Cervical Nucleoplasty Using Coblation Technology; Clinical Outcome

Abstract

Background Although the standard treatment for cervical disc herniation is open discectomy with or without fusion, nucleoplasty offers a new technique with encouraging results in well-selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy-based removal of part of the nucleus pulposus. Objective To assess the safety and clinical outcome of nucleoplasty procedure in well-selected cases. Methods Coblation technology was used in 47 cases that had symptoms of cervical root compression or pain owing to contained disc herniation or focal protrusion. Clinical outcome was assessed through visual analogue scale and neck disability index questionnaire for 24 months. The procedure was carried out through an anterior approach and in most cases with local anesthesia. Results According to visual analogue scale, 72% of patients had complete resolution of symptoms 1 month postoperatively. After 3 months, 83% of patients had complete resolution and at 6 month, 79% of patients had complete resolution and this result was the same during follow-up. Regarding neck disability index questionnaire, 30 patients (63.8%) showed significant improvement, whereas (19%) showed moderate improvement at 1 month. Five patients (10.6%) did not show improvement, whereas 6.3% showed deterioration of their abilities. At 3 months, 76.6% showed significant improvement. Conclusion Nucleoplasty does not require general anesthesia, offers less morbidity and shortens recovery time. Contained herniated disc or focal protrusion is the most important inclusion criteria. This technique is a promising tool in well-selected cases.