Percutaneous Disc Decompression Provides Relief of Sciatica Pain

A new study claims that minimally invasive percutaneous disc decompression is superior to traditional conservative treatment for painful herniated discs.

Researchers at the University of Athens (Greece) conducted a prospective study that randomized 31 patients to traditional management--six weeks of treatment with analgesics, anti-inflammatory drugs, muscle relaxants, and physiotherapy--and 31 patients to percutaneous disc decompression. All patients had intervertebral disc herniation confirmed on magnetic resonance imaging (MRI), and had undergone one or more unsuccessful trials of medical treatment. The patients rated their pain severity before and after treatment on a numeric visual scale, with 1 being the least and 10 being the most severe pain.

The results showed that the patients who were managed traditionally improved more quickly; the mean pain score was 6.8 before the start of conservative management. One month later, it had dropped to 0.9; by month 12, it had risen to 3.9, and stood at 4.09 at 24 months. In the patients who underwent disc decompression, on the other hand, the mean pain score was 7.4 before treatment; at one month, it was 2.96; at 12 months, it was 1.67; and at 24 months, it was 1.61. The results of the study were presented at the Radiological Society of North America (RSNA) 95th scientific assembly and annual meeting, held during November-December 2009 in Chicago (IL, USA).

"Sciatica and back pain due to small herniation do not seem to have the tendency to disappear by themselves after 2 years,” said lead author interventional radiologist Alexios Kelekis, M.D, Ph.D. "All conservative-care patients relapsed to their previous status; the patients treated with the percutaneous approach, however, did not relapse. The clinical significance is that patients should not wait as long to have a percutaneous treatment if one sees relapses of back and leg pain that correlates with a small herniated disc on MRI.”

Percutaneous disc decompression is performed on an outpatient basis under local anesthetic. With fluoroscopic guidance, a needle is inserted within the intervertebral disc and material is removed, diminishing the pressure from the hernia to produce pain relief. Potential risks include discitis or infection of the disc, epidural abscess, reflex sympathetic dystrophy, nerve root injury, and injury to retroperitoneal structures.

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