CT-guided percutaneous lumbar herniectomy: clinical outcomes from an 11-year experience in a minimally invasive treatment strategy

Abstract

Lumbar disc herniation is a major cause of radicular pain and a public health burden. Minimally invasive image-guided techniques have been developed to provide targeted treatment while aiming to reduce procedure-related morbidity and accelerate recovery. To evaluate the clinical, functional, and safety outcomes of CT-guided percutaneous lumbar herniectomy over an 11-year period. This prospective single-institution study included patients treated between January 2012 and September 2023. Inclusion criteria comprised radicular pain due to contained lumbar disc herniation unresponsive to conservative treatment and periradicular infiltration. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, the Quebec Back Pain Disability Score, the straight leg raise test, the finger-to-ground distance, and the Schober test. Follow-up consultations were conducted at 1, 3, and 6 months, with primary outcome analysis at 1 month post-procedure. Statistical analyses included Wilcoxon signed-rank tests and Cox proportional hazards regression. A total of 173 patients were analyzed. The median VAS score significantly decreased from 8 (IQR 6–8) at baseline to 2 (IQR 1–4) at 1 month (p<0.001), with sustained improvement at 6 and 12 months. All functional and clinical parameters showed significant improvement. No major complications were observed; five cases of post-procedural headache were successfully managed with an epidural blood patch. CT-guided percutaneous lumbar herniectomy provides rapid and sustained pain relief, functional improvement, and a favorable safety profile. This technique represents a valuable minimally invasive therapeutic option in selected cases, with the potential to limit complications and promote faster recovery.