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Usually, coccydynia cases are caused by herniated discs, with lower back pain and sciatica as initial symptoms. However, whether lumbar disc herniation causes coccydynia without back pain remains unclear. We report a case of lumbar disc herniation diagnosed as the underlying cause of coccydynia by discoblock. A woman in her mid-20s was treated for coccydynia experienced during sitting, for several years. There was no coccyx tenderness upon palpation. As the location of the pain could not be identified, it was not possible to perform a block at the site of the pain. Magnetic resonance imaging showed a herniated L5/S1 lumbar disc, without lower back pain and sciatica. Following discoblock, coccydynia was diagnosed as associated pain due to the herniated L5/S1 lumbar disc that was treated with percutaneous discectomy. After surgery, coccydynia was relieved while sitting; no medication was required.Discoblock was used to diagnose lumbar disc herniation as the cause of coccydynia. Percutaneous discectomy was effective for coccydynia without back pain, thus lumbar disc herniation should be considered as a differential diagnosis. Discoblock can be useful for differentiation., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Showa University Ethics Committee issued approval CR2023027-B; dated September 29, 2023. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kobayashi et al.)

Background:clinical outcome data was analyzed for 100 patients withcontained disc herniation who underwent percutaneous discdecompression procedure using Coblation® technology,after failing to respond toconservative management. Patients and Methods: Patients presented with clinicalsymptoms of discogenic low back pain and/or leg painFollow-up data was collected up to 12 months.Patient gender distribution was 68% female, 32% male, witha mean age of 39 years.With mean duration of back pain of 8.57 ,ranging from 3 to 17 month and mean duration of leg pain of 4.36 .ranging from 2 to 10 monthaccording to visual analogue scale for pain assessment.The mean pre-procedure pain level for all patients wasReported as 7.56 for back and 7.72 for leg while average pain level was 4.86 for back and 3.42 for leg at the 12-month follow-up post procedure period. And according to Oswestry disability index for functional assessment. The mean pre procedure index was 31.48 range from 23-40. It decreased after 12 month to 13.82 range from 5-32. Results:The results of this analysis indicated that PDD usingCoblation technology, isan effective procedure for patients presenting withdiscogenic back and/or leg pain who have failed conservativetherapies. [ABSTRACT FROM AUTHOR]

Background: Less invasive treatment methods for intervertebral disc disease and decompression of neural structures as a consequence of contained disc herniation represent an alternative to surgical procedure. Percutaneus nucleotomy uses a percutaneous approach to the intervertebral disc. The article presents the evolution of numerous procedureds in clinical practice.Methods: Percutaneous nucleoplasty is a fluoroscopy-guided procedure which enables controlled and safe entrance into the intervertebral disc. The procedure is performed under strict aseptic conditions, using a local anaesthesia with the patient under analgosedation. Based on the principle of therapeutic intradiscal action, the procedures can be divided into three groups: chemical (chemonucleolysis with chimopapain, alcohol, ozone), mechanical (automated percutaneous lumbar discectomy – APLD, arthroscopic discectomy) and thermical methods (laser, radiofrequency ablation, intradiscal electrothermal annuloplasty – IDET, Coblation®).Results: Percutaneous nucleotomy by the majority of the mentioned procedures results in a therapeutic effect (reduction of pain and decompression of neural structures). Fast recovery represents a major advantage of less invasive treatment.Conclusions: Less invasive method (nucleotomy using different procedures) represents a successful alternative approach to surgical discectomy. Proper patient selection and safe technique are mandatory in order to achieve a good clinical outcome.

Background context Percutaneous laser disc decompression (PLDD) is a minimally invasive treatment for lumbar disc herniation, with Food and Drug Administration approval since 1991. However, no randomized trial comparing PLDD to conventional treatment has been performed. Purpose In this trial, we assessed the effectiveness of a strategy of PLDD as compared with conventional surgery. Study design/Setting This randomized prospective trial with a noninferiority design was carried out in two academic and six teaching hospitals in the Netherlands according to an intent-to-treat protocol with full institutional review board approval. Patient sample One hundred fifteen eligible surgical candidates, with sciatica from a disc herniation smaller than one-third of the spinal canal, were included. Outcome measures The main outcome measures for this trial were the Roland-Morris Disability Questionnaire for sciatica, visual analog scores for back and leg pain, and the patient's report of perceived recovery. Methods Patients were randomly allocated to PLDD (n=57) or conventional surgery (n=58). Blinding was impossible because of the nature of the interventions. This study was funded by the Healthcare Insurance Board of the Netherlands. Results The primary outcome, Roland-Morris Disability Questionnaire, showed noninferiority of PLDD at 8 (−0.1; [95% confidence interval (CI), −2.3 to 2.1]) and 52 weeks (−1.1; 95% CI, −3.4 to 1.1) compared with conventional surgery. There was, however, a higher speed of recovery in favor of conventional surgery (hazard ratio, 0.64 [95% CI, 0.42–0.97]). The number of reoperations was significantly less in the conventional surgery group (38% vs. 16%). Overall, a strategy of PLDD, with delayed surgery if needed, resulted in noninferior outcomes at 1 year. Conclusions At 1 year, a strategy of PLDD, followed by surgery if needed, resulted in noninferior outcomes compared with surgery. [ABSTRACT FROM AUTHOR]

This report describes two elderly patients with large disc fragments extruded into lumbar radicular recesses not treatable by any conventional conservative, minimally invasive or surgical approach. Direct access to the disc fragments was obtained crossing the articular zygapophyseal cavity instead of the interlaminar space and spinal canal, using a small needle through which a laser fibre was inserted to deliver energy for tissue ablation. The procedures obtained regression of both symptoms and the bulk of the fragments at early and late clinical and MR follow-ups. [ABSTRACT FROM AUTHOR]

Objectives. The objective of this study was to determine if the available literature answers the following questions: does percutaneous disc decompression using Dekompressor device relieve radicular pain caused by a small disc herniation? Is the duration of response stable and clinically worthwhile? Is relief of pain corroborated by improvements in physical and social function? Does relief of pain result in reduction in the use of other health care? Is there a risk of serious side effects or complications? Design/Settings. The study was designed as a narrative review and description of the available evidence, drawn from the databases of PubMed, EMBASE, and the Cochrane Library. Innovatively, the concept of the 'context of the patient' was introduced in the assessment. It required the assessors to consider the alternatives the patients and their treating practitioners faced. Results. The literature search identified three nonrandomized clinical trials, and a single case series. All studies were reasonably rigorous in reporting relief of pain and the use of analgesics. Evidence with respect to physical functioning was scarce. Although investigators reported on the relief of pain, they lacked rigor when reporting associated outcome measures such as use of other health care and physical functioning. Conclusions. Unfortunately, the context of a patient with persistent radicular pain caused by a small disc herniation is the lack of good alternatives to Dekompressor procedure. The moral question is whether Dekompressor is any less valid an option than perpetual opioids or discectomy. This question would be much easier to answer if the literature on Dekompressor was more rigorous and more compelling in its evidence. [ABSTRACT FROM AUTHOR]

Complications of minimally invasive interventions to treat discogenic pain can be classified as infectious, hemorrhagic, neurological, allergic, and other less specific complications such as temporary pain exacerbation and vasovagal reactions. Discitis, spinal abscesses, and vertebral osteomyelitis were all reported after percutaneous intradiscal procedures for treatment of back and leg pain. Misplacement of trocars, probes, or heating elements are frequently responsible for neurological complications such as cauda equina and nerve root damage. Allergic reactions occur usually in patients with immunological hypersensitivity to one or more of the agents used during the interventions, such as chymopapain for nucleolysis or the contrast dye for discography. [Copyright &y& Elsevier]

Effective treatment of low back pain has been a challenge for physicians and patients alike. After the description of herniations by Mixter and Barr, attempts were made to account for back pain in the absence of a frank herniation. Painful discs with a normal external morphology and not causing nerve root compression were first described by Dandy as a “concealed ruptured intervertebral disc.” Crock later introduced the term “internal disc disruption” for a damaged intervertebral disc which included annular tears, nuclear displacement and contained herniations. The inflammatory response to an internally disrupted intervertebral disc can be acute or progress to chronic inflammation with pain and permanent damage. Pain from activation of this inflammatory process may be severe enough for patients to consider surgical intervention. Open surgery, however, may not be applicable for pain from contained herniations nor does it always yield a successful result. Many patients are not good candidates for surgery or choose not to undergo spinal operations for pain. In the past, few options existed for these patients. Disc decompression by partial removal of the nucleus was shown to decrease pressure in the disc and relieve pain. Nucleoplasty is a newer minimally invasive procedure used to treat lumbar discogenic pain by percutaneous disc decompression. The scientific rationale, patient treatment evidence and indications for nucleoplasty are presented, along with a discussion of antibiotic prophylaxis in minimally invasive procedures. [Copyright &y& Elsevier]

Background: The navigable percutaneous disc decompression (PDD) device L'DISQ is an effective and safe option for the treatment of lumbar discogenic pain. However, few studies have evaluated the prognostic factors of successful PDD using this device., Objective: This study aimed to evaluate the prognostic factors associated with the successful outcome of PDD using the L'DISQ for treating lumbar discogenic pain by following up patients before and one, 2, 3, and 6 months after the procedure., Study Design: Retrospective cohort study., Setting: Tertiary university hospital., Methods: A successful outcome was defined as a >= 50% reduction in the numeric rating scale scores for pain and a >= 40% reduction in the Oswestry Disability Index scores at 6 months after the procedure. Clinical parameters and patient demographics, including pain duration, history of surgery, number of treatment levels, and the radiographic findings of lumbar magnetic resonance imaging (MRI), were also examined., Results: Of the 106 patients included, 80 (75.5%) had successful outcomes at 6 months. Multivariable logistic regression analysis revealed that the presence of high-intensity zones (HIZs) (P = 0.016) was an independent positive predictor of successful PDD outcomes; conversely, migration of the herniated disc (P = 0.017) and bilaterally herniated discs (P = 0.001) were negative predictors., Limitations: The limitations of this study were its retrospective design, absence of a control group, and difficulty in predicting the effect when multiple levels were involved because of the use of MRI characteristics of the disc as a predictor., Conclusions: The presence of HIZs, the absence of migration of herniated discs, and the presence of unilaterally herniated discs are positive predictors of successful outcomes of PDD using the L'DISQ.