title: Current evidence of percutaneous nucleoplasty for the cervical herniated disk: a systematic review.
abstract: BACKGROUND
  Although percutaneous cervical nucleoplasty (PCN) has been shown to be both safe and effective, its application is still debated. PCN applied in disk herniation has not been systematically reviewed before, resulting in a limited insight into its effectiveness and safety, and the quality of available evidence. Therefore, we systematically reviewed the evidence on the efficacy and safety of PCN in patients with a (contained) herniated disk.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library (Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and nonrandomized studies using the following keywords: "Nucleoplasty," "Cervical," "Hernia," "Herniation," "Prolapse," "Protrusion," "Intervertebral disk," and "Percutaneous disk decompression." First, all articles were appraised for methodological quality, and then, RCTs were graded for the level of evidence according a best-evidence synthesis, because a meta-analysis was not possible. Finally, the RCTs' applicability and clinical relevance also was assessed.
  
  
  RESULTS
  Of 75 identified abstracts, 10 full-text articles were included (3 RCTs and 7 nonrandomized studies). These studies represented a total of 1021 patients: 823 patients (≥ 892 disks) were treated by PCN. All studies showed low methodological quality, except for two. The level of evidence of the RCTs was graded as moderate, with low to moderate applicability and clinical relevance.
  
  
  CONCLUSIONS
  All included studies showed PCN to be an effective and safe procedure in the treatment of (contained) herniated disks at short-, mid-, and long-term follow-up. However, the level of evidence is moderate and shows only low to moderate applicability and clinical relevance.
authors.affiliation: Department of Orthopedic Surgery, St. Anna Hospital, Geldrop, The Netherlands.
authors.forename: Jorgen A
authors.initials: JA
authors.lastname: Wullems
authors.forename: Willy
authors.initials: W
authors.lastname: Halim
authors.forename: Walter
authors.initials: W
authors.lastname: van der Weegen
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D017587:Diskectomy, Percutaneous / Q000009:adverse effects; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
keywords: cervical herniated disk; cervical pain; coblation; neck pain; nucleoplasty; percutaneous nucleoplasty; systematic review