61. Percutaneous lumbar discal nucleoplasty (PLN): Initial experience in 51 patients affected by small/contained herniated disc

Abstract

<h3>BACKGROUND CONTEXT</h3> Percutaneous lumbar nucleoplasty (PLN) is a nonoperative, fluoroscopy-guided method for the treatment of nonsequestrated herniated discs in patients with discogenic low back pain (LBP). PLN with controlled ablation ("Coblation") of the disc consists of a combination of tissue removal through plasma molecular dissociation (ablation) and thermal treatment via radiofrequency (RF) heating (coagulation). <h3>PURPOSE</h3> To estimate the effectiveness of PLN in patients with LBP. <h3>STUDY DESIGN/SETTING</h3> Retrospective/day hospital/orthopedic institution. <h3>PATIENT SAMPLE</h3> Inclusion criteria were axial LBP with or without radiating pain, MRI visualization of a contained disc protrusion and/or small contained herniated disc that was concordant with pain's characteristics (side and level), disc height ≥50% and failed conservative therapy for ≥3 months. Exclusion criteria were complete annular derangement, migrated or sequestrated disc, moderate to severe spinal stenosis. <h3>OUTCOME MEASURES</h3> 1) rate of pain reduction one-month postprocedure on a visual analog 1-to-10 scale (VAS); 2) rate of reduction in the protruded disc size at MRI between preoperative and post procedure. <h3>METHODS</h3> From October 2020 to January 2021, 51 patients were treated at our Institution for LBP. All fluoroscopy-guided PLN were performed by one experienced interventional radiologist. A contralateral approach technique permitted precise localization of the intradiscal target navigating inside the nucleus with a curved tip that can rotate 360° within a 5 cm range. All patients underwent MRI before and 3, 6 months after treatment, using axial and sagittal planes T2-weighted images. The PLN treatment was considered successful when the VAS decreased of at least 3 points. The VAS distribution was given as median and interquartile interval. <h3>RESULTS</h3> Out of 51 patients, 35 (70%) experienced a successful outcome after PLN, 13 patients reported a VAS unchanged or a 1-2 points reduction, while the remaining 3 patients reported a worsening of the pain. The overall distribution of VAS was 8 (7–9) before treatment and 4.5 (2–8) after treatment (VAS reduction of 46%). MRI showed reduction in herniated disc dimension in 40 patients (80%), strongly associated with VAS reduction. No serious complications related to PLN occurred. <h3>CONCLUSIONS</h3> PLN with coblation is a minimally invasive method that achieve mostly sudden pain relief as well as MRI-documented volumetric reduction of the herniated disc. No damage or necrosis were reported inside nucleus and surrounding discal structures (annulus, vertebral endplate, nerve root). In this preliminary study, effectiveness was estimated to be 70% and the VAS reduction after treatment was nearly 50%. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.