disc herniation.

3. APLD does not preclude subsequent surgical intervention in case of partial or no improved outcomes.

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Amoretti, N., Dalili, D., Palominos, D. et al. Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study. Neuroradiology 63, 1135–1143 (2021). https://doi.org/10.1007/s00234-021-02633-x

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  • DOI: https://doi.org/10.1007/s00234-021-02633-x

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