Real-world 24-month pain outcomes of disk percutaneous ablation and extraction versus Disc-FX nucleoplasty for lumbar discogenic pain and contained lumbar disk herniation: a single-center retrospective cohort study.

INTRODUCTION

Discogenic pain and contained lumbar disk herniation are important causes of chronic low back pain. Current intradiscal minimally invasive techniques have long-term efficacy limitations. Disk percutaneous ablation and extraction (DPAE) lacks systematical long-term outcomes evaluation. This study compared mid-to-long-term clinical outcomes of DPAE and standard Disc-FX in such patients.

METHODS

This single-center retrospective cohort study included 198 patients: 110 underwent DPAE, 88 received Disc-FX. Primary outcome was the change in low back pain visual analog scale (VAS) score at 24 months. Secondary outcomes included Oswestry Disability Index (ODI), Patient Global Impression of Change (PGIC), achievement of the minimal clinically important difference (MCID), composite treatment success, and reintervention rate. The safety endpoint was perioperative/follow-up complications. Propensity score matching controlled confounding; statistical analyses included analysis of covariance, linear mixed-effects models, logistic regression, and Cox models.

RESULTS

At 24 months, DPAE group had a mean VAS reduction of 5.29 ± 2.06 vs. 4.17 ± 2.24 in Disc-FX group (p < 0.001), with an additional 1.05-point reduction (β = -1.05, 95%CI -1.57 to -0.53; p < 0.001). The DPAE group demonstrated better improvement in ODI, higher PGIC marked improvement, higher VAS/ODI MCID rates, and higher composite success rate (70.0% vs. 51.1%, all p < 0.05). Reintervention rate was 7.3% (DPAE) vs. 14.8% (Disc-FX); DPAE reduced reintervention risk (HR = 0.46, 95%CI 0.20 to 0.99; p = 0.047). Complication rates (6.4% vs. 9.1%) had no statistically significant difference.

DISCUSSION: Disk percutaneous ablation and extraction may offer a more durable minimally invasive treatment option. Future multicenter prospective studies are warranted to further validate its long-term efficacy and define its optimal indications.