Percutaneous cervical nucleoplasty using coblation technology. Clinical results in fifty consecutive cases.
Conventional open cervical discectomy, with or without bony fusion, in common neurosurgical knowledge is considered the standard treatment for cervical disc herniation. Percutaneous procedures are minimally invasive and offer decreased morbidity, require no bone graft and promise shorter recuperation time. Nevertheless, candidates for a percutaneous procedure as inclusion criteria must complain of symptoms related to contained herniated disc or focal protrusion. It does not substitute conventional open procedures required for extruded discs. We used the coblation technology for nucleoplasty of the cervical intervertebral discs. Early and long-term effects and/or complications observed with this procedure have not been reported yet. Fifty consecutive patients presenting with contained herniated cervical disc or focal protrusion causing compression of the cervical roots or cervical pain underwent a nucleoplasty procedure on the pathological disc. A randomized control group of twenty patients was treated conservatively with medical and physical therapy in the same period and completed the identical follow-up form. In the nucleoplasty group results were complete resolution of symptoms in 80% of cases, only 10% referred some residual cervical or radicular pain and are still under follow-up with a wait-and-see prospective. Patients who did not have a clinical resolution were treated with alternative traditional methods (10%). Despite the relative low cases number and the limited follow-up the encouraging results induce us to utilize this technique in well-selected cases.
Available from: PubMed Central
- "However, compared to other percutaneous decompression or even lumbar nucleoplasty, there is a relative lack of research on and clinical experience with cervical nucleoplasty. Cervical nucleoplasty has only limited evidence (level IV) in the literature concerning the technique like lumbar nucleoplasty, and indications are limited to contained herniation and protrusion similar to the lumbar area [1,2,5]. Therefore, the goal of this study is to evaluate on the efficacy, side effects and patient satisfaction with cervical nucleoplasty performed on patients with cervical disc disorders that were unresponsive to conservative treatments. "
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ABSTRACT: Nucleoplasty is a minimally invasive spinal surgery using a Coblation® technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder.
Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc™ DC Spine Wand™. Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months.
Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other.
Percutaneous decompression with a nucleoplasty using a Coblation® technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.
Available from: ajnr.org
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ABSTRACT: Several techniques, including chymopapain, mechanical aspiration, laser-based disk decompression, and endoscopic keyhole surgery, have been proposed as minimally invasive alternatives to fusion for treating cervical disk herniation, though none has gained wide acceptance. The purpose of this study was to assess feasibility, safety, and preliminary clinical results of percutaneous plasma-mediated radio-frequency-based diskectomy for cervical disk herniation.
Patients (N = 55) with cervical soft disk protrusion were treated over a 29-month period. They had radicular pain; 3 patients also had moderate myelopathy. The procedure was performed with the Perc-DC SpineWand by using an anterior approach. Most cases were conducted with local anesthetic on an outpatient basis. Clinical outcomes were graded by using the Macnab criteria.
At 2 months, outcomes were good or excellent in 44/55 (80%) patients; the success rate was similar at 6 months, when 44 (85%) patients (n = 52/55) had good or excellent results. One clinically relevant complication (infectious diskitis) occurred within the first month postprocedure and was successfully treated. One technical complication (in situ rupture of the device tip) was observed; however, the patient remained asymptomatic during the 2-year follow-up. The 3 patients with clinical myelopathy experienced regression of cord compression symptoms; MR imaging in 2 patients showed morphologic evidence of reduction of cord compression.
Plasma radio-frequency-based diskectomy in the cervical spine appears to be a minimally invasive low-risk approach, which is easy to perform, associated with only minimal discomfort to the patient, and effective in the short term.
Available from: Richard Derby
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ABSTRACT: Chronic low back pain is a major social, economic, and healthcare issue in the United States. Various techniques are utilized in managing discogenic pain, with or without disc herniation. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression, and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s. Technical advances in the use of intradiscal therapies led to the development of intradiscal electrothermal annuloplasty (IDET), DISC Nucleoplasty, and DeKompressor, along with laser-assisted, endoscopic, and Nucleotome disc decompressions. The indications for percutaneous lumbar disc decompression include low back and lower extremity pain caused by a symptomatic disc. Internal disc disruptions and disc herniations are common causes of low back and/or lower extremity pain which may become chronic, if not diagnosed and treated. Annular tears lead to migration of the nuclear material and deranged internal architecture. In the chronically damaged intervertebral disc, leakage of nuclear material from annular tears can initiate, promote, and continue the inflammatory process and delay or stop recovery of vital remaining intradiscal tissue. The most often stated goal of central nuclear decompression is to lower the pressure in the nucleus and to allow room for the herniated fragment to implode inward. Provocative discography prior to percutaneous lumbar disc decompression is recommended. Percutaneous disc decompression may result in a small number of complications but occasionally, these could be serious.
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