Is trans-sacral endoscopic laser decompression truly effective? Clinical and functional assessment of a single spine center

Abstract

Background: Herniated nucleus pulposus (HNP), without causing significant neurological deficit, is a more frequently occurring disease of the spine affecting the activities of daily living with chronic back pain and sometimes progressing to produce significant functional deficit. Trans-sacral epiduroscopic laser decompression (SELD) is being increasingly used as a treatment modality for these conditions and has been shown to give effective results. We present the clinical outcomes of the patients undergoing SELD in our institute for HNP. Methods: A retrospective study of 411 patients who underwent SELD for lumbar disc herniation was done, analyzing the clinical outcomes by measuring visual analog scale (VAS) scores for leg pain and back pain, Oswestry Disability Index (ODI) score, and Short form health survey (SF -36) scores and followed up for 6 months. Results: A total of 195 males and 216 females underwent SELD, with a mean age of 33.2 ± 0.9 years and a mean follow-up period of 7 ± 1.6 months. VAS scores for back pain and leg pain improved significantly from 6.9 ± 0.5 and 6.6 ± 0.6 preoperatively to 1.1 ± 0.5 (P > 0.05) and 0.4 ± 0.5 (P > 0.05) at 6 months. ODI score decreased from 28.2 ± 1.7 to 9.4 ± 1.7 at 6 months from the intervention (P < 0.05). SF-36 showed significant improvement in overall categories through 6 months of follow-up. Twenty-four patients had dural punctures, and four patients needed blood patches but recovered without any complications. One patient had aggravation of the disc herniation post-procedure, and was managed by endoscopic discectomy. Conclusion: SELD is a safe, accurate, and effective procedure in treating symptomatic lumbar disc herniation with excellent clinical outcomes and effective pain relief with minimal damage to paraspinal muscles with an easier learning curve, reproducible results, and high safety index.