Ogbonnaya Sunny, Kaliaperumal Chandrasekaran, Qassim Abdulla, O'Sullivan Michael
Department of Neurosurgery, Cork University Hospital, Cork, Ireland.
J Nat Sci Biol Med. 2013 Jan;4(1):187-90. doi: 10.4103/0976-9668.107288.
Nucleoplasty (percutaneous lumbar disc decompression) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation, against open microdiscectomy, which would be the mainstay treatment modality. The literature reports a favorable outcome in up to 77% of patients at 6 months.
To evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain.
The medical notes of 33 patients, admitted for nucleoplasty between June 2006 and September 2007, were reviewed retrospectively. All had radicular pain, and contained herniated disc as seen on magnetic resonance imaging (MRI) of lumbosacral spine. Patients were followed up at 1 and 3 months post-procedure. The outcome measures employed in this study were satisfaction with symptoms and self-reported improvement.
Thirty-three cases were examined (18 males and 15 females). Twenty-seven procedures were performed with no complications and six were abandoned due to anatomical reasons. There were 18 and 15 cases of disc herniation at L5/S1 and L4/5 levels, respectively. Four weeks following the procedure, 13 patients reported improvement in symptoms, and 14 remained symptomatically the same and subsequently had open microdiscectomy.
Nucleoplasty has been shown to be a safe and minimal-access procedure. Less than half of our selected cohort of patients reported symptomatic improvement at 1-month follow-up. We no longer offer this procedure to our patients. Possible reasons are discussed.
髓核成形术（经皮腰椎间盘减压术）是一种微创手术，它利用射频能量治疗有症状的腰椎间盘突出症，与作为主要治疗方式的开放式显微椎间盘切除术相对。文献报道，在6个月时，高达77%的患者有良好疗效。
评估髓核成形术治疗椎间盘源性神经根性疼痛的有效性。
回顾性分析2006年6月至2007年9月期间因髓核成形术入院的33例患者的病历。所有患者均有神经根性疼痛，且腰骶部脊柱磁共振成像（MRI）显示有椎间盘突出。术后1个月和3个月对患者进行随访。本研究采用的疗效指标为症状满意度和自我报告的改善情况。
共检查33例（男性18例，女性15例）。27例手术无并发症，6例因解剖原因放弃手术。L5/S1和L4/5水平分别有18例和15例椎间盘突出。术后4周，13例患者报告症状改善，14例症状无变化，随后接受了开放式显微椎间盘切除术。
髓核成形术已被证明是一种安全且创伤小的手术。在我们选择的患者队列中，不到一半的患者在1个月随访时报告有症状改善。我们不再向患者提供此手术。文中讨论了可能的原因。
