RSNA: 30-minute IR procedure provides long-term sciatica relief

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CHICAGO--A 30-minute outpatient procedure can provide long-term back pain relief in middle-aged individuals suffering from sciatica, according to Alexios Kelekis, MD, PhD, assistant professor of interventional radiology at the University of Athens in Greece, at the Radiological Society of North America (RSNA) annual conference on Wednesday.

The randomized, controlled study compared conservative treatment and percutaneous disc decompression treatments for herniated discs.

Herniated or budging discs, according to Kelekis, push outward and irritate the spinal nerves, resulting in back and leg pain and weakness. Between 70-90 percent of individuals will experience bulging disc pains during the course of their lives.

Initial treatment of sciatica includes over-the-counter (OTC) anti-inflammatory medications, in which physicians typically suggest a six-week course before recommending further treatment. Herniated discs can typically be resolved after approximately three months of pain medication, physical therapy and diet change, said Kelekis.

"Most protocols call for a minimal approach to initially treat a herniated disc," said Kelekis. “But by deflating the disc and giving the nerve root the space it needs, disc decompression solves the problem of root irritation and prevails in the long run."

From January 2005 to January 2008, 31 patients (17 men and 14 women, average age of 36) with a history of unsuccessful treatment of their sciatica were recruited to participate in the study after undergoing an MRI to confirm that the participants’ back pain could in fact be attributed to a herniated disc. The participants additionally completed a questionnaire, marking their pain on a scale of one through 10, with 10 being the highest amount of pain.

The study randomly placed the participants into two groups. Group A underwent conservative and typical treatment of their sciatica, with a rigorous six-week treatment course consisting of analgesics, anti-inflammatory drugs and muscle relaxants.

Group B received percutaneous disc decompression, a method of puncturing a bulging disc through the skin with a needle to deflate the disc by either removing some tissue or using energy to dissolve it. The minimally invasive procedure takes approximately 30 minutes and is done under local anesthesia. Moreover, the patients can return home after four hours and return to normal activity after 30 days, said Kelekis.

The study found that Group A, after completing a conservative treatment program, saw immediate results after one month, with pain decreasing from an average of 6.87 to 0.9. The participants in this group remained pain-free for the first six to 12 months post-treatment, but then saw a gradual increase in their pain thereafter, resulting in a average 4.09 pain scale at the 24-month mark.

Participants in Group B, or the percutaneous group, began with an average of 7.4 on the pain scale and saw their pain scale steadily decrease from the time of treatment, eventually reaching 1.61 at the 24-month mark post-treatment.

“The percutaneous Group B underwent a procedure that accelerated what nature will do by itself,” said Kelekis. “If you can give the patient a 30-minute procedure that will take away their pain for the rest of their life, I think that’s a benefit.”

Kelekis noted, however, that the percutaneous treatment is not for all individuals and not all disc problems, as the study only involved participants between the ages of 30 to 40. This is because as the individual ages, there can be many different reasons for back and leg pain besides sciatica, said Kelekis.