Lumbar disc nucleoplasty using coblation technology: clinical outcome.

BACKGROUND AND PURPOSE

Although the standard treatment for lumbar disc herniation is lumbar microdiscectomy, nucleoplasty offers a new technique with encouraging results in well selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy based removal of part of the nucleus pulposus. The purpose of this study was to assess the safety and clinical outcome of the nucleoplasty procedure in well selected cases.

METHODS

Coblation technology was used in 50 patients, who had radicular leg pain due to contained disc herniation or focal protrusion, from 2005 to 2008. Clinical outcome was assessed by the Visual Analog Scale and Oswestry Disability Index Questionnaire. Reduction in analgesic treatment was also recorded. The procedure was performed under local anesthesia.

RESULTS

The mean Visual Analog Scale score decreased from 8.2 to 1.3 at the 1 year evaluation (p=0.001). The Oswestry Disability Index Questionnaire decreased from 62.2 to 9.6 at the 1 year follow-up (p=0.001). Analgesic consumption was reduced or stopped in 90% of cases after 1 year. There was complete resolution of symptoms in 40 patients after 1 year. There were four patients who underwent conventional microdiscectomy. Five cases had postoperative discitis which cleared clinically and radiologically within 2 months without sequelae in four of them. One patient had to undergo operative instrumental fusion at the affected level.

CONCLUSION

Nucleoplasty does not require general anesthesia, offers less morbidity and shortens recovery time. Contained herniated disc or focal protrusion are the most important inclusion criteria. Hence this technique is a promising tool in well selected cases.