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One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy.

Cincu R, Lorente Fde A, Gomez J, Eiras J, Agrawal A - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Analgesic consumption was reduced or stopped in 90% of these cases after 1 year.Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity.In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University General Hospital, Valencia, Spain.

ABSTRACT

Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.

Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.

Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105-130 months) with a mean age was 52 years (range 26-74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3-4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.

Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopic view of the position of the needle in disc space
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Figure 3: Fluoroscopic view of the position of the needle in disc space

Mentions: The present retrospective study included 50 patients who underwent intradiscal cool ablation therapy for symptomatic but contained lumbar degenerative disc disease. The inclusion criteria in this group were patient with one symptomatic contained, focal herniated lumbar disc, with age between 18 years and 75 years old with a visual analogue pain scale (VAS) for radicular pain of seven or greater on a scale of 0–10. The radicular pain concordant with image findings (magnetic resonance imaging (MRI) or computed tomography) and the disc herniation must be no >1/3 the sagittal diameter of the spinal canal. In every case the conservative management including medications, physical therapy and epidural steroid injections documented as ineffective. The exclusion criteria were previous spinal surgery at the level to be treated, patient is morbidly obese (body mass index >40) or have spinal fracture, tumor or infection, the back pain greater than radicular (leg) pain or radicular pain originating from more than one disc level or radiological evidence of severe stenosis at the level to be treated, radiological evidence of spondylolisthesis at the level to be treated, severe disc degeneration (with >50% loss of disc height), evidence of extruded or sequestered disc herniation on MRI, patients who had clinical evidence of cauda equina syndrome or progressive neurological deficit and allergy to the contrast media or drugs to be used in the procedure. The data were collected, and response to the cool ablation both immediate and at follow up was analyzed. Relief of low back pain, leg pain and numbness after the operation were assessed using VAS, function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed every year. Reduction in analgesic treatment was also recorded. The procedure was performed under local anesthesia. In all cases, the percutaneous approach to the ipsilateral side was used [Figures-1,2 and 3].


One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy.

Cincu R, Lorente Fde A, Gomez J, Eiras J, Agrawal A - Asian J Neurosurg (2015 Jan-Mar)

Fluoroscopic view of the position of the needle in disc space
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352623&req=5

Figure 3: Fluoroscopic view of the position of the needle in disc space
Mentions: The present retrospective study included 50 patients who underwent intradiscal cool ablation therapy for symptomatic but contained lumbar degenerative disc disease. The inclusion criteria in this group were patient with one symptomatic contained, focal herniated lumbar disc, with age between 18 years and 75 years old with a visual analogue pain scale (VAS) for radicular pain of seven or greater on a scale of 0–10. The radicular pain concordant with image findings (magnetic resonance imaging (MRI) or computed tomography) and the disc herniation must be no >1/3 the sagittal diameter of the spinal canal. In every case the conservative management including medications, physical therapy and epidural steroid injections documented as ineffective. The exclusion criteria were previous spinal surgery at the level to be treated, patient is morbidly obese (body mass index >40) or have spinal fracture, tumor or infection, the back pain greater than radicular (leg) pain or radicular pain originating from more than one disc level or radiological evidence of severe stenosis at the level to be treated, radiological evidence of spondylolisthesis at the level to be treated, severe disc degeneration (with >50% loss of disc height), evidence of extruded or sequestered disc herniation on MRI, patients who had clinical evidence of cauda equina syndrome or progressive neurological deficit and allergy to the contrast media or drugs to be used in the procedure. The data were collected, and response to the cool ablation both immediate and at follow up was analyzed. Relief of low back pain, leg pain and numbness after the operation were assessed using VAS, function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed every year. Reduction in analgesic treatment was also recorded. The procedure was performed under local anesthesia. In all cases, the percutaneous approach to the ipsilateral side was used [Figures-1,2 and 3].

Bottom Line: Analgesic consumption was reduced or stopped in 90% of these cases after 1 year.Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity.In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University General Hospital, Valencia, Spain.

ABSTRACT

Objectives: Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.

Methods: In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.

Results: There were 27 male and 23 female with followup mean follow up of 115 months (range 105-130 months) with a mean age was 52 years (range 26-74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3-4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.

Conclusions: Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

No MeSH data available.


Related in: MedlinePlus