Percutaneous disc decompression using nucleoplasty.
The objective of this study was to evaluate the effectiveness of Nucleoplasty for decompression of contained herniated discs, in a prospective, single site study that evaluated 49 consecutive patients with complaints of back with or without leg pain secondary to a contained focal protrusion. Access to the disc was obtained via the posterolateral discography approach, with a 17-gauge introducer needle inserted through the annulus and into the nucleus. The introducer remained in place within the outer annulus during the entire procedure, providing access for the SpineWand into the nucleus. The procedure was performed on an outpatient basis. One month, three month, six-month and twelve month outcomes were assessed by the treating physician and support staff. Success was defined as a minimum 2-point reduction on a Visual Analog Scale (VAS), patient satisfaction, absence of narcotic use, and return to work if not working secondary to back pain. The pre-procedure and post-procedure VAS differences were 4.28 (p<0.001), 4.66 (p<0.001), 4.75 (p<0.001), and 3.3 (p=0.002) at the one month, 3 month, 6 month, and 12 month intervals respectively. Overall, there was a 79% success rate, with 67% success in the group of patients that had previous surgery and 82% success in the group that had no prior surgical intervention. Results indicate that Nucleoplasty may be a promising and efficacious minimally invasive procedure for the treatment of symptoms associated with contained herniated discs. Randomized, controlled studies with subgroup analysis are required to further delineate the role for this procedure.
Sharps
Lewis S
LS
Orthopedic Surgery and Sports Medicine Group, Hospital of University of Pennsylvania, Phoenixville, PA 19460, USA.
Isaac
Zacharia
Z