Gerszten Peter C, Welch William C, King Joseph T
Department of Neurosurgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Healthcare System, Pennsylvania, USA.
J Neurosurg Spine. 2006 Jan;4(1):36-42. doi: 10.3171/spi.2006.4.1.36.
Nucleoplasty is a minimally invasive surgical procedure for disc decompression developed to treat patients with symptomatic contained herniated discs. Nucleoplasty uses nonheat-driven radiofrequency energy to ablate and coagulate the disc nucleus via a percutaneous "discography" trajectory under fluoroscopic guidance. In this study the authors evaluated pain, functioning, and quality of life (QOL) in patients with radicular leg and back pain who underwent nucleoplasty-based percutaneous disc decompression.
The study was designed as a prospective nonrandomized longitudinal cohort study in an academic medical center. Sixty-seven patients (mean age 41 years) with primarily radicular pain due to a contained disc herniation underwent nucleoplasty-based decompression in an outpatient setting. Patients completed the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey, EuroQol 5D (EQ5D), and a visual analog scale (VAS) for pain preoperatively, and at 3 and 6 months after surgery. Postoperative QOL differences were assessed using the Wilcoxon signed-rank test. A surgical probe, the Perc-DLE SpineWand, was placed percutaneously into the disc after application of a local anesthetic or induction of general anesthesia to remove part of the disc (that is, a percutaneous discectomy). Nucleoplasty-treated levels were L2-3 (one case), L3-4 (five cases), L4-5 (44 cases), and L5-S 1 (40 cases); there were 22 multiple treatment levels and 42 bilateral treatments. There were no infections or nerve root injuries associated with the procedure. Compared with preoperative QOL, there was a statistically significant improvement in QOL at 3 months as measured using the SF-36 Physical Component Summary (PCS) scale (mean score improvement 4.4 [p = 0.014]), the EQ5D (mean score improvement 0.22 [p = 0.001]), and the VAS for pain (mean score improvement 0.13 [p = 0.021). Six-month results in 36 patients continued to reflect improvement as measured using the SF-36 PCS (mean score improvement 7.6 [p = 0.002]) and the EQ5D (mean score improvement 0.27 [p = 0.001]).
Nucleoplasty-based percutaneous disc decompression in patients with symptomatic contained disc herniations is safe and improves QOL as measured by the SF-36, EQ5D, and VAS for pain, three generic QOL outcome instruments. Nucleoplasty is an effective minimally invasive surgical treatment alternative in patients with symptomatic contained disc hemiations. Further follow-up evaluation is underway to determine the durability of QOL improvement after nucleoplasty.
髓核成形术是一种用于椎间盘减压的微创手术，旨在治疗有症状的包容性椎间盘突出症患者。髓核成形术利用非热驱动射频能量，在荧光透视引导下，通过经皮“椎间盘造影”轨迹消融和凝固椎间盘髓核。在本研究中，作者评估了接受基于髓核成形术的经皮椎间盘减压术的腿痛和背痛伴神经根症状患者的疼痛、功能和生活质量（QOL）。
本研究设计为在一家学术医疗中心进行的前瞻性非随机纵向队列研究。67例（平均年龄41岁）主要因包容性椎间盘突出症导致神经根性疼痛的患者在门诊接受了基于髓核成形术的减压治疗。患者在术前、术后3个月和6个月完成医学结局研究36项简短健康调查（SF - 36）、欧洲五维健康量表（EQ5D）以及疼痛视觉模拟量表（VAS）。使用Wilcoxon符号秩检验评估术后生活质量差异。在局部麻醉或全身麻醉诱导后，将手术探针Perc - DLE SpineWand经皮置入椎间盘以切除部分椎间盘（即经皮椎间盘切除术）。接受髓核成形术治疗的节段为L2 - 3（1例）、L3 - 4（5例）、L4 - 5（44例）和L5 - S1（40例）；有22个多节段治疗和42个双侧治疗。该手术未发生感染或神经根损伤。与术前生活质量相比，术后3个月时，使用SF - 36身体成分汇总（PCS）量表（平均得分改善4.4 [p = 0.014]）、EQ5D（平均得分改善0.22 [p = 0.001]）以及疼痛VAS（平均得分改善0.13 [p = 0.021]）测量，生活质量有统计学显著改善。36例患者术后6个月的结果继续显示出改善，使用SF - 36 PCS（平均得分改善7.6 [p = 0.002]）和EQ5D（平均得分改善0.27 [p = 0.001]）测量。
对于有症状的包容性椎间盘突出症患者，基于髓核成形术的经皮椎间盘减压术是安全的，并且通过SF - 36、EQ5D和疼痛VAS这三种通用生活质量结局指标测量，可改善生活质量。髓核成形术是有症状的包容性椎间盘突出症患者一种有效的微创手术治疗选择。正在进行进一步的随访评估，以确定髓核成形术后生活质量改善的持久性。
