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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

Pain recurrence in the follow up period (number of cases)
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Figure 4: Pain recurrence in the follow up period (number of cases)

Mentions: There were 27 male and 23 female with follow up mean follow up of 114 months (range 103–130 months) with a mean age was 52 years (range 26–74 years) [Table-1]. In 36 cases were the radiculopathy was not clearly identifiable with the dermatome and MR objective degeneration in consecutive levels a provocative discography was performed previous to the surgery to confirm that the disc is the cause of low back, pseudoradicular and radicular pain. Twenty-four patients presented with acute and continuous pain symptomatology of <12 weeks duration, the rest of patients have more than 12 weeks. From these 24 patients who have more than 12 weeks of pain, four patients presented with only intermittent radicular pain, 10 patients presented with intermittent low back and radicular pain and 12 patients presented with continuous low back and radicular pain partially responding to conservative management. In all patients, intervention was performed at L4-L5 level. Nine patients had previous L5-S1 surgery discectomy or arthrodesis. Forty-five patients showed clinical improvement within 72 hours. Fifteen patients presented with recurrence in pain within 30 days and were needed another type of treatment. 12 months post-intervention 27 patients had improvement in VAS of pain five points and 24 patients ODI 9.2 [Table 2]. 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. At 48 months the VAS was 4.2 and OS was 7. At 72 months the VAS was 4.8 and OS was 7 and we repeat the proceeding in two cases at the same level and two patients how has L5-S1 surgery previously to the proceeding go to surgery for rigid fixation from L4 to S1 level one in our hospital and one in another center. At 84 months follow up three patients more was operated for L4-L5, one case from previously L5-S1 and he receive a L4-S1 rigid fixation, and another two cases from L4 to L5 nucleoplasty in one case we do a simple discectomy and in another one a L4-L5 discectomy and L4-L5 and insertion of interespinous Coflex device. One and half year later this last patient underwent rigid arthrodesis of L4-L5. Analgesic consumption was reintroduced in 80% of the cases after 7 years follow up. Ten patients continue to be asymptomatic after 114 months of intervention [Figure 4]. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.


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)

Pain recurrence in the follow up period (number of cases)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Pain recurrence in the follow up period (number of cases)
Mentions: There were 27 male and 23 female with follow up mean follow up of 114 months (range 103–130 months) with a mean age was 52 years (range 26–74 years) [Table-1]. In 36 cases were the radiculopathy was not clearly identifiable with the dermatome and MR objective degeneration in consecutive levels a provocative discography was performed previous to the surgery to confirm that the disc is the cause of low back, pseudoradicular and radicular pain. Twenty-four patients presented with acute and continuous pain symptomatology of <12 weeks duration, the rest of patients have more than 12 weeks. From these 24 patients who have more than 12 weeks of pain, four patients presented with only intermittent radicular pain, 10 patients presented with intermittent low back and radicular pain and 12 patients presented with continuous low back and radicular pain partially responding to conservative management. In all patients, intervention was performed at L4-L5 level. Nine patients had previous L5-S1 surgery discectomy or arthrodesis. Forty-five patients showed clinical improvement within 72 hours. Fifteen patients presented with recurrence in pain within 30 days and were needed another type of treatment. 12 months post-intervention 27 patients had improvement in VAS of pain five points and 24 patients ODI 9.2 [Table 2]. 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. At 48 months the VAS was 4.2 and OS was 7. At 72 months the VAS was 4.8 and OS was 7 and we repeat the proceeding in two cases at the same level and two patients how has L5-S1 surgery previously to the proceeding go to surgery for rigid fixation from L4 to S1 level one in our hospital and one in another center. At 84 months follow up three patients more was operated for L4-L5, one case from previously L5-S1 and he receive a L4-S1 rigid fixation, and another two cases from L4 to L5 nucleoplasty in one case we do a simple discectomy and in another one a L4-L5 discectomy and L4-L5 and insertion of interespinous Coflex device. One and half year later this last patient underwent rigid arthrodesis of L4-L5. Analgesic consumption was reintroduced in 80% of the cases after 7 years follow up. Ten patients continue to be asymptomatic after 114 months of intervention [Figure 4]. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.

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