Advertisement

Nucleoplasty as an Alternative Intradiscal Therapy: Indications and Technique

  • Koang Hum Bak
  • Seong Hoon Oh
  • Jae Min Kim
  • Hyeong Joong Yi
  • Cheong Jin Hwan
  • Choong Hyun Kim
Conference paper

Summary

This study was designed to determine the outcome of treatment of herniated intervertebral discs with Nucleoplasty (Arthrocare Spine, Sunnyvale, CA, USA). Nucleoplasty, a minimally invasive procedure for treating the contained herniated intervertebral discs, was introduced recently. Nucleoplasty utilizes coblation technology for ablating and coagulating soft tissue for partial disc removal. Sixty-five patients underwent Nucleoplasty at Hanyang University Hospital from August 2000. All patients had axial pain, and 49 patients had accompanying radiating pain in the leg. The mean follow-up period was 6.2 months. Fifty-six patients underwent the one-level procedure, and nine patients underwent the two-level procedure. The operated levels were L2-3 in 4 cases, L3-4 in 3 cases, L4-5 in 36 cases, and L5-S in 3 cases. The average operation time was 46 min. Most patients underwent the procedure under local anesthesia and were discharged on the same day or the next day. Ruptured or migrated disc herniations, spinal stenosis, previous major spinal surgery, and definite radiological spinal instability were contraindications. A visual analogue scale (VAS) and the MacNab classification were used to measure symptoms at each visit. The subjects were 27 men and 19 women, with a mean age of 38.5 years at the time of surgery. The surgical results according to the MacNab classification were excellent or good in 54 cases, fair in 6 cases, and poor in 5 cases. The mean VAS score was 7.5 at the time of surgery and 2.2 at 1 month after the procedure. Most patients showed symptom improvement 1 or 2 days after surgery. Difficulties were found in targeting into and navigating in the L5-S level. Three patients underwent open discectomy and one patient received an epidural steroid injection during the follow-up period. One case of discitis was treated with intravenous antibiotics as a surgery-related complication. These results indicate that Nucleoplasty is a new and reliable addition to the armamentarium of minimally invasive disc surgery for contained herniated intervertebral discs. Patient selection is the most important key to successful surgical results.

Key words

Herniated intervertebral disc Intradiscal therapy Minimally invasive spine surgery Nucleoplasty 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kim YS, Roh SW, Yoon DH, et al (1994) Percutaneous automated discectomy using nucleotome in lumbar disc herniation. J Kor Neurosurg Soc 23:625–629Google Scholar
  2. 2.
    Maroon JC, Onik G (1987) Percutaneous discectomy: a new method for lumbar disc removal. J Neurosurg 66:143–146PubMedGoogle Scholar
  3. 3.
    Onik G (1985) Percutaneous lumbar discectomy using a new aspiration probe. Am J Neuroradiol 6:290–296Google Scholar
  4. 4.
    Onik G, Helms CA, Ginsberg L, et al (1985) Percutaneous lateral discectomy using a new aspiration probe: porcine and cadaver model. Radiology 155:251–252PubMedGoogle Scholar
  5. 5.
    Onik G, Mooney V, Maroon JC, et al (1990) Automated percutaneous discectomy: a prospective multi-institutional study. Neurosurgery 26:228–233PubMedGoogle Scholar
  6. 6.
    Javid MJ, Nordby EJ, Ford LT, et al (1983) Safety and efficacy of chymopapain in herniated nucleus pulposus with sciatica. JAMA 249:2489–2494CrossRefPubMedGoogle Scholar
  7. 7.
    Onofrio BM (1975) Injection of chymopapain into intervertebral disc: preliminary report on 72 patients with symptoms of disc disease. J Neurosurg 42:384–388PubMedGoogle Scholar
  8. 8.
    Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans. JAMA 187:137–140PubMedGoogle Scholar
  9. 9.
    Choy DSJ, Ascher PW, Saddeking S (1992) Percutaneous laser disc decompression. Spine 17:949–956PubMedGoogle Scholar
  10. 10.
    Mayer HM, Brock M (1987) Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:216–225Google Scholar
  11. 11.
    Saal JS, Saal JA (2000) Management of chronic discogenic low back pain with a thermal intradiscal catheter. Spine 25:382–388CrossRefPubMedGoogle Scholar
  12. 12.
    MacNab I (1971) Negative disc exploration: an analysis of the cause of nerve-root involvement in sixty-eight patients. J Bone Joint Surg 58:891–903Google Scholar
  13. 13.
    Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215Google Scholar
  14. 14.
    Watts C (1977) Complications of chemonucleolysis for human disc disease. J Neurosurg 1:2–5Google Scholar
  15. 15.
    Park KW, Cho KG (1989) Chemonucleolysis versus percutaneous automated discectomy using nucleotome. J Kor Neurosurg Soc 18:439–446Google Scholar
  16. 16.
    Williams RW (1978) Microlumbar discectomy. Spine 3:175–182PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Koang Hum Bak
    • 1
  • Seong Hoon Oh
    • 1
  • Jae Min Kim
    • 1
  • Hyeong Joong Yi
    • 1
  • Cheong Jin Hwan
    • 1
  • Choong Hyun Kim
    • 1
  1. 1.Department of NeurosurgeryHanyang University HospitalSeoulKorea

Personalised recommendations