Percutaneous Disc Radiofrequency Versus Spinal Instrumented Fixation and Fusion in the Management of Refractory Axial Pain in Single-Level Lumbar Disc Degeneration

Background: Lumar disc degeneration has been estimated to account for approximately 39 Methods: This is a retrospective analysis of the data of patients who underwent single-level PLIF or PIRFT augmented with lumbar facet medial branch nerve ablation for persistent disabling LBP refractory to conservative treatment. In total, 18 patients had the minimally invasive percutaneous intradiscal radiofrequency procedure (Group 1), while the remaining 14 patients underwent PLIF (Group 2). Data analyzed included demographic characteristics, such as sex, age, level operated, duration of preoperative conservative treatment, preoperative radiological score for the presence of microinstability or dysfunctional level, follow-up duration, and complications. The clinical outcome was assessed using Visual Analog Score (VAS) for LBP and Oswestry Disability Index (ODI), which were documented for each case preoperatively, at the third postoperative month, and the final follow-up. Results: The demographic data, preoperative radiological scores for microinstability, duration of conservative management, and complications were comparable between both groups. There was a significant difference between both groups as regards the hospital stay in favor of Group 1, which had a mean of 0.61 ± 0.2 (0.5–1) day, while in Group 2, it was 2.86 ± 0.95 (2–5) days. At the final follow-up, both groups showed significant improvement in the LBP VAS and ODI compared to the preoperative. However, in favor of Group 2, Group 1 had significantly higher VAS (5.8 ± 1.1) and ODI (19.7 ± 5.58) than VAS (3.6 ± 0.94) and ODI (13.6 ± 3.25) in Group 2. Conclusion: All patients with persistent discogenic LBP should be thoroughly assessed for the presence of microinstability or dysfunctional discs. PIRFT had the advantage of a significantly shorter hospital stay. Both PIRFT and PLIF provided initial pain relief. Still, the improvement of postoperative VAS and ODI scores was maintained, and the final follow-up in the PLIF group was significantly better.