Abstract
Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, −46.87 ± 2.71 vs. −15.26 ± 1.97; 3 months, −53.16 ± 2.74 vs. −30.45 ± 2.59; 6 months, −56.22 ± 2.63 vs. −40.26 ± 2.56; 1 year, −65.73 ± 2.24 vs. −36.45 ± 2.86; GEE, P < 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: −9.15 ± 1.06 vs. −4.61 ± 0.53, P < 0.0001) and 1 year (PDD vs. CC: −16.70 ± 0.29 vs. −12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 + 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a “relapse, showing signs of decline in most measurements, whereas PDD patients showed continued stable improvement.
Similar content being viewed by others
References
Alo KM, Wright RE, Sutcliffe J, Brandt SA (2004) Percutaneous lumbar discectomy: clinical response in an initial cohort of fifty consecutive patients with chronic radicular pain. Pain Pract 4(1):19–29
Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99(1–2):41–50
Bonaldi G, Baruzzi F, Facchinetti A, Fachinetti P, Lunghi S (2006) Plasma radio-frequency-based diskectomy for treatment of cervical herniated nucleus pulposus: feasibility, safety, and preliminary clinical results. AJNR Am J Neuroradiol 27(10):2104–2111
Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R (1992) Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 185(1):135–141
Bush K, Chaudhuri R, Hillier S, Penny J (1997) The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine 22(2):183–186
Bush K, Cowan N, Katz DE, Gishen P (1992) The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine 17(10):1205–1212
Chen YC, Lee SH, Saenz Y, Lehman NL (2003) Histologic findings of disc, end plate and neural elements after coblation of nucleus pulposus: an experimental nucleoplasty study. Spine J 3(6):466–470
Choy DS, Ascher PW, Ranu HS, Saddekni S, Alkaitis D, Liebler W, Hughes J, Diwan S, Altman P (1992) Percutaneous laser disc decompression. A new therapeutic modality. Spine 17(8):949–956
Cimbiz A, Bayazit V, Hallaceli H, Cavlak U (2005) The effect of combined therapy (spa and physical therapy) on pain in various chronic diseases. Complement Ther Med 13(4):244–250
Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15(6):602–617
Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) The minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry disability index, Medical Outcomes Study Questionnaire Short Form 36, and pain scales. Spine J
Copay AG, Subach BR, Glassman SD, Polly DW Jr, Schuler TC (2007) Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7(5):541–546
Derby R, Kine G, Saal JA, Reynolds J, Goldthwaite N, White AH, Hsu K, Zucherman J (1992) Response to steroid and duration of radicular pain as predictors of surgical outcome. Spine 17(6 Suppl):S176–S183
Dillin W, Booth R, Cuckler J, Balderston R, Simeone F, Rothman R (1986) Cervical radiculopathy. A review. Spine 11(10):988–991
Fielding JW (1992) Complications of anterior cervical disk removal and fusion. Clin Orthop Relat Res 284:10–13
Flynn TB (1982) Neurologic complications of anterior cervical interbody fusion. Spine 7(6):536–539
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr (2007) Anterior cervical discectomy and fusion associated complications. Spine 32(21):2310–2317
Frederic S, Benedict R, Payer M (2006) Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study. J Neurosurg Spine 4(4):292–299
Gerszten PC, Welch WC, King JT (2006) Quality of life assessment in patients undergoing nucleoplasty-based percutaneous discectomy. J Neurosurg Spine 4(1):36–42
Goldie I (1958) Granulation tissue in the ruptured intervertebral disc. Acta Pathol Microbiol Scand 42(4):302–304
Haden N, Latimer M, Seeley HM, Laing RJ (2005) Loss of inter-vertebral disc height after anterior cervical discectomy. Br J Neurosurg 19(6):469–474
Hauerberg J, Kosteljanetz M, Boge-Rasmussen T, Dons K, Gideon P, Springborg JB, Wagner A (2008) Anterior cervical discectomy with or without fusion with ray titanium cage: a prospective randomized clinical study. Spine 33(5):458-464
Ito T, Yamada M, Ikuta F, Fukuda T, Hoshi SI, Kawaji Y, Uchiyama S, Homma T, Takahashi HE (1996) Histologic evidence of absorption of sequestration-type herniated disc. Spine 21(2):230–234
Kobayashi N, Asamoto S, Doi H, Ikeda Y, Matusmoto K (2003) Spontaneous regression of herniated cervical disc. Spine J 3(2):171–173
Lee SH, Ahn Y, Choi WC, Bhanot A, Shin SW (2006) Immediate pain improvement is a useful predictor of long-term favorable outcome after percutaneous laser disc decompression for cervical disc herniation. Photomed Laser Surg 24(4):508–513
Lee SH, Lee JH, Choi WC, Jung B, Mehta R (2007) Anterior minimally invasive approaches for the cervical spine. Orthop Clin North Am 38(3):327–337
Lees F, Turner JW (1963) Natural history and prognosis of cervical spondylosis. Br Med J 2(5373):1607–1610
Li J, Yan DL, Zhang ZH (2008) Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation. Eur Spine J 17(12):1664–1669
Maigne JY, Deligne L (1994) Computed tomographic follow-up study of 21 cases of nonoperatively treated cervical intervertebral soft disc herniation. Spine 19(2):189–191
Maroon JC (2002) Current concepts in minimally invasive discectomy. Neurosurgery 51(5 Suppl):137–145
Masala S, Massari F, Fabiano S, Ursone A, Fiori R, Pastore F, Simonetti G (2007) Nucleoplasty in the treatment of lumbar diskogenic back pain: one year follow-up. Cardiovasc Intervent Radiol 30(3):426–432
Masui T, Yukawa Y, Nakamura S, Kajino G, Matsubara Y, Kato F, Ishiguro N (2005) Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years. J Spinal Disord Tech 18(2):121–126
Matsumoto M, Chiba K, Ishikawa M, Maruiwa H, Fujimura Y, Toyama Y (2001) Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations. Spine 26(14):1592–1598
Mayer HM (1994) Spine update. Percutaneous lumbar disc surgery. Spine 19(23):2719–2723
Mirzai H, Tekin I, Yaman O, Bursali A (2007) The results of nucleoplasty in patients with lumbar herniated disc: a prospective clinical study of 52 consecutive patients. Spine J 7(1):88–92
Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K (1998) Regression of cervical disc herniation observed on magnetic resonance images. Spine 23(9):990–995
Nardi PV, Cabezas D, Cesaroni A (2005) Percutaneous cervical nucleoplasty using coblation technology. Clinical results in fifty consecutive cases. Acta Neurochir Suppl 92:73–78
Nowakowski A, Kubaszewski L, Kaczmarczyk J (2007) Management of pain syndromes related to cervical herniated disc. Chir Narzadow Ruchu Ortop Pol 72(2):85–88
Onik G, Helms CA, Ginsberg L, Hoaglund FT, Morris J (1985) Percutaneous lumbar diskectomy using a new aspiration probe: porcine and cadaver model. Radiology 155(1):251–252
Pool JJ, Ostelo RW, Hoving JL, Bouter LM, de Vet HC (2007) Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain. Spine 32(26):3047–3051
Quigley MR, Maroon JC (1994) Laser discectomy: a review. Spine 19(1):53–56
Riew KD, Cheng I, Pimenta L, Taylor B (2007) Posterior cervical spine surgery for radiculopathy. Neurosurgery 60(Suppl 1):S57–S63
Riley LH, Jr, Robinson RA, Johnson KA, Walker AE (1969) The results of anterior interbody fusion of the cervical spine. Review of ninety-three consecutive cases. J Neurosurg 30(2):127–133
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine 33(9):940–948
Saal JA (1996) Natural history and nonoperative treatment of lumbar disc herniation. Spine 21(24 Suppl):2S-9S
Saal JA, Saal JS, Herzo RH (1990) The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine 15:683–686
Saal JS, Saal JA, Yurth EF (1996) Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine 21(16):1877–1883
Sharps LS, Isacc Z (2002) Percutaneous disc decompression using nucleoplasty. Pain Physician 5(2):121–126
Singer AJ, Thode HC Jr (1998) Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale. Acad Emerg Med 5(10):1007–1011
Singh V (2004) Percutaneous disc decompression for the treatment of chronic atypical cervical discogenic pain. Pain Physician 7:115–118
Singh V, Piryani C, Liao K (2004) Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study. Pain Physician 7(4):419–425
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J.Bone Joint Surg Am 40-A(3):607–624
Smith LW (1986) Enzyme dissolution of nucleus pulposus in humans. Clin Orthop Relat Res 206:4–9
Splendiani A, Puglielli E, De Amicis R, Barile A, Masciocchi C, Gallucci M (2004) Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. Neuroradiology 46(11):916–922
Teplick JG, Haskin ME (1985) Spontaneous regression of herniated nucleus pulposus. AJR Am J Roentgenol 145(2):371–375
Tew JM Jr, Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23:424–434
Tewarie RDSN, Bartels RHMA, Peul WC (2007) Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J 16(9):1411–1416
der van Haven I, van Loon PJ, Bartels RH, van Susante JL (2005) Anterior cervical interbody fusion with radiolucent carbon fiber cages: clinical and radiological results. Acta Orthop Belg 71(5):604–609
Vernon H, Mior S (1991) The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 14(7):409–415
Ware JE, Kosinski M (2001) Interpreting SF-36 summary health measures: a response. Qual Life Res 10(5):405–413
Ware JE Jr, Kosinski M (2005) SF-36 Physical & mental health summary scales: a manual for users of version 1. Second
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483
Weber H, Holme I, Amlie E (1993) The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine 18(11):1433-1438
Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M (2002) French translation and validation of 3 functional disability scales for neck pain. Arch Phys Med Rehabil 83(3):376–382
Yakovlev A, Tamimi MA, Liang H, Eristavi M (2007) Outcomes of percutaneous disc decompression utilizing nucleoplasty for the treatment of chronic discogenic pain. Pain Physician 10(2):319–328
Yonenobu K (2000) Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment? Eur Spine J 9(1):1–7
Zoega B, Karrholm J, Lind B (2000) Outcome scores in degenerative cervical disc surgery. Eur Spine J 9(2):137–143
Acknowledgments
The author would like to thank the ArthroCare Corporation for a financial grant that covering the cost of clerical staff to collect data, as well as Tami Crabtree for performing statistical analysis, and Nik Sawe for technical writing assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cesaroni, A., Nardi, P.V. Plasma disc decompression for contained cervical disc herniation: a randomized, controlled trial. Eur Spine J 19, 477–486 (2010). https://doi.org/10.1007/s00586-009-1189-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-009-1189-0