title: The results of percutaneous intradiscal high-pressure injection of saline in patients with extruded lumbar herniated disc: comparison with microendoscopic discectomy.
abstract: OBJECTIVE
  Intradiscal high-pressure injection of saline (IDHP) is a noninvasive procedure for a lumbar intervertebral disc extrusion and an alternative treatment to surgery, such as microendoscopic discectomy (MED). The purpose of this study was to compare the representative outcomes of IDHP with MED in terms of pain relief, reduction of disability, and risk of complications.
  
  
  METHODS
  Forty-five patients with primarily radicular pain due to an extrusion type disc herniation who underwent either IDHP (N = 24) or MED (N = 21) were enrolled in the study. The visual analog pain scale (VAS) and the Japanese Orthopedic Association (JOA) scoring system for the treatment of low-back disorders were assessed at pretreatment, 2 weeks posttreatment, and JOA was again taken 3 months posttreatment. Patients were asked to choose their satisfaction from four alternatives, "excellent,""good,""fair," and "poor," 3 months after treatment.
  
  
  RESULTS
  Mean VAS decreased from 65.1 to 18.8 mm in the IDHP group, and from 80.6 to 16.5 in the MED group. Mean JOA recovery rates at 3 months posttreatment were 67.2 and 75.2, and patients with "excellent" or "good" results were 73.7% and 78.6% in the IDHP and in MED, respectively.
  
  
  CONCLUSIONS
  IDHP produced significant effects on patients with radicular pain, leading to the improvement of VAS and JOA. Although IDHP displayed slightly less efficacy than MED, IDHP appears to be an alternative as a nonoperative treatment for a lumbar intervertebral disc extrusion.
authors.affiliation: Pain Management Clinic, Department of Anesthesiology, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. sei@belle.shiga-med.ac.jp
authors.forename: Sei
authors.initials: S
authors.lastname: Fukui
authors.forename: Narihito
authors.initials: N
authors.lastname: Iwashita
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Nitta
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tomie
authors.forename: Shuichi
authors.initials: S
authors.lastname: Nosaka
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D017586:Diskectomy / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008012:Lidocaine / Q000008:administration & dosage; D008159:Lumbar Vertebrae; D008297:Male; D010147:Pain Measurement; D011312:Pressure; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D012965:Sodium Chloride; D008012:Lidocaine