Effectiveness of nucleoplasty applied for chronic radicular pain

Abstract

Background: Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year.

Material/methods: Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index.

Results: Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating "good" and "excellent" satisfaction was 66% (23 persons) on the last follow-up.

Conclusions: While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

Figure 1

Changes in mean VAS and ODI scores during follow-up periods. VAS, visual analog scale; ODI, oswestry disability index. * Statistically significant decrease for VAS and ODI.

Figure 2

A graph showing percentage of patients reporting ≥30% decrease in VAS and ODI scores at 1, 6, 12 and 24 months follow-up. VAS, visual analog scale; ODI, oswestry disability index.