Describe the functional outcomes of patients with contained lumbar disc herniation L4-L5, L5-S1 treated with manual percutaneous nucleotomy MPN and demonstrate that it remains a technique with good results. The evaluation was pre-surgical and 4, 30, and days after the surgery. Descriptive and inferential statistics for differences. NPS preoperative average: 7. The prognosis ODI was good to 79
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Describe the functional outcomes of patients with contained lumbar disc herniation L4-L5, L5-S1 treated with manual percutaneous nucleotomy MPN and demonstrate that it remains a technique with good results. The evaluation was pre-surgical and 4, 30, and days after the surgery.
Descriptive and inferential statistics for differences. NPS preoperative average: 7. The prognosis ODI was good to 79 Low back pain has been identified as the main cause of disability in patients younger than 45 years of age and as the second greatest cause of lost days of work in the United States, 1 , 2 affecting almost 10 million people at an estimated cost of more than 20 billion dollars.
Treatment of this disease can be conservative changes to daily activities, exercise, analgesics, physiatry, and rehabilitation or surgical. Percutaneous nucleotomy is a minimally invasive disc decompression technique approved by the Food and Drug Administration FDA in the year , 12 defining it as any discectomy procedure not requiring open dissection of the thoracolumbar fascia.
Figures 1 and 2 The percutaneous nucleotomy, as a minimally invasive decompression technique, enables a reduction of pain and of the complications associated with open intervention standard discectomy and an earlier return to daily activities, in addition to reducing the total cost of medical treatment.
However, today it is not widely practiced and whether or not there is clear evidence presented about the superiority of this minimally invasive technique as compared to others is still being debated. There is a lack of high-quality studies to support it or the new techniques being devveloped.
The objective of our study is to describe the functional outcomes of patients with contained lumbar disc hernia L4-L5, L5-S1 treated with percutaneous manual nucleotomy PMN after one year of evolution and to demonstrate that it continues to be a viable technique with good results. Descriptive, longitudinal, prospective, cohort study including patients selected from the outpatient service with low back pain secondary to lumbar disc hernia of L4-L5 and L5-S1.
We included those with only one level affected, with chronic lumbosciatic pain previously treated with medications and rehabilitation for more than six months without good response, and who underwent percutaneous manual nucleotomy under fluoroscopy. We excluded those patients with changes in behavior, calcified or non-contained hernias, narrow lumbar canal, spondylolisthesis, congenital deformities, and instability. Patients who wished to leave the study, who did not attend follow-up, or who underwent surgical reintervention were eliminated.
All the patients were diagnosed clinically and corroborated by plain radiographs and lumbar magnetic resonance without contrast. In the numeric pain scale we considered zero to be without pain, 1 to 4 points as mild pain, 5 and 6 points as moderate pain, and 7 to 10 points as severe pain. For the Oswestry Disability Index, the percentage of disability was considered to be minimal from 0 to 20 points, moderate from 21 to 40 points, severe from 41 to 60 points, disability from 61 to 80 points, and exaggerated for 81 points and above.
For the Macnab Criteria, results were considered to be excellent when the patient presented no pain or restriction of activity, good when there was occasional pain in the lower back or legs sufficient enough to interfere with the patient's daily life activities or their ability to enjoy leisure time, normal with improved functional capacity but with intermittent pain severe enough to limit or modify work or leisure activities, and poor when there was no improvement or the improvement was not enough to permit increased activity and a new surgical intervention may be necessary.
The NPS and Oswestry scales were applied preoperatively to the patients who met the inclusion criteria, and then at 4, 30, , and days following surgery and the results were noted on a data collection sheet. For the purpose of this study, we considered the results to be good when there was a reduction of 4 points compared to the initial score, when a return to normal activities was possible, and when there were no signs of radicular compression or functional limitation NPS of 0 to 4 and Oswestry of 0 to Regulations of the General Health Law.
According to the regulations of the General Health Law for Research Material, for health, Titles from the first to the sixth and ninth Technical Norm no.
Federal regulation: title 45, section 46 and what is consistent with good clinical practices. Declaration of Helsinki: ethical principles in medical research on human beings, with the latest revision in Scotland, October Ethical principles originating in the World Medical Association's Declaration of Helsinki, titled, "All the subjects being studied will sign the informed consent regarding the scope of the study and the authorization for use of the data obtained in scientific presentations and publications, maintaining the anonymity of the participants".
The letter of informed consent was accepted. There were a total of patients, 58 of whom The average results of the NPS were 7. The differences between the NPS values measured prior to surgery and at days are shown in Table 1. The differences between the ODI measured prior to surgery and at days are shown in Table 2. Therapeutic effectiveness was established in our series according to the prognosis based on the ODI, which was good in 79 According to the Macnab criteria, 16 78 In Mexico, intervertebral disc disease is a highly prevalent socio-economic problem.
In our study, the average age of the patients was Another Mexican series 3 reported an average age of This difference is most likely because in our environment the population begins to work at an early age, making our average age lower 14 years. In terms of the sex of the patients who underwent intervention, On the contrary, Hijikata 14 , 15 reports a predominance of males of Given that the studies were conducted in different countries, we could say that in the case of Mexico most women of working age perform not only the physical activities related to their trade or profession, but they also take on other activities such as housework.
However, no correlation with sex has been established. In terms of the level operated, In terms of the results of the NPS, an average reduction of 5. Because this increase was very small, it had no repercussions and no clinical outcome in the pain of the patients. However, Amoretti et al. In our review of the literature, we found no studies that evaluated the Oswestry disability index, the numeric pain scale, or the Macnab criteria in patients who underwent mechanical percutaneous nucleotomy for lumbar disc hernia.
However, other authors have used this for this type of patient, but with percutaneous nucleotomy guided by laser under fluoroscopy, endoscopy, or with dehydration of the intervertebral discs using chemical substances, making a comparison of these studies difficult.
We did not find any studies that included the numeric pain scale, Oswestry functional disability index, or Macnab criteria in a together in the same study in patients with low lumbar hernias treated with this technique. In order to arrive at a complete, integrated evaluation of these patients, we took on the task of using the 3 evaluation scales, something that no study published in the literature has yet undertaken.
The clinical evolution of patients treated with percutaneous manual nucleotomy was good, yielding the therapeutic benefits reported in the literature. It is a minimally invasive surgical technique that should not fall into disuse given that it only requires the percutaneous nucleotomy tool and a fluoroscope to locate the anatomical landmarks. The proper selection of the patient will no doubt allow the maximum benefit to be obtained from the technique and for this reason we conclude that it continues to be a viable technique.
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Calle del Carmen No. All authors declare that there are no potential conflicts of interest regarding this article. This is an open-access article distributed under the terms of the Creative Commons Attribution License. Services on Demand Journal.
The procedure involves removing a portion of an intervertebral disc , which causes pain, weakness or numbness by stressing the spinal cord or radiating nerves. The traditional open discectomy, or Love's technique, was published by Ross and Love in Advances have produced visualization improvements to traditional discectomy procedures e. In conjunction with the traditional discectomy or microdiscectomy, a laminotomy is often involved to permit access to the intervertebral disc. Laminotomy means a significant amount of typically normal bone the lamina is removed from the vertebra, allowing the surgeon to better see and access the area of disc herniation.
Diskectomy is the surgical removal of the damaged portion of a herniated disk in your spine. A herniated disk occurs when some of the softer material inside the disk pushes out through a crack in the tougher exterior. This can irritate or compress nearby nerves and cause pain, numbness or weakness. Diskectomy is a surgical procedure to remove the damaged portion of a herniated disk in your spine. A herniated disk can irritate or compress nearby nerves. Diskectomy is most effective for treating pain that radiates down your arms or legs.