CONFRONTO TRA DISCECTOMIA PERCUTANEA LOMBARE SECONDO ONIK, MICRODISCECTOMIA E TRATTAMENTO CONSERVATIVO. RISULTATI PRELIMINARI DI UNO STUDIO PROSPETTICO CONTROLLATO (PERDIRAT)

Translated title of the contribution: Comparison between percutaneous discectomy according to Onik, microdiscectomy and conservative treatment

D. Rossi, L. Munari, A. Ubbiali, D. Palumbo, M. Fornari, G. Lucarelli, G. Belloni, M. Porta

Research output: Contribution to journalArticle

Abstract

The purpose of this pilot study is to evaluate the therapeutical efficacy - and the indications in terms of protrusion and patient's clinical condition - of percutaneous diskectomy according to Onik, in patients suffering from symptomatic disk protrusion. A comparison is made with conservative and microsurgical treatments. The degree of pain remission and the patient's satisfaction with the treatment received were evaluated during the follow-up. Material and method. From October 1991 to December 1992, 40 patients were enrolled in the study and divided into two main groups: group I and group II. A comparison between the efficacy of percutaneous diskectomy and conservative treatment was made in group I. Group II patients were randomly referred for percutaneous diskectomy and microdiskectomy. Therefore, four groups were obtained: Ia (diskectomized patients), Ib (patients treated with conservative therapy), IIa (diskectomized patients), and IIb (microdiskectomized patients). The fundamental criterion for enrollment in group I was the presence of one or more median and paramedian disk protrusions. Patients with lateral or intraforaminal protrusions were ascribed to group II. The following parameters were evaluated in each group: age, sex, neurological objective condition, intensity and location of pain, duration of pain symptoms, degree of disability and CT radiological protrusion level. The patients were followed up by telephone six months after treatment using a questionnaire that allowed the evaluation of the degree of pain remission and the degree of patient's satisfaction with the treatment received. All data were processed by statistical tests. Results. Our data show that patient's report a higher therapeutical effect during the acute phase with any of the treatments. The therapeutical efficacy was higher in group Ia than in group Ib (0.056P60.02). After six months, response to treatment in groups IIa and IIb was overlapping (P60.05). The patients submitted to microdiskectomy and percutaneous diskectomy were the most satisfied with the treatment received (positive percentage of sastisfaction in the groups: Ia: 77%; Ib: 55%; IIa: 60%; IIb: 77%). Discussion. This pilot study has led to clinical therapeutical conclusions as well as observations on the personality of patients with ischialgia and backache. The degree of invasiveness of the treatment is directly proportional to the positive therapeutical response and patient's satisfaction. In groups Ia and IIa a reduction in pain was observed in 63% of cases, compared with 40% in the group that received a conservative treatment. 68% of diskectomized patients were satisfied with the cure, versus 55% of the non-diskectomized patients. Most of the patients interviewed, belonging to all groups, claimed that the therapeutical results obtained did not meet their expectations. Finally, a prompt treatment is accompanied by a better therapeutical response. Conclusions. The following conclusions can be drawn. a) Percutaneous diskectomy according to Onik is indicated for the treatment of median and lateral protrusions in patient's suffering form backache and/or ischialgia. 2) Microdiskectomy obtained the best therapeutical response, while the conservative treatment proved to be the least effective. 3) The tendency of pain symptoms to become chronic requires early treatment. 4) Patients consider the invasive approach more beneficial than medical treatment alone, hence the need to follow a conservative protocol, envisaging physiotherapy together with the pharmachological therapy. 5) The overlapping therapeutical response to percutaneous diskectomy of lateral and median hernias suggests the need to confine the definitive study to only two arms involving medical therapy, supported by physiotherapy, and percutaneous diskectomy.

Translated title of the contributionComparison between percutaneous discectomy according to Onik, microdiscectomy and conservative treatment
Original languageItalian
Pages (from-to)445-452
Number of pages8
JournalRivista di Neuroradiologia
Volume6
Issue number4
Publication statusPublished - 1993

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Radiological and Ultrasound Technology

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