The results of cervical nucleoplasty in patients with cervical disc disorder: a retrospective clinical study of 22 patients

Abstract

Background: Nucleoplasty is a minimally invasive spinal surgery using a Coblation® technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder.

Methods: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc™ DC Spine Wand™. Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months.

Results: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other.

Conclusions: Percutaneous decompression with a nucleoplasty using a Coblation® technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.

Keywords: cervical; disc; diskectomy; nucleoplasty; percutaneous.

Fig. 1

Intraoperative fluoroscopic imaging. PercTM DC Spine WandTM placement adjacent to the lesion sites within the C5-6 intervertebral disc level during ablation. (A) Antero-posterior views. (B) Oblique views. (C) Lateral views.

Fig. 2

Pain intensity at the baseline and 1, 6 months of a follow-up period after the cervical nucleoplasty. Mean ± C.I (Confidence interval). P < 0.05.

Fig. 3

Outcome of the nucleoplasty according to the modified Macnab criteria at 6 months.

Fig. 4

Pre- and post-nucleoplasty Magnetic Resonance Imaging for a 29-year-old man. Preoperative sagittal (A) and axial (B) images show the disc protrusion with mild cord indentation at C5-6 intervertebral disc level. Postoperative sagittal (C) and axial (D) images show the volume reduction of protruded intervertebral disc segment.

Fig. 5

Pre- and post-nucleoplasty Magnetic Resonance Imaging for a 65-year-old woman. Preoperative sagittal (A) and axial (B) images show the disc protrusion causing right neural for aminal stenosis at C6-7 intervertebral disc level. Postoperative sagittal (C) and axial (D) images do not show the evident volume reduction of protruded intervertebral disc segment.