Nucleoplasty as an Alternative Intradiscal Therapy: Indications and Technique
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 wordsHerniated intervertebral disc Intradiscal therapy Minimally invasive spine surgery Nucleoplasty
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