Abstract

Objectives: The main aim of this retrospective study was to evaluate the usefulness and early outcome and radiological changes after discectomy with DIAM implant insertion for patients with herniation of nucleus pulposus.

Methods: Thirty-three patients underwent discectomy with DIAM implant insertion for a herniation of nucleus pulposus between June 2009 and April 2014 in Hospital Kuala Lumpur, Malaysia were considered for this study. All datas were collected by reviewing the patient’s medical record. All patients had back pain and leg or buttock pain associated with radiological evidence of herniation of nucleus pulpous with failure to 3 months of conservative management. All patients had post-operative follow-up at 2 weeks, 3 months and 6 months after the surgery with documented VAS scores (back and leg pain) and Oswestry Disability Index preoperative and postoperatively. Disc height was measured on the preoperative and postoperative plain radiograph.

Results: 23 male and 10 female were treated. The mean age was 39.82 years old. The most common level was L5/S1 (58%). Preoperative VAS score for leg pain and low back pain improved from 4.3±1.7 and 4.5±1.4 to 1.1±0.8 and 2.2±1.2 respectively at last clinic visit (p<0.001). The average preoperative ODI was 24.6±18.1 and postoperative at 6-month was 12.5±10.2 giving a statistically significant difference (p<0.001) in functional disability outcome. There was no significant in preoperative and postoperative disc height and intervertebral angle at index level.

Conclusion: The early outcome of treatment of low back pain with radiculopathy treated with discectomy and placement of non-fusion DIAM interspinous process spacer showed significant ODI and VAS outcome scores at baseline, 2 weeks, 3 months and at 6 months follow up. There were no significant changes in preoperative and postoperative disc height and intervertebral angle at index level. No adverse local or systemic reaction to the DIAM was noted.

Keywords: Interspinous spacer; Herniation nucleus pulposus; Clinical outcome