Abstract
Purpose
The spine is an important source of pain and disability, affecting two thirds of adults at some time in their lives. Treatment in these patients is mainly conservative medical management, based on medication, physical therapy, behavioral management, and psychotherapy, surgery being limited to elective cases with neurologic deficits. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful diskal protrusions and contained herniations.
Methods
From February 2004 to October 2005, 72 patients (48 men, 24 women; mean age 48 years) affected by lumbar disk herniation were treated with nucleoplasty coblation. All patients were evaluated clinically and with radiography and MRI in order to confirm the presence of lumbalgic and/or sciatalgic pain, in the absence of major neurologic deficit and with lack of response after 6 weeks of conservative management.
Results
Average preprocedural pain level for all patients was 8.2 (on a visual analog scale of 1 to 10), while the average pain level at 12 months follow-up was 4.1. At the 1 year evaluation, 79% of patients demonstrated a statistically significant improvement in numeric pain scores (p < 0.01): 17% (12 patients) were completely satisfied with complete resolution of symptoms, and 62% (43 patients) obtained a good result.
Conclusion
Our data indicate that nucleoplasty coblation is a promising treatment option for patients with symptomatic disk protrusion and herniation who present with lumbalgic and/or sciatalgic pain, have failed conservative therapies, and are not considered candidates for open surgery.
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References
Olmarker K, Rydebik B (1991) Pathophysiology of sciatica. Orthop Clin North Am 22:223–234
Kirkald-Willis WH (1999) Pathology and pathogenesis of the low back pain. In: Bernard T Jr (ed) Managing low back pain, 4th edn. Churchill Livingstone, Philadelphia, pp 65–95
Dworkin GE (2002) Advanced concepts in interventional spine care. J Am Osteopath Assoc 102S:8–11
Nardi PV, Cabezas D, Cesaroni A (2005) Percutaneous cervical nucleoplasty using coblation technology: Clinical results in fifty consecutive cases. Acta Neurochir Suppl 92:73–78
Alexandre A, Coro L, Azuelos A, Pellone M (2005) Percutaneous nucleoplasty for discoradicular conflict. Acta Neurochir 92:83–86
Cohen SP, Williams S, Kurihara C, Griffith S, Larkin TM (2005) Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc. J Spinal Disord Tech 18S:119–124
Marin FZ (2005) CAM versus nucleoplasty. Acta Neurochir Suppl 92S:111–114
Welch WC, Gerszten PC (2002) Alternative strategies for lumbar discectomy: Intradiscal electrothermy and nucleoplasty. Neurosurg Focus 13:E7
Kelekis AD, Somon T, Yilmaz H, et al. (2005) Interventional spine procedures. Eur J Radiol 55:362–383
Bogduk N (1995) Discography. In: Aprilo C, Darby R, White AH, Schofferman JA (eds) Spine care. Mosby-Year Book, St Louis, pp 219–239
Fortin J (1995) Lumbar and thoracic discography with CT and MRI correlations. In: Lennard TA (ed) Physiatric procedures and clinical practice. Hanley & Belfus, Philadelphia
Carragee EJ, Lincoln T, Parmar VS, Alamin T (2006) A gold standard evaluation of the “discogenic pain” diagnosis as determined by provocative discography. Spine 31:2115–2123
Nau WH, Diederich CJ (2004) Evaluation of temperature distributions in cadaveric lumbar spine during nucleoplasty. Phys Med Biol 49:1583–1594
Weinstein J (1990) Recent advances in the neurophysiology of pain. Phys Med Rehabil: State of the Art Reviews 4:201–220
Manchikanti L, Pampati V, Fellows B, et al. (2001) Characteristics of chronic low back pain in patients in an interventional pain management setting: A prospective evaluation. Pain Physician 4:131–142
Nachemson AL (1976) Advances in low-back pain. Clin Orthop Relat Res Nov 200:266–278
Saal JA (1990) The role of inflammation in lumbar pain. Phys Med Rehabil: State of the Art Reviews 4:191–200
Woodward J (1995) Epidural procedures in spine pain management. In: Lennard TA (ed) Physiatric procedures and clinical practice. Hanley & Belfus, Philadelphia, pp 260–291
Dreyfuss P (1995) Zygapophyseal joint injection techniques in the spinal axis. In: Lennard TA (ed) Physiatric procedures and clinical practice. Hanley & Belfus, Philadelphia
Manchikanti L, Pampati V, Bakhit CE, et al. (2001) Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: A randomized clinical trial. Pain Physician 4:101–117
Manchikanti L, Pampati V, Fellows B, Rivera J, Beyer CD, Damron KS (2001) Role of one day epidural adhesiolysis in management of chronic low back pain: A randomized clinical trial. Pain Physician 4:153–166
Slipman CW, Zacharia I (2001) The role of diagnostic selective nerve root blocks in the management of spinal pain. Pain Physician 4:214–226
Choy DSJ, Ascher PW, Saddekni S, et al. (1992) Percutaneous laser disc decompression: A new therapeutic modality. Spine 17:949–956
Andreula C, Muto M, Leonardi M (2004) Interventional spinal procedures [review]. Eur J Radiol 50:112–119
Saal JA (1990) Intervertebral disc herniation: Advances in nonoperative treatment. Phys Med Rehabil: State of the Art Reviews 4:214–227
Schrieber A, Suezawa Y (1986) Transdiscoscopic percutaneous nucleotomy in disc herniation. Orthop Rev 15:75–78
Onesti ST (2004) Failed back syndrome [review]. Neurologist 10:259–264
Anderson PA, Rouleau JP (2004) Intervertebral disc arthroplasty. Spine 29: 2779–2786
Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N (1995) The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 20:1878–1883
Sprangfort EV (1972) The lumbar disc herniation: A computer aided analysis of 2504 operations. Acta Orthop Scand 142:1–93
Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans. JAMA 187:137–140
Gill K (1993) Percutaneous lumbar discectomy. Am Acad Orthop Surg 1:33–40
Kamlin P, Brager MD (1987) Percutaneous posterolateral discectomy: Anatomy and mechanism. Clin Orthop 223:145–154
Choy DSJ, Case RB, Fielding JW, et al. (1987) Percutaneous laser nucleolysis of the lumbar disc. N Engl J Med 317:771–772
Liebler WA (1995) Percutaneous laser disc nucleotomy. Clin Orthop 310:58–66
Saal JA, Saal JS (2000) Intradiscal electrothermal treatment for chronic discogenic low back pain: A prospective outcome study with minimum 1-year follow-up. Spine 25:2622–2627
Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC (2005) A randomized, double-blind, controlled trial: Intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine 30:2369–2377
Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M (2003) Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol 24:996–1000
Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disk by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol 31:183–189
Wang JC, Kabo JM, Tsou PM, Halevi L, Shamie AN (2005) The effect of uniform heating on the biomechanical properties of the intervertebral disc in a porcine model. Spine J 5:64–70
Chen YC, Lee SH, Saenz Y, Lehman NL (2003) Histologic findings of disc, end plate and neural elements after coblation of nucleus pulposus: An experimental nucleoplasty study. Spine J 3:466–470
Chen YC, Lee SH, Chen D (2003) Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers. Spine 28:661–665
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Masala, S., Massari, F., Fabiano, S. et al. Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up. Cardiovasc Intervent Radiol 30, 426–432 (2007). https://doi.org/10.1007/s00270-006-0223-4
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DOI: https://doi.org/10.1007/s00270-006-0223-4