St. Catherine Hospital, Zabok, Croatia.
School of Medicine, University of Rijeka, Rijeka, Croatia.
Pain Med. 2018 Aug 1;19(8):1550-1558. doi: 10.1093/pm/pnx270.
Minimally invasive percutaneous spinal procedures are popular in trying to reduce spinal pain. The aim of this paper is to evaluate the safety of intervertebral disc chemonucleolysis and to report the effectiveness of a percutaneous, minimally invasive treatment for contained herniated intervertebral discs in the lumbar spine using the recently marketed radiopaque gelified ethanol.
Pain relief before and after the procedure was self-evaluated by each patient using a verbal numeric scale (VNS) ranging from 0 to 10. Patients were also scored prior to procedure and after chemonucleolysis during several follow-up periods using the Roland-Morris low back pain and disability questionnaire (RMQ). Follow-up periods were defined as 0-6, 6-12, 12-18, 18-24, and 24-30 months. Clinically significant functional improvement (CSFI) was defined as a decrease of five or more points on the RMQ scale and a decrease of at least 50% of pain intensity using VNS.
Using the RMQ scale, CSFI was achieved in 20/29 patients in the first follow-up period, 20/27 patients in the second follow-up period, 9/12 patients in the third follow-up period, 8/9 patients in the fourth follow-up period, and 4/4 patients in the last follow-up period. Using the VNS rating, CSFI was accomplished in 19/29 patients in the first follow-up period, 19/27 patients in the second follow-up period, 9/12 patients in the third follow-up period, 8/9 patients in the fourth follow-up period, and 4/4 in the last follow-up period.
Intradiscal application of gelified ethanol may be effective in pain reduction using the VNS and Roland-Morris low back pain and disability questionnaire. The treatment is safe and easy to handle.
微创经皮脊柱手术在减轻脊柱疼痛方面很受欢迎。本文旨在评估椎间盘化学核溶解术的安全性，并报告使用最近市售的不透射线凝胶化乙醇对腰椎间盘局限性突出进行经皮微创治疗的效果。
每位患者使用 0 到 10 的数字评分量表（VNS）自行评估治疗前后的疼痛缓解情况。在治疗前和化学核溶解后，患者还使用 Roland-Morris 腰痛和残疾问卷（RMQ）在多个随访期进行评分。随访期定义为 0-6、6-12、12-18、18-24 和 24-30 个月。临床显著功能改善（CSFI）定义为 RMQ 评分下降 5 分或更多，VNS 疼痛强度下降至少 50%。
使用 RMQ 评分，20/29 例患者在第一个随访期达到 CSFI，20/27 例患者在第二个随访期达到 CSFI，9/12 例患者在第三个随访期达到 CSFI，8/9 例患者在第四个随访期达到 CSFI，最后一个随访期有 4/4 例患者达到 CSFI。使用 VNS 评分，19/29 例患者在第一个随访期达到 CSFI，19/27 例患者在第二个随访期达到 CSFI，9/12 例患者在第三个随访期达到 CSFI，8/9 例患者在第四个随访期达到 CSFI，最后一个随访期有 4/4 例患者达到 CSFI。
椎间盘内应用凝胶化乙醇可能通过 VNS 和 Roland-Morris 腰痛和残疾问卷有效减轻疼痛。该治疗方法安全且易于操作。
