Sacral Epidural Laser Discectomy Efficacy in Non-Operated Lumbar Disc Herniation-A Single Center Experience

Öz

Sacral Epidural Laser Discectomy (SELD) which is an effective and minimally invasive procedure for the direct visualization and therapeutic treatment of pain due to spinal disorders. The aim of this study is to share the effect of SELD on clinical findings and pain. 43 patients who had not undergone back surgery and were found to have lumbar intervertebral disc herniation at L4-5 or L5-S1 level without any indication for back surgery, and who underwent SELD for the treatment patients with low back and/or radicular pain were evaluated. Physical examination findings (the straight leg raising test (SLR) <45 degrees positive(+), SLR >45 degrees negative(-) test were accepted) and visual pain scale (VAS) values were evaluated at admission, on the same day of post-op, 1st and 6th months. Disc herniation was observed at L4-5 level in 27 patients (62.79%) and at L5-S1 level in 16 patients (37.21%). 31 patients (72.09%) benefited from SELD treatment, while surgery was recommended for 10 patients (23.26%). With SELD procedure no permanent complication was observed. The clinical response of SELD according to the lumbar disc level, a more significant improvement was found in both physical examination and VAS scores in patients with disc herniation at the L5-S1 level (p<0.001). There was no statistically significant relationship between the SLR (+) side and the outcome. SELD is a more effective option, especially in patients with good physical examination findings at admission and mild-to-moderate soft disc herniation at the L5-S1 level.

Anahtar Kelimeler

• sacral epidural laser discectomy
• back pain
• radicular pain
• lumbar disc herniation

Non-Opere Lomber Disk Herniasyonlu Hastalarda Sakral Epidural Lazer Diskektomi Etkinliği- Tek Merkez Deneyimi

Öz

Sakral Epidural Lazer Diskektomi (SELD) omurga hastalıklarına bağlı ağrıda doğrudan görüntüleme ve tedavi olanağı sağlayan minimal invaziv bir yöntemdir. Bu çalışmanın amacı SELD tedavisinin klinik bulgular ve ağrı üzerine etkinliğini değerlendirmektir. Omurga cerrahisi geçirmemiş ve cerrahi endikasyonu olmayan L4-5 veya L5-S1 düzeyinde lomber intervertebral disk herniasyonu nedeniyle SELD uygulanmış 43 hasta çalışmaya dahil edildi. Tüm hastalarda başvuru şikayeti olarak bel ve/veya radiküler ağrı mevcuttu. Hastaların başvuru, post-op aynı gün, 1. ve 6.ay kontrollerinde fizik muayene bulguları (düz bacak kaldırma testi (SLR) <45 derece pozitif(+), SLR>45 derece negatif(-) test kabul edildi) ve görsel ağrı skalası (VAS) skorları değerlendirildi. 27 hastada (%62.79) L4-5 düzeyinde, 16 hastada (%37.21) L5-S1 düzeyinde lomber disk hernisi gözlendi. SELD tedavisinden 31 hasta (%72.09) klinik olarak fayda görürken, 10 hastaya (%23.26) omurga cerrahisi önerildi. SELD prosedürü ile hiçbir hastada kalıcı bir komplikasyon gözlenmedi. L5-S1 düzeyinde disk hernisi olan hastalarda SELD hem fizik muayene hem de VAS skorlarında daha anlamlı düzelme sağladı(p<0.001). SLR (+) tarafı ile klinik yanıt arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. SELD, özellikle başvuru sırasında fizik muayene bulguları iyi olan ve L5-S1 düzeyinde hafif-orta derecede yumuşak disk hernisi olan hastalarda daha etkili bir tedavi seçeneğidir.

Anahtar Kelimeler

• sakral epidural lazer diskektomi
• bel ağrısı
• radiküler ağrı
• lomber disk hernisi
• ağrı tedavisi

Kaynakça

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