Ranc Paul-Alexis, Dien Emmanuel, Pavan Luca-Jacopo, Vivarrat-Perrin Thomas, Peyret Nicolas, Prestat Alexandre, Desalos Kevin, Elbaze Simon, Rudel Alexandre, Amoretti Nicolas
Radiology Department, CHU Nice Pasteur 2, Nice, France.
Centre d'Imagerie Médicale Claude Bernard, Metz, France.
Eur Radiol. 2025 Jun 7. doi: 10.1007/s00330-025-11736-5.
This study aimed to evaluate procedural pain during CT-guided percutaneous lumbar discectomy (PLD) under local anesthesia to treat disc herniation and assess patient satisfaction at 6 months post-treatment.
This prospective observational study enrolled patients who underwent the procedure between December 2019 and April 2021. Patients were selected based on lumbar radiculalgia refractory to medical treatment and infiltrations, with disc herniation confirmed via MRI. Procedural pain was assessed using a visual analog scale (VAS) and a questionnaire immediately after the procedure, while patient satisfaction was evaluated through a questionnaire at 6 months post-treatment. Pain perception during the intervention, tolerability, and willingness to undergo the procedure again were examined. Data were analyzed using descriptive statistics, appropriate tests for variable types, and multivariable logistic regression to identify predictors of procedural pain (VAS > 5).
90 patients (mean age, 56 ± 16; 43 men) were enrolled. The median pain reported during the procedure was 5, and 87% of patients rated the experience as tolerable or perfectly tolerable. Disc degeneration (Pfirrmann grades 3 and above) was significantly correlated with increased pain intensity during the procedure (p < 0.05). At the 6-month follow-up, 81% of patients expressed satisfaction with the treatment outcomes, and 94% indicated they would recommend the procedure to others with similar conditions.
CT-guided percutaneous discectomy under local anesthesia is well-tolerated, with manageable procedural pain and high levels of patient satisfaction. The use of local anesthesia enables real-time clinical evaluation, enhances procedural safety, and minimizes the risk of nerve injuries.
Question CT-guided PLD is a minimally invasive technique that can be performed under local anesthesia; however, studies have not evaluated per-procedural pain or long-term satisfaction. Findings Patients treated under local anesthesia reported a median pain score of 5/10 during the procedure, with 82,7% expressing satisfaction with the outcomes at 6 months. Clinical relevance CT-guided PLD is a procedure that can be performed under local anesthesia, offering acceptable tolerance and a high rate of patient satisfaction for those suffering from radiculalgia related to a disc herniation refractory to infiltrations.
本研究旨在评估局部麻醉下CT引导经皮腰椎间盘切除术（PLD）治疗椎间盘突出症时的操作疼痛，并评估治疗后6个月患者的满意度。
这项前瞻性观察性研究纳入了2019年12月至2021年4月期间接受该手术的患者。患者入选标准为经药物治疗和局部浸润治疗无效的腰椎神经根痛，且经MRI证实为椎间盘突出症。术后立即使用视觉模拟量表（VAS）和问卷评估操作疼痛，治疗后6个月通过问卷评估患者满意度。检查干预过程中的疼痛感知、耐受性以及再次接受该手术的意愿。使用描述性统计、针对变量类型的适当检验以及多变量逻辑回归分析数据，以确定操作疼痛（VAS>5）的预测因素。
共纳入90例患者（平均年龄56±16岁；43例男性）。手术过程中报告的中位疼痛为5分，87%的患者将该体验评为可耐受或完全可耐受。椎间盘退变（Pfirrmann分级3级及以上）与手术过程中疼痛强度增加显著相关（p<0.05）。在6个月的随访中，81%的患者对治疗结果表示满意，94%的患者表示会向其他有类似情况的人推荐该手术。
局部麻醉下CT引导经皮椎间盘切除术耐受性良好，操作疼痛可控，患者满意度高。局部麻醉的使用能够进行实时临床评估，提高手术安全性，并将神经损伤风险降至最低。
问题CT引导下PLD是一种可在局部麻醉下进行的微创技术；然而，此前研究尚未评估术中疼痛或长期满意度。发现局部麻醉下治疗的患者在手术过程中的中位疼痛评分为5/10，82.7%的患者在6个月时对结果表示满意。临床意义CT引导下PLD是一种可在局部麻醉下进行的手术，对于因椎间盘突出症导致神经根痛且局部浸润治疗无效的患者，具有可接受的耐受性和较高的患者满意度。
