Nucleoplsty as an alternative intradiscal therapy

Abstract

Until now, numerous treatment options for the percutaneous intradiscal procedures (chemonucleolysis, APLD, MED, IDET) have been evolved. Among them, nucleoplsty has gained popularity for its simple maneuverability and immediate effects. Nucleoplasty ablates, coagulates and decompresses the nucleus pulposus by way of high-density plasma field rather than by way of high thermal energy. Author intended to report the effect, indications and technical details.

From August 2001 to January 2002, author performed nucleoplasty for 20 patients (23 levels) and evaluated the short-term (2-month) prognosis according to MacNab criteria. Exclusion criteria were essentially the same for the other percutaneous procedures; significant or ruptured, sequestered disc material, spinal stenosis, spinal instability, etc. Intraoperative discogram was prerequisite for determination of the precise causative level. Average operation time was 40 minutes, and patients discharged the next day to procedure.

Male was outnumbered by 12 to 8 and age was ranged 20 to 67 years old (avr : 38.5). Procedures were performed on single level (17 cases) and two levels (3 cases). L4-5 was the most commonly involved level. According to MacNab's outcome criteria, excellent and good outcome was achieved in 15 patients (75%), and fair and poor outcome was in 3 and 2 patients, respectively.

Nucleoplasty by using coblation method showed 75% of immediate relief rate for leg and back pain in short-term context. Information about the more patient gathering, more longer follow-up period, and more refined inclusion and exclusion criteria were demanded.