Lemcke J, Al-Zain F, Mutze S, Meier U
Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Minim Invasive Neurosurg. 2010 Oct;53(5-6):236-42. doi: 10.1055/s-0030-1269860. Epub 2011 Feb 7.
The Disc Dekompressor and Nucleoplasty are 2 different, minimally invasive, percutaneous methods in the therapy for chronic discogenic low back pain. The aim of this study is to compare the effectiveness of both methods concerning the outcome one year after surgery.
We included patients with MRI-proven disc protrusion suffering from low back pain and/or radiating pain in the lower extremities. The pain perception of the patients was documented using the visual analogue pain scale (VAS). Furthermore, the patients were queried about analgesic consumption, disability in daily life and ability to work. Percutaneous minimally invasive nucleotomy using the Nucleoplasty or the Disc Dekompressor was carried out under fluoroscopic and CT-guidance. We carried out a follow-up examination at 6 and 12 months after the operation.
From April 2005 to November 2007 a total of 126 patients underwent percutaneous minimally invasive nucleotomy using Nucleoplasty (April 2005 - December 2006) or the Disk Dekompressor (February 2006 - November 2007) and were followed up after 6 and 12 months. In the Nucleoplasty group the mean age of the 27 females (39%) and 42 males (61%) was 42 years (range: 18-74). In the Disc Dekompressor group the mean age of the 22 females (39%) and 35 males (61%) was 44 years (range: 16-76). The mean duration of symptoms in the Nucleoplasty group was 30.5 months (range: 1-120), and in the Disc Dekompressor group 16.3 months (range: 1-72). Statistically significant postoperative improvement concerning the VAS score was evident in both groups. Whereas the VAS score slightly increased in the Nucleoplasty group comparing the early postoperative score and the score after 12 months, the VAS score stayed on a low level in the Disc Dekompressor group. A statistically significant reduction in analgesic consumption, disability and occupational incapacitation was observed in the Nuceloplasty group and the Disc Dekompressor group.
Both Nucleoplasty and Disc Dekompressor are effective therapies for chronic, discogenic back pain. Regardless of the different mechanism no significant differences in the outcomes were found. Both techniques result in significant reductions in levels of disability and incapacity for work as well as decreased analgesic consumption.
椎间盘减压器和髓核成形术是治疗慢性椎间盘源性下腰痛的两种不同的、微创的经皮治疗方法。本研究的目的是比较这两种方法在术后一年的疗效。
我们纳入了经MRI证实有椎间盘突出且患有下腰痛和/或下肢放射性疼痛的患者。使用视觉模拟疼痛量表（VAS）记录患者的疼痛感受。此外，询问患者的镇痛药使用情况、日常生活中的残疾情况和工作能力。在荧光镜和CT引导下，使用髓核成形术或椎间盘减压器进行经皮微创髓核切除术。我们在术后6个月和12个月进行了随访检查。
从2005年4月至2007年11月，共有126例患者接受了使用髓核成形术（2005年4月至2006年12月）或椎间盘减压器（2006年2月至2007年11月）的经皮微创髓核切除术，并在6个月和12个月后进行了随访。在髓核成形术组中，27名女性（39%）和42名男性（61%）的平均年龄为42岁（范围：18 - 74岁）。在椎间盘减压器组中，22名女性（39%）和35名男性（61%）的平均年龄为44岁（范围：16 - 76岁）。髓核成形术组的平均症状持续时间为30.5个月（范围：1 - 120个月），椎间盘减压器组为16.3个月（范围：1 - 72个月）。两组术后VAS评分均有统计学意义的明显改善。与术后早期评分和12个月后的评分相比，髓核成形术组的VAS评分略有上升，而椎间盘减压器组的VAS评分保持在较低水平。在髓核成形术组和椎间盘减压器组中，观察到镇痛药使用量、残疾程度和职业失能有统计学意义的降低。
髓核成形术和椎间盘减压器都是治疗慢性椎间盘源性背痛的有效方法。尽管机制不同，但在疗效上未发现显著差异。两种技术都能显著降低残疾程度和工作失能水平，并减少镇痛药的使用量。
