経皮的椎間板減圧術におけるDisc-FXとL'DISQの比較：最小臨床重要差を用いたパイロット比較研究

Lumbar disc herniation often causes disabling radicular pain and impaired quality of life (QOL). Disc-FX and L'DISQ are minimally invasive percutaneous disc decompression devices, but their comparative efficacy remains uncertain.

We retrospectively reviewed adults with single-level lumbar disc herniation treated with Disc-FX or L'DISQ at a single centre (October 2018-August 2023). Eligibility required radicular pain consistent with magnetic resonance imaging and either positive provocative discography or pain relief after intradiscal injection. Pain intensity (Numerical Rating Scale [NRS]) and QOL (EuroQOL 5-Dimension 5-Levels [EQ-5D-5 L]) were assessed at baseline and up to 6 months. The primary outcome was the between-group difference in change in NRS from baseline to 6 months. Secondary outcomes included 6-month change in EQ-5D-5 L and minimal clinically important difference (MCID) attainment (NRS ≥ 2-point reduction; EQ-5D-5 L ≥ 0.08 increase).

Forty-two patients were included (Disc-FX n = 16; L'DISQ n = 26). Both procedures reduced NRS pain scores over 6 months, and the primary outcome showed no statistically significant between-group difference (mean difference 1.32 points; 95% CI - 0.36 to 3.01). Among patients with baseline EQ-5D-5 L data (n = 38), Disc-FX showed greater 6-month EQ-5D-5 L improvement (mean difference 0.134; 95% CI 0.013 to 0.255) and higher EQ-5D-5 L MCID attainment (83.3% vs. 50.0%), but these are secondary results from a small retrospective cohort.

In this pilot study, Disc-FX and L'DISQ had comparable short-term pain outcomes. Any apparent QOL advantage with Disc-FX should be interpreted cautiously as exploratory and potentially confounded, and requires confirmation in adequately powered prospective comparative studies.