Introduction: The clinical course after percutaneous epidural neuroplasty (PEN) among the different types of HLD is not well documented. The purpose of this study is to determine whether treatment outcome is affected by the type of HLD and to evaluate effectiveness of PEN in single level HLD.

Methods: A consecutive series of 430 patients who underwent PEN for single level HLD were included in this study. Preoperatively, all patients were categorized into bulging (B), protrusion (P), extrusion (E) and sequestration (S) with Pfirrmann grade (G0 to G3). Visual analog scale (VAS) score, SF-12 and Odom’s criteria were measured in preoperative and scheduled postoperative follow-up period (1, 3, 6 and 12 months).

Results: There was no significant difference in treatment outcomes according to the type of HLD (p>0.05) except more decreased in VAS (leg) in E and S groups than in B and P groups (0<0.05). Subsequent surgery was considered in 59 patients (13.7%), and the operation was more frequently observed in E and S than B and P and in G1 to G3 than G0. Mean back pain and leg pain VAS of total follow-up patients were decreased respectively, from 6.90 and 4.23 in preoperative to 2.25 and 1.45 in 1 month, to 2.61 and 1.68 in 3 months, to 2.28 and 1.48 in 6 months, and to 2.88 and 1.48 in 12 months after PEN (p<0.001). More than 70% of all patients with PEN showed good and excellent Odom’s criteria during 12 months follow-up, and more than 70% of patients with E and S type of HLD doesn’t needed surgical treatment.

Conclusions: The efficacy of PEN was not differently affected by the different type of HLD. PEN is a safe and effective treatment for back and leg pain due to single level HLD in 12 months follow-up study.

Patient Care: Percutaneous epidural neurolplasty is a safe and effective treatment for back and leg pain due to single level HLD in 12 months follow-up study, and could applicable in patients with single level HLD without considering the type of HLD.

Learning Objectives: More than 70% of all patients with PEN showed good and excellent Odom’s criteria during 12 months follow-up, and more than 70% of patients with HLD could prevent from surgical treatment.

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