Preliminary Results of Patients Treated with Percutaneous Hydrodiscectomy
for Radiculopathy Secondary to Herniated Nucleus Pulposus
Background Data: Lumbar disc herniation is one of
the leading causes of lower back pain and sciatica. If
conservative treatments such as physical therapy and
epidural steroid injections fail, microdiscectomy is often
considered. Since microdiscectomy was fi rst described,
advancements in minimally invasive techniques, including
percutaneous mechanical lumbar discectomy, to reduce
intradiscal pressure on the nerve root have evolved.
Percutaneous hydrodiscectomy is performed using an
approach similar to standard discography to mechanically
remove disc material with a high velocity, non-thermal saline
fluid jet through a cannulated system.
Objectives: To evaluate clinical outcomes of patients treated
with percutaneous hydrodiscectomy.
Methods: Single center retrospective study on consecutive
patients that failed conservative management for
radiculopathy secondary to subligamentous lumbar
herniated nucleous pulposus treated with percutaneous
hydrodiscectomy at a single lumbar level.
Results: Fifteen patients (73% male), mean age of 48.7 years
(range 26-83) that failed conservative treatment including
transforaminal epidural steroid injections underwent
percutaneous hydrodiscectomy without complications.
Fourteen patients (93%) had improvement in back pain and
radiculopathy and met the short-term clinical success criteria
of improvement within 6 months post procedure. Mean
VAS decreased from 70.7 to 30 (p=0.0002) and mean ODI
improved from 41.1% to 22.8% (p=0.0007) at last followup.
Four patients that had successful short-term outcomes
subsequently had additional intervention; 2 spinal cord
stimulators, 1 hydrodiscectomy at a second level and index
level, and 1 artifi cial disc replacement.
Conclusions: These preliminary results demonstrate
percutaneous hydrodiscectomy is a viable non-surgical
treatment option in a select group of patients with
radiculopathy secondary to subligamentous lumbar herniated
nucleous pulposus. Larger prospective controlled studies are
needed to further refi ne patient selection and validate the
long-term benefi ts of this promising new technology.
Thomas C. Kowalkowski
Fellow of Interventional Pain Practice
Fellow of ABPM&R
Interventional Pain & Physical Medicine Clinic