Cincu Rafael, Lorente Francisco de Asis, Gomez Joaquin, Eiras Jose, Agrawal Amit
Department of Neurosurgery, University General Hospital, Valencia, Spain.
Department of Neurosurgery, Miguel Servet University Hospital, Zaragoza, Spain.
Asian J Neurosurg. 2015 Jan-Mar;10(1):21-5. doi: 10.4103/1793-5482.151504.
Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.
In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.
There were 27 male and 23 female with followup mean follow up of 115 months (range 105-130 months) with a mean age was 52 years (range 26-74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3-4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.
Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.
髓核成形术是一种微创手术，旨在治疗有症状但椎间盘突出或膨出局限的患者。本研究的目的是评估经皮激光椎间盘减压术治疗腰椎间盘突出症的十年随访结果。
在这项回顾性研究中，纳入了50例因有症状但局限的腰椎退行性椎间盘疾病接受椎间盘内激光减压治疗的患者。通过视觉模拟疼痛量表（VAS）评估术后腰痛、腿痛和麻木的缓解情况。采用Oswestry功能障碍指数（ODI）评估患者下肢功能和日常生活情况，并记录和分析总体满意度的主观综合评分。
男性27例，女性23例，平均随访115个月（范围105 - 130个月），平均年龄52岁（范围26 - 74岁）。1年后，90%的患者止痛药物用量减少或停用。随访24个月时，VAS评分为4分，ODI为7.2。3例患者在36个月后重复了冷消融治疗，其中2例在L3 - 4节段。10例患者在干预114个月后仍无症状。该手术无并发症发生，包括神经根损伤、椎间盘炎或过敏反应。
髓核成形术可为局限型椎间盘突出症提供间歇性缓解，且并发症少、发病率低。根据文献，椎间盘内激光减压术治疗慢性椎间盘源性腰痛的证据为中等；髓核成形术似乎是安全有效的。
