Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain.

Abstract

Endoscopic discectomy with annuloplasty is considered as a novel minimally invasive technique for treating chronic discogenic low back pain (DLBP). The purpose of this study was to evaluate the outcome predictors and to describe technical aspects for endoscopic solutions against DLBP. We performed a prospective study of 87 patients who underwent percutaneous endoscopic lumbar discectomy and thermal annuloplasty (PELDTA) for DLBP. The inclusion criteria were disc degenerations with annular tear confirmed by imaging studies and discography. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. The univariate and multivariate analyses were performed to evaluate the outcome predictors. The 2-year follow-up rate was 90.8% (79 of 87 patients). The VAS and ODI scores at postoperative 6 months and 2 years were significantly improved (p < 0.001). Based on the modified MacNab criteria, the global outcomes were excellent in 39 out of 79 patients (49.4%), good in 17 patients (21.5%), fair in 10 patients (12.7%), and poor in 13 patients (16.5%). Therefore, the percentage of symptomatic improvement was 83.5% and the success rate (excellent or good) was 70.9%. In the univariate and multivariate analyses, the presence of concurrent disc herniation with DLBP was the most significant predictor (OR = 3.207, 95% CI 1.02-10.06, p = 0.046). PELDTA may be effective for patients with chronic DLBP in selected cases. Central disc herniation causing DLBP was the most important predictor for clinical success.