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Abstract
Objectives
This aim of this article is to provide current information on nucleoplasty as a therapeutic intervention for herniated disc or discogenic back pain in degenerative disc disease.
Summary of Literature Review
Nucleoplasty as a therapeutic intervention for discogenic pain is performed with increasing frequency, and has been reported to involve few complications and to have satisfactory clinical results.
Results
In nucleoplasty, the intervertebral disc is approached percutaneously. In this paradigm, a bipolar high frequency device in combination with ablation and coagulation is used to create a channel in the intervertebral disc in order to reduce intervertebral disc volume and to decrease intervertebral pressure and inflammatory markers. Standard indications for nucleoplasty have not been established, but it has been reported that the procedure had excellent outcomes regardless of the presence of radiculopathy or the results of discography. Many studies have reported their outcomes using various categories, because the procedure is comparatively new. Concomitantly, longterm follow-up studies remain to be performed, and each study reported a different follow-up period.
Conclusions
Nucleoplasty has been found to show an excellent prognosis for discogenic back pain and a low incidence of complications. Moreover, since it is a minimally invasive procedure, it offers improved possibilities for return to daily life and work. If degenerative changes have not progressed to a great extent or the intervertebral level remains intact, nucleoplasty may be considered prior to surgery. Due to the lack of reports on the subject, prospective analyses in the future are required.
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Fig. 1.
Kambin's triangle (triangle). (A) Kambin's triangle on a fluoroscopic image (the empty dot indicates the guide pin tip). (B) A schematic diagram of Kambin's triangle. The schematic diagram was adapted from the study of Hoshide et al.12)
Fig. 2.
Fluoroscopic images, with the guide needle placed at the center of the intervertebral L4-L5 disc. (A) Anteroposterior view, (B) lateral view.
Table 1.
Factors were associated with the outcomes after nucleoplasty
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