Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc.
OBJECTIVE
In industrialized societies, the prevalence of radicular low back pain has exploded in recent years. The growing economic and personal costs of this challenging entity have led to the development of a wide array of new treatments, ranging from pharmacotherapy with neuropathic medications to open surgical treatment. Among the therapeutic options to emerge are a plethora of minimally invasive treatments aimed at removing nuclear material and lowering intradiscal pressure through devices inserted percutaneously into intervertebral discs. Yet there is a compelling lack of clinical evidence to support the use of these procedures. This study was undertaken to determine the treatment outcomes of 16 consecutive patients with lumbar radicular pain secondary to a herniated disc who underwent nucleoplasty as their primary therapy.


METHODS
Included in this series were nine patients with significant axial back pain, sitting intolerance, and positive discography who also underwent intradiscal electrothermal therapy (IDET). Among the 7 patients who only had nucleoplasty, 4 had 2 discs treated and 3 had 1 disc. In the 9 patients who also had IDET, 6 had 1 disc treated and 3 had 2 discs treated. Of the 32 total disc treatments, 20 were at L5-S1, 10 were at L4-5 and 2, one each for IDET and nucleoplasty, were at L3-4.


RESULTS
In the overall cohort, the average Visual Analogue Scale (VAS) pain score decreased from 6.7 to 5.6 at a mean follow-up of 9 months. In the seven patients who underwent only nucleoplasty, the mean VAS score decreased from 6.0 to 4.8. Only one patient reported a >/=50% reduction in pain score.


CONCLUSIONS
We conclude that with use of the present selection criteria, nucleoplasty is not an effective long-term treatment for lumbar radiculopathy, either alone or with IDET. Before conducting future clinical trials, we recommend modifying these criteria to include only those patients with small (<6-mm) contained disc herniations whose annular integrity is documented by computed tomography discography and corresponding radicular symptoms confirmed by either selective nerve root blocks or electromyography and nerve conduction studies.
Cohen
Steven P
SP
Pain Management Center, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. spc5_2000@yahoo.com
Williams
Shawn
S
Kurihara
Connie
C
Griffith
Scott
S
Larkin
Thomas M
TM
D000328:Adult; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006772:Hospitals, Military / Q000706:statistics & numerical data / Q000639:trends; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007404:Intervertebral Disc Chemolysis / Q000379:methods* / Q000706:statistics & numerical data; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome