Nucleoplasty in the treatment of lumbar diskogenic back pain: one year follow-up.
OBJECTIVE
The spine is an important source of pain and disability, affecting two thirds of adults at some time in their lives. Treatment in these patients is mainly conservative medical management, based on medication, physical therapy, behavioral management, and psychotherapy, surgery being limited to elective cases with neurologic deficits. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful diskal protrusions and contained herniations.


METHODS
From February 2004 to October 2005, 72 patients (48 men, 24 women; mean age 48 years) affected by lumbar disk herniation were treated with nucleoplasty coblation. All patients were evaluated clinically and with radiography and MRI in order to confirm the presence of lumbalgic and/or sciatalgic pain, in the absence of major neurologic deficit and with lack of response after 6 weeks of conservative management.


RESULTS
Average preprocedural pain level for all patients was 8.2 (on a visual analog scale of 1 to 10), while the average pain level at 12 months follow-up was 4.1. At the 1 year evaluation, 79% of patients demonstrated a statistically significant improvement in numeric pain scores (p < 0.01): 17% (12 patients) were completely satisfied with complete resolution of symptoms, and 62% (43 patients) obtained a good result.


CONCLUSIONS
Our data indicate that nucleoplasty coblation is a promising treatment option for patients with symptomatic disk protrusion and herniation who present with lumbalgic and/or sciatalgic pain, have failed conservative therapies, and are not considered candidates for open surgery.
Masala
Salvatore
S
Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy. salva.masala@tiscali.it
Massari
Francesco
F
Fabiano
Sebastiano
S
Ursone
Antonio
A
Fiori
Roberto
R
Pastore
Francesco
F
Simonetti
Giovanni
G
D000328:Adult; D017587:Diskectomy, Percutaneous / Q000295:instrumentation*; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015641:Radiography, Interventional / Q000295:instrumentation*; D012585:Sciatica / Q000000981:diagnostic imaging / Q000601:surgery*