Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation
Objectives: Evaluation of effects of postoperative (PO) facet nerve continuous thermal radiofrequency neurotomy (CTRFN), nerve root pulsed RF (PRF) and triamcinolone with hyaluronidase injection on outcome of patients undergoing open lumber discectomy. Patients & methods: Seventy patients were allocated into the following groups: Group S underwent open discectomy alone and Group M underwent open discectomy followed by the three adjuvant procedures. Low back pain (LBP) severity was assessed using numeric rating scale (NRS) and disability was assessed using the Oswestry Disability Index (ODI). Primary outcome measure was at least 50% improvement of NRS and ODI. Secondary outcome involved scoring of pain medication requirements, Odom's criteria for improvement of preoperative abnormal findings and patients' satisfaction. Results: Throughout 12-m follow-up, mean NRS and ODI scores of all patients were significantly lower than preoperative scores with significantly lower scores in group M than in group S. Frequency of patients had ≥50% improvement which was significantly higher in group M than in group S. Patients of both groups showed significant reduction of scoring of consumed analgesics with significantly less consumption of PO analgesics in group M than in group S. Odom's scoring, resumption of activity and overall satisfaction scoring were significantly higher in group M than in group S. Conclusion: Open discectomy provided significant improvement of LBP and disability secondary to LDH. Discectomy with adjuvant therapy including PRF, CTRFN and triamcinolone and hyaluronidase intraluminar injection significantly improved outcome compared to discectomy alone.
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