RADIOFREQUENCY FACILITATED MANUAL SEMI-ENDOSCOPIC DISCECTOMY UTILIZING THE DISC FX® SYSTEM IN THE TREATMENT OF DISC-PREDOMINATE LUMBAR SPINAL STENOSIS

Background: Lumbar spinal stenosis (LSS)occurs with increasing prevalence in the elderlypopulation. The American Academy of OrthopedicSurgeons has estimated that by 2021,2.4 million adults in the United States (8-11% ofthe population) will be affected by this condition.Surgical options for LSS are being performedwith increased frequency, high cost, and substantialrisk of life-threatening complications.While nonsurgical treatment options for LSS areavailable, they are limited by patient selection(ligamentum flavum hypertrophy) or high ratesof reoperation (Interspinous process spacerdevices).This study is the first to suggest a minimallyinvasive treatment option for disc-predominatelumbar central canal stenosis.Objectives: To evaluate the clinical efficacy ofradiofrequency facilitated manual semi-endoscopicdiscectomy utilizing the Disc FX® systemin the treatment of disc-predominate lumbarspinal stenosis.Study Design: Single center, prospective, observationalstudy.Setting: Multi-specialty private practice clinic.The Medical Group of South Florida, Jupiter, FL.Methods: This study involved 6 patients withdisc-predominant lumbar central spinal stenosis.All patients were treated with the Disc FX®system. Radiographic evidence of central lumbarstenosis was confirmed by measurement of minimumAP canal diameter (mm) performed by 1board-certified neuroradiologist. Inclusion criteriaincluded absence of lumbar surgery, physicaltherapy within the previous 6 months, failure ofepidural steroid injections (3) within the previous8 months, spondylolisthesis limited to Grade I,disc height > 50%, presence of low back axialpain + leg pain exacerbated by walking, andrelieved with sitting or forward flexion, absenceof dermatomal radicular leg pain, radiographicevidence of disc displacement > 4 mm from discendplate. Zurich claudication (symptom severityand physical function scale was administered 1week preoperatively, and again 6 months postoperatively.There were no patients lost to follow up.Results: All patients in the study demonstratedmoderate-severe or severe central canal stenosis,with an average AP canal diameter of 6.63mm for all treated disc levels and 5.5 mm for themost severe levels. There was a mean improvementof 57% in a symptom severity scale and56% in the physical function scale at 6 months.This exceeds the improvement reported withinterspinous spacer devices.Limitations: Limitations include very smallsample size, observational design, non-randomization,absence of share controls, shortfollow-up period.Conclusion: For patients suffering from discpredominantlumbar spinal stenosis, The DiscFX® System provides an effective, low-costalternative to surgical intervention.Key words: Spinal, stenosis, claudication, disc,Disc FX®, operative, minimally invasive, Zürichclaudication score