Radiology, Kwame Nkrumah University of Science and Technology, PMB University Post Office, KNUST, Kumasi, Ghana.
Radiology, Spectra Health Imaging and Interventional Radiology Centre, P.O. Box KS 5431, Kumasi, Ghana.
Lasers Surg Med. 2020 Jun;52(5):419-423. doi: 10.1002/lsm.23149. Epub 2019 Sep 2.
On the basis of reported immediate and short-term excruciating pain by patients in the post-procedural period of computed tomography (CT)-guided percutaneous laser disc decompression (PLDD) in our clinic, we present our initial clinical experience with a novel combi-therapy using a combination of CT-guided PLDD and CT-guided epidural nerve blocks, which proved effective in managing the pain.
STUDY DESIGN/MATERIALS AND METHODS: A total of 100 patients who met the criteria for PLDD, underwent treatment for lumbar discogenic radiculopathy between 2014 and 2017. Fifty-five percent of the patients were males and 45% were females with a mean age of 46.25 years. Ninety-five patients underwent one level PLDD and five patients two-level PLDD procedures. CT-guided epidural nerve block with a combination of Bupivacaine, Lignocaine, and Kenalog was used in a 3× procedure separated by a 1-week interval. The first nerve block was given the same day, immediately after the PLDD procedure. The visual analogue scale (VAS) for pain was used during the pre-procedure and post-procedure periods.
Among the patients who underwent one level PLDD, 88 had L4-L5 levels, 5 had L5-S1 levels and 2 had L3-L4 levels. L4-L5 and L5-S1 levels were the most common two-level PLDD locations in seven patients. Five patients in our study subsequently underwent open surgical treatment. All patients reported immediate pain relief, which was sustained after the procedure. The average pre-procedure VAS score was 7.6 (range from 5 to 8.2) and the VAS score immediately after the procedure was on average 0.5 (ranging from 0 to 2).
Findings from this initial experience using a combi-therapy of CT-guided PLDD and CT-guided epidural nerve block have shown the benefits of this novel approach, offering significant immediate pain relief in the post-procedural phase, favorable outcomes in the short to mid-term and a significantly reduced rate of re-surgery (7%) compared with the use of only CT-guided PLDD. Lasers Surg Med 00:1-5, 2019. © 2019 Wiley Periodicals, Inc.
在我们诊所，接受 CT 引导下经皮激光椎间盘减压术（PLDD）治疗后的患者会报告即刻和短期剧痛，基于此，我们提出了一种新的联合治疗方法的初步临床经验，该方法将 CT 引导下 PLDD 与 CT 引导下硬膜外神经阻滞相结合，该方法在缓解疼痛方面非常有效。
研究设计/材料和方法：2014 年至 2017 年间，共有 100 名符合 PLDD 治疗标准的患者接受了腰椎间盘源性根性病变的治疗。其中 55%为男性，45%为女性，平均年龄为 46.25 岁。95 例患者接受了 1 个节段的 PLDD，5 例患者接受了 2 个节段的 PLDD。CT 引导下的硬膜外神经阻滞采用布比卡因、利多卡因和曲安奈德联合使用，3 次/疗程，间隔 1 周。第一次神经阻滞在 PLDD 手术后同一天进行。在术前和术后期间使用视觉模拟量表（VAS）评估疼痛。
在接受 1 个节段 PLDD 的患者中，88 例为 L4-L5 节段，5 例为 L5-S1 节段，2 例为 L3-L4 节段。L4-L5 和 L5-S1 是 7 例患者中最常见的 2 个节段 PLDD 位置。在我们的研究中，有 5 例患者随后接受了开放性手术治疗。所有患者均报告立即缓解疼痛，且在术后仍持续缓解。术前平均 VAS 评分为 7.6（5 至 8.2 分），术后即刻平均 VAS 评分为 0.5（0 至 2 分）。
这项使用 CT 引导下 PLDD 和 CT 引导下硬膜外神经阻滞联合治疗的初步经验发现，这种新方法具有显著优势，可在术后即刻显著缓解疼痛，中短期效果良好，与仅使用 CT 引导下 PLDD 相比，手术再治疗率（7%）显著降低。激光外科医学 00:1-5, 2019. © 2019 Wiley Periodicals, Inc.
