Percutaneous Diskectomy SpineJet x Open Microdiskectomy in Treatment of Lumbar Radiculopathy

NCT ID: NCT01367860

Last Updated: 2014-06-04

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-06-30

Study Completion Date

2013-01-31

Brief Summary

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Approximately 300,000 patients undergo open surgical procedures to treat symptoms caused by disc herniation.

Among the various surgical techniques practiced the percutaneous discectomy occupies its space since the first description of the technique by Hijikata, 1975. Throughout, many techniques have been described. Studies indicate that the treatment was successful for pain and disability resulting from herniated disc associated with radiculopathy small.

However, some methods remove very small amounts of tissue with little change in volume of the disc. Thus, studies on the cadaver with Percutaneous Diskectomy by SpineJet ® showed more macroscopic changes of the disc with a predictable amount of removal and significant disc material.

The Percutaneous Diskectomy by SpineJet ® is a new technique of percutaneous diskectomy which creates a suction effect in tissues adjacent to the exit point of the fluid and the opening point of the collector. However, no studies have examined the effect of the Percutaneous Diskectomy by SpineJet ® in humans about the disk size after treatment or measures of disc degeneration by imaging methods or how these characteristics might correlate with clinical outcomes.

Thus, the study will compare outcomes of patients with contained or extruded disc herniation, with complaints of radiculopathy, concordant with the imaging findings. With treatment by surgical technique or the traditional by SpineJet ®, in order to determine whether percutaneous discectomy with SpineJet ® will produce results comparable to open microdiskectomy.

Detailed Description

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Conditions

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Radiculopathy Herniated Disk

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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OMicro

This group will be formed by randomization, which gets out surgery to open microdiscectomy

Group Type ACTIVE_COMPARATOR

Open microdiscectomy

Intervention Type PROCEDURE

The open microdiscectomy, will be performed under general anesthesia in the prone position with horizontal. The level of the spine indicated for surgical treatment will be identified with the aid of fluoroscopy. An incision is made about the dorsal disc level involved with dissection of the paravertebral muscles on the side of disc herniation. After laminectomy and resection of part of the yellow ligament, partial discectomy is done under direct vision.

SJet

This group will be formed by randomization, and receive the discectomy procedure addressed by the technique of Percutaneous Diskectomy SpineJet

Group Type EXPERIMENTAL

Percutaneous Diskectomy SpineJet

Intervention Type PROCEDURE

Percutaneous Diskectomy SpineJet be performed under local anesthesia, in which a needle is placed via percutaneous posterolateral extra-pedicular, below the neural foramen in the center of the disc, using the traditional approach for discography. The researcher will confirm the proper placement of the needle in front and side incidences on the fluoroscopy.

Interventions

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Open microdiscectomy

The open microdiscectomy, will be performed under general anesthesia in the prone position with horizontal. The level of the spine indicated for surgical treatment will be identified with the aid of fluoroscopy. An incision is made about the dorsal disc level involved with dissection of the paravertebral muscles on the side of disc herniation. After laminectomy and resection of part of the yellow ligament, partial discectomy is done under direct vision.

Intervention Type PROCEDURE

Percutaneous Diskectomy SpineJet

Percutaneous Diskectomy SpineJet be performed under local anesthesia, in which a needle is placed via percutaneous posterolateral extra-pedicular, below the neural foramen in the center of the disc, using the traditional approach for discography. The researcher will confirm the proper placement of the needle in front and side incidences on the fluoroscopy.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* single disc herniation, posterolateral, at any lumbar level, with a size of up to 1 / 3 of the spinal canal sagittal diameter, with radicular pain correlated with findings at MRI
* Failure of nonoperative treatment with at least one anti-inflammatory medication and at least two weeks of physical therapy within a period of 6 months
* acceptance of completion of informed consent

Exclusion Criteria

* Force \<4 / 5 in a muscle group in the lower limb
* Herniated Disc extrusa large (\> 1 / 3 of the sagittal canal diameter) or sequestered herniation
* moderate to grade stenosis of the central canal, lateral recess or foramen
* Surgery in the previous level involved
* Herniated disc at another level in the affected side
* Loss of disc height significantly (\> 60%) compared with the adjacent higher level
* Infection at the insertion of the device
* Pregnancy
* Any illness or medications that contraindicate surgical treatment
Minimum Eligible Age

18 Years

Maximum Eligible Age

76 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Sao Paulo

OTHER

Sponsor Role lead

Responsible Party

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Alexandre F. Cristante

PhD.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Institute of Orthopedics and Traumatology of the USP

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

References

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Hijikata S, Yamagishi M, Nakayama T, Oomori K. Percutaneous nucleotomy: a new treatment method for lumbar disk herniation. J Toden Hosp 1976, 6:6-13

Reference Type BACKGROUND

Choy DS, Hellinger J, Tassi GP, Hellinger S. Percutaneous laser disc decompression. Photomed Laser Surg. 2007 Feb;25(1):60. doi: 10.1089/pho.2006.9999. No abstract available.

Reference Type BACKGROUND
PMID: 17352640 (View on PubMed)

Davis GW, Onik G. Clinical experience with automated percutaneous lumbar discectomy. Clin Orthop Relat Res. 1989 Jan;(238):98-103.

Reference Type BACKGROUND
PMID: 2521319 (View on PubMed)

Mochida J, Toh E, Nomura T, Nishimura K. The risks and benefits of percutaneous nucleotomy for lumbar disc herniation. A 10-year longitudinal study. J Bone Joint Surg Br. 2001 May;83(4):501-5. doi: 10.1302/0301-620x.83b4.11508.

Reference Type BACKGROUND
PMID: 11380118 (View on PubMed)

Choy DS. Percutaneous laser disc decompression (PLDD): 352 cases with an 8 1/2-year follow-up. J Clin Laser Med Surg. 1995 Feb;13(1):17-21. doi: 10.1089/clm.1995.13.17.

Reference Type BACKGROUND
PMID: 10150569 (View on PubMed)

Wang JC, Shapiro MS, Hatch JD, Knight J, Dorey FJ, Delamarter RB. The outcome of lumbar discectomy in elite athletes. Spine (Phila Pa 1976). 1999 Mar 15;24(6):570-3. doi: 10.1097/00007632-199903150-00014.

Reference Type BACKGROUND
PMID: 10101821 (View on PubMed)

Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004 Jan-Feb;4(1):27-35. doi: 10.1016/j.spinee.2003.07.001.

Reference Type BACKGROUND
PMID: 14749191 (View on PubMed)

Casey KF, Chang MK, O'Brien ED, Yuan HA, McCullen GM, Schaffer J, Kambin P. Arthroscopic microdiscectomy: comparison of preoperative and postoperative imaging studies. Arthroscopy. 1997 Aug;13(4):438-45. doi: 10.1016/s0749-8063(97)90121-3.

Reference Type BACKGROUND
PMID: 9276049 (View on PubMed)

Delamarter RB, Howard MW, Goldstein T, Deutsch AL, Mink JH, Dawson EG. Percutaneous lumbar discectomy. Preoperative and postoperative magnetic resonance imaging. J Bone Joint Surg Am. 1995 Apr;77(4):578-84. doi: 10.2106/00004623-199504000-00011.

Reference Type BACKGROUND
PMID: 7713975 (View on PubMed)

Tonami H, Yokota H, Nakagawa T, Higashi K, Okimura T, Yamamoto I, Nishijima Y. Percutaneous laser discectomy: MR findings within the first 24 hours after treatment and their relationship to clinical outcome. Clin Radiol. 1997 Dec;52(12):938-44. doi: 10.1016/s0009-9260(97)80228-0.

Reference Type BACKGROUND
PMID: 9413969 (View on PubMed)

Krugluger J, Knahr K. Chemonucleolysis and automated percutaneous discectomy--a prospective randomized comparison. Int Orthop. 2000;24(3):167-9. doi: 10.1007/s002640000139.

Reference Type BACKGROUND
PMID: 10990391 (View on PubMed)

Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine (Phila Pa 1976). 2007 Feb 15;32(4):481-6. doi: 10.1097/01.brs.0000255075.11496.47.

Reference Type BACKGROUND
PMID: 17304141 (View on PubMed)

Dullerud R, Nakstad PH. Side effects and complications of automated percutaneous lumbar nucleotomy. Neuroradiology. 1997 Apr;39(4):282-5. doi: 10.1007/s002340050410.

Reference Type BACKGROUND
PMID: 9144678 (View on PubMed)

Wittenberg RH, Oppel S, Rubenthaler FA, Steffen R. Five-year results from chemonucleolysis with chymopapain or collagenase: a prospective randomized study. Spine (Phila Pa 1976). 2001 Sep 1;26(17):1835-41. doi: 10.1097/00007632-200109010-00002.

Reference Type BACKGROUND
PMID: 11568690 (View on PubMed)

Slotman GJ, Stein SC. Laminectomy compared with laparoscopic diskectomy and outpatient laparoscopic diskectomy for herniated L5-S1 intervertebral disks. J Laparoendosc Adv Surg Tech A. 1998 Oct;8(5):261-7. doi: 10.1089/lap.1998.8.261.

Reference Type RESULT
PMID: 9820717 (View on PubMed)

Amoretti N, Huchot F, Flory P, Brunner P, Chevallier P, Bruneton JN. Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports. Clin Imaging. 2005 Mar-Apr;29(2):98-101. doi: 10.1016/j.clinimag.2004.10.024.

Reference Type RESULT
PMID: 15752964 (View on PubMed)

Matsui H, Aoki M, Kanamori M. Lateral disc herniation following percutaneous lumbar discectomy. A case report. Int Orthop. 1997;21(3):169-71. doi: 10.1007/s002640050143.

Reference Type RESULT
PMID: 9266296 (View on PubMed)

Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993 Feb;78(2):216-25. doi: 10.3171/jns.1993.78.2.0216.

Reference Type RESULT
PMID: 8267686 (View on PubMed)

Teng GJ, Jeffery RF, Guo JH, He SC, Zhu HZ, Wang XH, Wu YZ, Lu JM, Ling XL, Qian Y, Zhang YM, Zhu MJ, Guan L, He XM. Automated percutaneous lumbar discectomy: a prospective multi-institutional study. J Vasc Interv Radiol. 1997 May-Jun;8(3):457-63. doi: 10.1016/s1051-0443(97)70589-x.

Reference Type RESULT
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Bernhardt M, Gurganious LR, Bloom DL, White AA 3rd. Magnetic resonance imaging analysis of percutaneous discectomy. A preliminary report. Spine (Phila Pa 1976). 1993 Feb;18(2):211-7.

Reference Type RESULT
PMID: 8441936 (View on PubMed)

Cristante AF, Rocha ID, MartusMarcon R, Filho TE. Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations. Clinics (Sao Paulo). 2016 May;71(5):276-80. doi: 10.6061/clinics/2016(05)06.

Reference Type DERIVED
PMID: 27276397 (View on PubMed)

Rocha ID, Cristante AF, Marcon RM, Oliveira RP, Letaif OB, Barros Filho TE. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics (Sao Paulo). 2014 Aug;69(8):529-34. doi: 10.6061/clinics/2014(08)05.

Reference Type DERIVED
PMID: 25141111 (View on PubMed)

Other Identifiers

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IOT

Identifier Type: OTHER

Identifier Source: secondary_id

SpJet2011

Identifier Type: -

Identifier Source: org_study_id

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