Value of Percutaneous Treatments of the Lumbar Spine in Back and Nerve Root Pain.
Percutaneous treatments are widely used in low back pain (LBP) and nerve root pain. The only treatment assessed in several controlled studies is chemonucleolysis. Automated percutaneous discectomy was proven non-effective in two controlled studies and manual percutaneous discectomies still require appropriate evaluation. The problem of facet joint treatments is to select patients with LBP originating from these joints. Epidural injections of steroids are the cornerstone of the medical management in sciatica, but the data from controlled studies are inconsistent. Further studies are needed to give guidelines on the best time after the onset of radicular pain, volume, number, and timing of the injections. In addition, the problem of misplacement of the needle should be considered. Foraminal injections of steroids under fluoroscopic control also need controlled studies. Endoscopic procedures in the epidural space should be studied by leading teams representing the spine specialists in the community. Finally, in addition to their technical aspect, each new percutaneous procedure should be evaluated by a stringent methodology to assess the risk-benefit.
Revel
Michel
M
Hopital Cochin, Service de reeducation et de readaptation de l'appareil locomoteur et des pathologies du rachis, Universite Rene Descartes, 27 Rue du Fbg St. Jacques, 75014 Paris, Francis.