Percutaneous cervical coblation as therapeutic technique in the treatment of algo-dysfunctional pain of discal herniation

Abstract

Objective: To confirm the validity of coblation nucleoplasty in reduction of cervical discogenic nature.

Study design: In a monocentric prospective clinical observational study recruiting 20 patients, treated with percutaneous coblation for cervical discogenic pain in 16 months in our hospital, we have clinically evaluated 18 patients. The pain was scored with the Visual Analogic Scale (VAS) in a pre-procedural questionary, 3/4 monthly follow-up from treatment and, finally, in a long-term follow-up 2 years after procedure.

Results: The mean pre-procedural VAS score was 7.9 ± 1.6 (95%-Confidence Interval 7.198-8.634), while the mean post-procedural score after 3-4 months has been 2.5 ± 3.1 (95%-Confidence Interval 1.089-3.965) and 2.5 ± 2.5 (95%-Confidence Interval 1.367-3.687) after 2 years. Among 18 patients, in the shortly post-treatment follow-up, nine had a complete pain relief, four had a > 50% VAS reduction, two hada < 50% VAS reduction, three did not have any variation of VAS; after 2 years, six patients had a total pain resolution, eight had a > 50% VAS reduction, two hada < 50% VAS reduction, two did not have any benefit. No peri- and post-procedural complication has been observed.

Conclusions: In a spite of a little sample, our results showed coblation as a valid therapeutic option to reduce cervical discogenic pain in medicine-refractory patients, as an alternative or a previous choice before a more invasive surgical treatment.

Keywords: Disc protrusion; Discogenic cervicobrachialgia; Mini-invasive therapy; Nucleoplasty; Visual analog scale (VAS).

Fig. 1

Introduction of Perc-DLE spine wand in a 43 years old woman with C5–C6 discal protrusion. (a Antero-Posterior view, b Latero-Lateral view)

Fig. 2

Histogram showing the differences between pre-treatment (black column), post-treatment after 3/4 months (light grey column) and 2 years subsequently to the procedure (dark grey) VAS score in the 18 patients

Fig. 3

Pie chart showing the variation of the VAS scale in the pre-operative and post-operative phases (after 3/4 months and after 2 years), divided in four classes: total remission of symptoms, reduction of more than 50%, reduction of less than 50% and unchanged

Fig. 4

Axial and sagittal T2 MR images pre-treatment (a, b) and post-treatment (c, d) in a 46 female patient with pain reduction more than 50%: in this case, we had not significant MRI changes of the discal protrusion, despite of clinical improvement