Nucleoplasty as an Alternative Intradiscal Therapy in Patients with Lumbar Disc Herniation

OBJECTIVE: The nucleoplasty ablates, coagulates and decompresses the nucleus pulposus by way of high-density plasma field rather than by way of high thermal energy. The authors intended to describe the effects, indications and technical details of nucleoplasty. METHODS: From August 2001 to January 2002, the authors performed nucleoplasty for 40 consecutive patients (45 levels) and evaluated the short-term(mean 3 months) result after the procedure according to Macnab criteria. Exclusion criteria were 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 on the next day after the procedure. RESULTS: Male was outnumbered female by 21 to 19 and age was ranged from 20 to 67 years old(mean: 42.9). Procedures were performed at single level in 35 cases and at two levels in 5 cases. The L4-5 level was the most commonly involved. According to Macnab's outcome criteria, excellent and good outcome was achieved in 35 patients(87.5%), and fair and poor outcome was in 3(7.5%) and 2(5%) patients, respectively. CONCLUSION: Nucleoplasty by using coblation method in patients with lumbar disc herniation shows immediate relief of leg and back pain in 87.5% of the patients during the short span of follow-up. However, data collection with respect to the lengthening of population number and follow-up span, and refinement of strict inclusion/exclusion criteria are prerequisite in near future.

Intradiscal therapy with 10% hypertonic saline for lumbar disc herniation / 介入放射学杂志

Objective A clinical trial of intradiscal injection of hypertonic saline to treat lumbar disc herniation, and observation of its effect, complications and changes in intervertebral disc tissue were performed for clinical application. Methods Discography was performed under local anesthesia, followed by a single injection of 1.0～2.5 ml 10% hypertonic saline. Results 262 cases were included in the study, with 4 years of average follow up. The final outcome ranked excellent in 93 cases and good in 100 cases. As a whole, the effective rate was 75.7% and the improvement rate was 71.5%. The procedure was effective in protrusion and confined extrusion types. 13 cases (6.7%) relapsed after the injection. No complication occurred. 26 cases resorted to surgery because of failure in intradiscal therapy, but no change was found, in the nerve and surrounding tissue of the intervertebral disc attributable to the injection during the surgical operation. The main causes of failure were the marked protrusion or non-contained extrusion, or the combination with spinal canal stenosis. Changes in the nucleus pulposus shown microscopically were similar to those resulted by the action of enzyme injection, but the injury to the disc was much milder.Conclusions Intradiscal therapy with 10% hypertonic saline for lumbar disc herniation is effective, mini-traumatic and safe.