Journal List > J Korean Soc Spine Surg > v.24(2) > 1076132

Lee, Jeong, Oh, and Kim: Nucleoplasty: Percutaneous Plasma Disc Decompression for the Treatment of Lumbar Disc Herniation

Abstract

Study Design

A review of the literature regarding nucleoplasty.

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.

Materials and Methods

Review of the literature.

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)
jkss-24-129f1.tif
Fig. 2.
Fluoroscopic images, with the guide needle placed at the center of the intervertebral L4-L5 disc. (A) Anteroposterior view, (B) lateral view.
jkss-24-129f2.tif
Table 1.
Factors were associated with the outcomes after nucleoplasty
Positive factors
  Chronic lower back pain had been treated with conservative therapy for six months
  Pain must be significant enough to interfere with daily activities
  Preservation of disc height ≥ 50%
  Disc protrusion ≤ 6 mm
  Accurate identification of the symptomatic disc level prior to the procedure
  On MRI (such as black disc or Modic change [phase I or II])
  The disc in question falls within Pfirrmann grade 2 to 4 on pre-procedure MRI
  Axial back pain with radiculopathy
  Positive or negative provocative discography findings (Concordant pain during discography did not influence the outcomes after nucleoplasty)
Nagative factors
  Moderate to severe spinal stenosis or foraminal stenosis on MRI
  Disc protrusion occupying more than a third of the canal
  More than 3 suspected levels involved
  Less effective for patients with discogenic back pain without radicular
symptom
  Previously operated segments
  Spinal instability
  Sequestrated disc
  Severe neurologic deficits
  Spinal tumor, trauma or infection
  Diabetic, heavy opioid usage or drinking, significant comorbidities
  Uncontrolled psychological disorder
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