Epiduroscopic lumbar discectomy through the sacral hiatus for sciatica

A non-randomised comparative study of 98 patients compared treatment by endoscopic adhesiolysis, foraminoplasty and discectomy (n=78) with endoscopic adhesiolysis and foraminoplasty without discectomy (n=20). Visual analogue scale (VAS) scores (ranging from 0 to 10, with lower scores indicating less pain) for radicular pain improved from 7.6 to 3.6 with discectomy and from 8.5 to 6.1 without discectomy at final follow-up (p values not reported; mean follow-up periods were 21 and 23 months respectively). A non-randomised comparative study of 57 patients compared treatment by endoscopic adhesiolysis, foraminoplasty and discectomy (n=32) with endoscopic adhesiolysis and foraminoplasty without discectomy (n=25). The improvement in VAS score for low back pain was statistically significant with discectomy (from 8.1 to 4.4; p=0.01) but not without discectomy (from 8.5 to 6.7; p=0.12) at 24-month follow-up. The difference between the groups was statistically significant (p<0.01). In the same study, improvements in VAS scores for leg pain were not statistically significant (from 6.2 to 4.7; p=0.07 and from 6.7 to 5.2; p=0.15, respectively) at 24-month follow-up. The difference between the groups was statistically significant (p=0.05). In a case series of 154 patients, there was a statistically significant decrease in VAS score for pain from 7.5 at baseline to 3.4 at follow-up (p<0.005). In a case series of 250 patients, the mean VAS score for leg pain decreased from 7.1 at baseline to 2.6 (p<0.01) and the mean VAS score for back pain decreased from 5.9 at baseline to 2.7 (p<0.01) at 3-month follow-up.

In the non-randomised comparative study of 98 patients, Roland Morris disability questionnaire scores (ranging from 0 to 24, with lower scores indicating less disability) changed from 18.8 to 10.6 with discectomy and from 11.3 to 11.4 without discectomy at final follow-up (p values not reported; mean follow-up periods were 21 and 23 months respectively). In the non-randomised comparative study of 57 patients, the change in Roland Morris disability questionnaire scores was statistically significant with discectomy (from 13.2 to 8.5; p=0.03) but not without discectomy (from 12.6 to 10.4; p=0.09) at 24-month follow-up. The difference between the groups was statistically significant (p<0.01). In the case series of 154 patients, the change in Roland Morris disability questionnaire score was statistically significant, from 18.1 at baseline to 10.3 at follow-up (p<0.005). In the case series of 250 patients, the Oswestry Disability Index score (ranging from 0 to 100) improved from 50 at baseline to 12 at 3-month follow-up (p<0.01).

The specialist advisers listed key efficacy outcomes as relief of back or leg pain, improvement in patient-reported outcome measures (such as Oswestry Disability Index), reduced length of hospital stay and reduced time off work.