Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations.
OBJECTIVE
Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates.


METHODS
In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860.


RESULTS
During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups.


CONCLUSIONS
Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Departamento Ortopedia e Traumatologia, Divisão de Cirurgia de Coluna Vertebral, São Paulo/SP</state>Brazil.
Alexandre Fogaça
AF
Cristante
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Departamento Ortopedia e Traumatologia, Divisão de Cirurgia de Coluna Vertebral, São Paulo/SP</state>Brazil.
Ivan Diasda
ID
Rocha
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Departamento Ortopedia e Traumatologia, Divisão de Cirurgia de Coluna Vertebral, São Paulo/SP</state>Brazil.
Raphael
R
MartusMarcon
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Departamento Ortopedia e Traumatologia, Divisão de Cirurgia de Coluna Vertebral, São Paulo/SP</state>Brazil.
Tarcísio Eloy Pessoade Barros
TE
Filho
D000328:Adult; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D017116:Low Back Pain / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000145:classification; D017060:Patient Satisfaction; D011184:Postoperative Period; D016037:Single-Blind Method; D016896:Treatment Outcome