Percutaneous image guided lumbar disc nucleoplasty: a minimal invasive technique for lumbar disc decompression

ABSTRACT

Nucleoplasty is a minimally invasive, percutaneous procedure that uses radiofrequency energy to ablate nuclear material and create small channels within the disc. To evaluate the efficacy of nucleoplasty technique in patients with leg pain caused by radicular encroachment. This study was performed on 29 patients [23 males and 6 females] with lumbar disc prolapse causing unilateral sciatica with or without lower back pain for duration more than 3 months with no response to conservative treatment[in the form of medications, bed rest, and physiotherapy] in the period from November 2006 to November 2008. The Perc-D Spine Wand with 1 mm diameter and bipolar tip was used for coblation and the coagulation on the disc utilizing both radiofrequency coblation technology and thermal technology using a radiofrequency Arthrocare [Trade mark] generator system 2000 [Arthrocare Corporation [Trade mark], Sunnyvale, CA] to generate coblation and coagulation energy. The mean visual analogue score [VAS] for the treated patients preoperative was 8.3 and there was significant reduction in VAS in follow-up visits with the mean VAS = 3.4, 3.2, 2.5, 3.1, 3.5 at 1 week, 1 month, 3 months, 6 months, and 1 year duration respectively. All patients were satisfied with the procedure and the degree of pain relied at all follow-up visits. Percutaneous image guided lumbar disc decompression using nucleoplasty technique seems to be an effective, safe, simple and minimal invasive procedure for relief for sciatica due to lumbar disc prolapse in well selected cases. Nonetheless a longer follow-up period and a larger number of patients is needed to assess the long-term efficacy of this procedure