Quality of life assessment in patients undergoing nucleoplasty-based percutaneous discectomy.
OBJECTIVE
Nucleoplasty is a minimally invasive surgical procedure for disc decompression developed to treat patients with symptomatic contained herniated discs. Nucleoplasty uses nonheat-driven radiofrequency energy to ablate and coagulate the disc nucleus via a percutaneous "discography" trajectory under fluoroscopic guidance. In this study the authors evaluated pain, functioning, and quality of life (QOL) in patients with radicular leg and back pain who underwent nucleoplasty-based percutaneous disc decompression.


METHODS
The study was designed as a prospective nonrandomized longitudinal cohort study in an academic medical center. Sixty-seven patients (mean age 41 years) with primarily radicular pain due to a contained disc herniation underwent nucleoplasty-based decompression in an outpatient setting. Patients completed the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey, EuroQol 5D (EQ5D), and a visual analog scale (VAS) for pain preoperatively, and at 3 and 6 months after surgery. Postoperative QOL differences were assessed using the Wilcoxon signed-rank test. A surgical probe, the Perc-DLE SpineWand, was placed percutaneously into the disc after application of a local anesthetic or induction of general anesthesia to remove part of the disc (that is, a percutaneous discectomy). Nucleoplasty-treated levels were L2-3 (one case), L3-4 (five cases), L4-5 (44 cases), and L5-S 1 (40 cases); there were 22 multiple treatment levels and 42 bilateral treatments. There were no infections or nerve root injuries associated with the procedure. Compared with preoperative QOL, there was a statistically significant improvement in QOL at 3 months as measured using the SF-36 Physical Component Summary (PCS) scale (mean score improvement 4.4 [p = 0.014]), the EQ5D (mean score improvement 0.22 [p = 0.001]), and the VAS for pain (mean score improvement 0.13 [p = 0.021). Six-month results in 36 patients continued to reflect improvement as measured using the SF-36 PCS (mean score improvement 7.6 [p = 0.002]) and the EQ5D (mean score improvement 0.27 [p = 0.001]).


CONCLUSIONS
Nucleoplasty-based percutaneous disc decompression in patients with symptomatic contained disc herniations is safe and improves QOL as measured by the SF-36, EQ5D, and VAS for pain, three generic QOL outcome instruments. Nucleoplasty is an effective minimally invasive surgical treatment alternative in patients with symptomatic contained disc hemiations. Further follow-up evaluation is underway to determine the durability of QOL improvement after nucleoplasty.
Gerszten
Peter C
PC
Department of Neurosurgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Healthcare System, Pennsylvania, USA. gersztenpc@upmc.edu
Welch
William C
WC
King
Joseph T
JT
D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D019299:Decompression, Surgical / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011788:Quality of Life; D011843:Radiculopathy / Q000209:etiology