Percutaneous Cervical Nucleoplasty Research Articles

Analysis of the clinical and radiological outcomes of percutaneous cervical nucleoplasty: A case-control study.

Percutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically. The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT. The present study was designed as a case-control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2-7 Cobb's angle, and C2-7 sagittal vertical axis. Compared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement. To provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.

Long-Term Clinical Results of Percutaneous Cervical Nucleoplasty for Cervical Radicular Pain: A Retrospective Cohort Study.

PurposePercutaneous cervical nucleoplasty (PCN) is a minimally invasive treatment for cervical radicular pain due to a disc herniation. Preliminary results show equivalent patient-reported outcomes of PCN as compared to conventional anterior cervical discectomy. However, there is a paucity of long-term outcome data. Therefore, the primary objective of this study is to investigate the long-term clinical results of PCN.Patients and MethodsA retrospective analysis was conducted on patients who underwent PCN at a secondary referral center between 2010 and 2014. Before surgery and five days after surgery, numeric rating scales (NRS) for arm pain and neck pain and data on complications were collected. To determine long-term follow-up outcomes, patients were sent a questionnaire booklet containing the Core Outcome Measures Index-Neck (COMI-Neck), NRS for arm pain and neck pain, Likert-scales on patient satisfaction and questions regarding the incidence of reoperations and complications.ResultsThe baseline characteristics were collected for 158 patients. At a median follow-up of 41.5 months (interquartile range (IQR) 27.0 to 57.5), data were available for 118 patients (74.7%). At short-term follow-up, patients that underwent PCN had a mean decrease of 3.0 on the NRS for arm pain (95% CI 2.5 to 3.6) compared to baseline, while at long-term follow-up, a mean decrease of 2.8 (95% CI 1.0 to 3.6) was observed. At the long-term follow-up, 67.8% of the patients were fully recovered from all symptoms and 93.3% remained satisfied with the PCN treatment results. The reoperation rate for recurrent disc herniation was 21.4% at long-term follow-up.ConclusionPCN appears to be a safe and effective treatment at short-term and long-term follow-up of a specific selection of cervical herniated discs, with an acceptable long-term reoperation rate. These study results suggest a potential role of PCN as a less invasive treatment option for cervical radicular pain due to a soft disc herniation, before anterior cervical discectomy should be considered.

The Effect of Percutaneous Nucleoplasty vs Anterior Discectomy in Patients with Cervical Radicular Pain due to a Single-Level Contained Soft-Disc Herniation: A Randomized Controlled Trial

Background Cervical radicular pain (CRP) is a common problem in the adult population. When conservative treatment fails and the severe pain persist, surgical treatment is considered. However, surgery is associated with some serious risks. To reduce these risks, new minimally invasive techniques have been developed, such as percutaneous nucleoplasty. Several studies have shown that percutaneous nucleoplasty is a safe and effective technique for the treatment of CRP, but until now no randomized controlled trials have been conducted that compare percutaneous cervical nucleoplasty (PCN) to anterior cervical discectomy (ACD) in patients with a single-level contained soft-disc herniation. Objectives To compare the effects of PCN and ACD in a group of patients with CRP caused by a single-level contained soft-disc herniation. Study design A randomized, controlled, multi-center trial. Setting Medical University Center and local hospitals. Methods Forty-eight patients with CRP as a result of a single-level contained soft-disc herniation were randomized to one of the following 2 treatments: PCN or ACD. The primary outcome measure was arm pain intensity, measured with a Visual Analog Scale (VAS). Secondary outcomes were arm pain intensity during heavy effort, neck pain, global perceived effect, Neck Disability Index (NDI), and the patients' general health (Short Form Generated Health Survey [SF-36]). All parameters were measured at baseline (T0), 3 months after intervention (T2), and one year after intervention (T3). One week after the intervention (T1), an intermediate assessment of arm pain, arm pain during heavy effort, neck pain, satisfaction, and improvement were performed. Results At 3 months, the intention to treat analyses revealed a statistical significant interaction between the groups on the primary outcome, arm pain intensity, and on the secondary outcome of the SF-36 item pain, in favor of the ACD group. On the other secondary outcomes, no statistical significant differences were found between the groups over time. At 12 months, there was a trend for more improvement of arm pain in favor of the ACD group and no statistical interactions were found on the secondary outcomes. Limitations Firstly, the inclusion by the participating hospitals was limited. Secondly, the trial was ended before reaching the required sample size. Thirdly, at baseline, after the inclusion by the neurosurgeon, 13 patients scored less than 50.0 mm on the VAS. Fourthly, the withdrawal of the physiotherapy (PT) group and finally, the patients and interventionists could not be blinded for the treatment. Conclusions At 3 months, the ACD group performed significantly better on arm pain reduction than the PCN group in patients with CRP as a result of a single-level contained soft-disc hernia. However, the clinical relevancy of this treatment effect can be debated. For all parameters, after one year, no significant differences between the groups were found. When it comes to the longer-term effectiveness, we conclude that PCN can be a good alternative for ACD.

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

Long-Term Clinical Outcomes of Percutaneous Cervical Nucleoplasty for Cervical Degenerative Diseases with Neck Pain and Cervical Vertigo

Good short- and mid-term clinical efficacy of percutaneous cervical nucleoplasty (PCN) for cervical degenerative diseases (CDD) with neck pain has been reported. However, few studies have assessed its long-term influence in patients with both neck pain and cervical vertigo. This study aimed to evaluate the curative efficacy of PCN for CDD with neck pain andcervical vertigo with minimum of 6 years of follow-up. Inpatients who underwent PCN for CDD with neck pain and cervical vertigo between April 2010 and March 2013 were enrolled. Clinical outcomes were assessed using the Cervical Vertigo Evaluation Scale (CVES); greater CVES scores reflected less impairment. Additional open surgeries were recorded. Among 40 patients, 100% completed the 1-year short-term and 3-year mid-term follow-up (FU); 85%completed the 6-year long-term FU. Clinical effective rates were 67.5%, 67.5%, and 52.94% at short-, mid-, and long-term FU, respectively. CVES scores were greater than the preoperative CVES scores at all FU timepoints (P<0.01). However, the CVES score was lower at the final FU than at the 3-year FU (P < 0.05). The neck pain score significantly decreased over time and was lower than the cervical vertigo score at the final FU (P > 0.05). Reoperation rates were 1/40 (2.50%) and 3/34 (8.82%) at mid- and long-term FU, respectively. PCN in patients with CDD neck pain and cervical vertigo showed satisfactory clinical efficacy at short- and mid-term FU, and it was fair at long-term FU. Thus, PCN could be a complementary operation for CDD.

Retrospective Outcome Evaluation of Cervical Nucleoplasty Using Digital Infrared Thermographic Imaging.

ObjectivePercutaneous cervical nucleoplasty (PCN) is used to treat cervical disc herniation. Radiological imaging studies, including plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI), have been used to make early predictions of cervical spinal surgery outcomes. However, simple radiological studies do not provide sufficiently detailed information; moreover, CT and MRI are highly expensive. Herein, we aimed to elucidate the usefulness of digital infrared thermography imaging (DITI) as an outcome marker after cervical nucleoplasty by correlating the changes in thermal difference (ΔTD) with the changes in pain intensity after PCN expressed as visual analogue scale (ΔVAS) scores. MethodsFor this study, 255 patients treated with PCN at Thomas Hospital between March 2012 and August 2014 were included. For each patient, demographic and clinical data, including preoperative MRI results, ΔVAS, ΔTD at the disc level treated with PCN, subjective symptom improvement, procedure-related discomfort, overall satisfaction, and adverse effects, were collected and evaluated for up to 3 months retrospectively. ResultsThermal difference (TD) and VAS scores improved after PCN (p<0.05), but ΔTD showed no significant correlation with ΔVAS. If the preoperative TD was larger, the postoperative VAS was worse and there was less pain relief (ΔVAS) after PCN (p<0.05). Only few adverse effects were noticeable after PCN. ConclusionIn DITI, which was used to evaluate the outcomes after cervical nucleoplasty, the ΔTD did not seem to reflect the ΔVAS after PCN. However, preoperative DITI findings could be useful for predicting VAS reduction and clinical improvements after PCN.

The Frequency of Re-Surgery After Cervical Disc Nucleoplasty

In percutaneous cervical nucleoplasty (PCN) a portion of the nucleus tissue is ablated using the Coblation technique. Re-surgery is an important factor for the clinical outcome. However, the rate of subsequent surgery after PCN is still unknown. The aim of this study was to investigate the frequency of an additional open surgery after PCN in a retrospective of more than 10 years. Retrospective observational study. Consecutive patients with PCN between 2005 and 2007 were included. Patient's satisfaction was evaluated using McNab's outcome criteria. The necessity of an additional open surgery at the cervical spine, the period between PCN and the fusion, and the treated levels were analyzed. One hundred thirty-three patients were included. The follow-up time was longer than 5 years in 31.6% of patients and longer than 10 years in 6.0% of patients. The short-term success rate was 70.7%; however, subsequent surgery was performed in 19.5% of patients. Overall, 57.7 % of reoperations were performed during the first year after PCN. In patients with a good result after PCN, subsequent surgery was less frequent, and the interval between PCN and additional surgery was larger (P < 0.01). This is the first study reporting the frequency of re-surgery after PCN. Overall, 70.7% patient satisfaction was observed after 1 month. This result is worsened because of a re-surgery rate of 19.5%. The data from this study suggest that PCN is a poor replacement for conventional open surgery. Degeneration of the disc is progressive despite or because of PCN.

Predictive Factors of Successful Percutaneous Cervical Nucleoplasty for the Treatment of Pain with Cervical Herniated Disk.

Percutaneous cervical nucleoplasty (PCN) is an effective treatment for cervical herniated intervertebral disc (C-HIVD). In this retrospective study, we evaluated clinical predictors that affect the successful outcome of PCN. Fluoroscopically guided PCN was conducted for C-HIVD by one pain physician. Successful outcome was defined as a combination of greater than 50% pain relief on the numerical rating scale pain score, no increase in analgesics, and no cervical epidural steroid injection during the 3-month follow-up period. The relationship between outcomes and independent variables, including patient demographics, comorbid diseases, pain duration, type of disc herniation, presence of spinal stenosis, pain location, analgesics, and shape of the PCN needle tip, were investigated using multivariable analyses. Of 201 patients, 134 experienced a successful outcome after PCN. In the positive outcome group, shorter pain durations, rarer central canal stenosis, increased unilateral radiculopathy versus axial pain, and more frequent use of the curved tip technique, were reported. Multivariable analyses revealed that unilateral radiculopathy (P= 0.013) and use of the curved-tip technique (P=0.027) were independent positive predictors of successful PCN outcomes; conversely, longer pain duration (P= 0.014) and concurrent spinal stenosis (P < 0.001) were negative predictors. No serious complications related to PCN occurred. In this study, the success rate of PCN was 66.7% in patients with C-HIVD. Shorter pain duration, the absence of cervical central canal stenosis, pain location (i.e., unilateral radiculopathy vs. axial pain), and the use of the curved-tip technique were positive predictors of successful PCN.

The Efficacy of Percutaneous Cervical Nucleoplasty for Cervical Herniated Disc Disease in Patients with Upper Extremities Radiating Pain

The Efficacy of Percutaneous Cervical Nucleoplasty for Cervical Herniated Disc Disease in Patients with Upper Extremities Radiating Pain

Percutaneous cervical nucleoplasty using the L’DISQⓇ in patients with posterolateral disc extrusion −Three cases report−

Percutaneous cervical nucleoplasty using the L’DISQⓇ in patients with posterolateral disc extrusion −Three cases report−

Inferior thyroid arterial injury after percutaneous cervical nucleoplasty

Inferior thyroid arterial injury after percutaneous cervical nucleoplasty

Current Evidence of Percutaneous Nucleoplasty for the Cervical Herniated Disk: A Systematic Review

Although percutaneous cervical nucleoplasty (PCN) has been shown to be both safe and effective, its application is still debated. PCN applied in disk herniation has not been systematically reviewed before, resulting in a limited insight into its effectiveness and safety, and the quality of available evidence. Therefore, we systematically reviewed the evidence on the efficacy and safety of PCN in patients with a (contained) herniated disk. MEDLINE, EMBASE, and the Cochrane Library (Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and nonrandomized studies using the following keywords: "Nucleoplasty," "Cervical," "Hernia," "Herniation," "Prolapse," "Protrusion," "Intervertebral disk," and "Percutaneous disk decompression." First, all articles were appraised for methodological quality, and then, RCTs were graded for the level of evidence according a best-evidence synthesis, because a meta-analysis was not possible. Finally, the RCTs' applicability and clinical relevance also was assessed. Of 75 identified abstracts, 10 full-text articles were included (3 RCTs and 7 nonrandomized studies). These studies represented a total of 1021 patients: 823 patients (≥892 disks) were treated by PCN. All studies showed low methodological quality, except for two. The level of evidence of the RCTs was graded as moderate, with low to moderate applicability and clinical relevance. All included studies showed PCN to be an effective and safe procedure in the treatment of (contained) herniated disks at short-, mid-, and long-term follow-up. However, the level of evidence is moderate and shows only low to moderate applicability and clinical relevance.

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

The Long‐term Efficacy and Safety of Percutaneous Cervical Nucleoplasty in Patients with a Contained Herniated Disk

Percutaneous cervical nucleoplasty (PCN) is a safe and effective treatment in symptomatic patients with contained cervical herniated disks. It provides simple and efficient disk decompression, using a controlled and highly localized ablation, but evidence regarding long-term efficacy is limited. We conducted a retrospective study to investigate the long-term efficacy and safety of PCN, and the influence of ideal selection settings. A total of 27 patients treated with PCN fulfilling ideal selection criteria (Group A) were studied and compared to 42 patients not meeting these criteria (Group B). Outcomes were assessed using the Visual Analogue Scale (VAS) and a four-level Likert item for perceived pain and satisfaction, the Neck Disability Index (NDI), and the Short Form 36 (SF-36). Additional relevant outcomes were retrieved from medical records. The postoperative mean VAS pain for Group A was 29.9 (SD±32.6) at a mean follow-up of 24months (range: 2-45). Only 10% of these patients reported mild transient adverse events. There was a trend, but no difference between both groups in pain scores; however, treatment satisfaction was higher for Group A (74.1±27.2-55.5±31.4, P=0.02). Group A also reported better physical functioning based on the Physical Component Summary (43.6±10.6-37.3±12.0, P=0.03) and showed a larger proportion of patients no longer using any medication postoperatively (63-26%, P=0.01). These results show long-term effectiveness and safety of PCN in patients with a one-level contained cervical herniated disk, and the reliance of selecting patients meeting ideal criteria for successful PCN.

Percutaneous minimally invasive techniques in the treatment of cervical disc herniation

Objective To compare the therapeutic effects of percutaneous cervical discectomy (PCD group),percutaneous cervical disc nucleoplasty(PCN) and the association of them (PCDN) for the treatment of cervical intervertebral disk displacement and instability of cervical vertebral column.Methods From February 2003 to April 2011,171 consecutive patients with cervical disc herniation have presented at the authors' hospital and were retrospectively studied.The average age of patients was 47.8 years (ranged,21-74).Ninety-seven cases were treated with PCD,50 cases with PCN,and the other 24 cases with PCDN.Clinical result and the stability of cervical vertebral column after operation were evaluated and compared among the 3 groups.Results All cases had been followed up for a median of 4.1 years.There was significant difference in the pre- and post-operation the Japanese Orthopaedic Association(JOA) scoring system on within 3groups (PCD:t=21.85,P＜0.05; PCN:t=14.50,P＜0.05; PCDN:t=8.56,P＜0.05).All cases had been successfully operated.There was no significant difference between groups among the 3 groups in terms of the clinical outcomes(The recovery rate of JOA standard evaluation,F=2.19,P=0.12).According to Odom criteria,the excellent and good rate are as follows:81.35％ in PCD,82.44％ in PCN,83.19％ in PCDN,respectively.There was no significant difference between groups among the 3 groups in terms of the clinical success rate (P＞0.05).There was no instability of cervical vertebral column cases in 3 groups after operation (P＞0.05),and no significant difference was found in terms of cervical vertebral column stability in pre- and post-operation in each group.Conclusion All the three operations including PCN,PCD and PCDN are safe,minimally invasive spine surgery for the treatment of cervical intervertebral disk displacement; they achieve good clinical outcomes and there are no difference on the stability of cervical vertebral column between preoperation and postoperation. Key words: Cervical vertebrae; Intervertebral disk displacement; Diskectomy, percutaneous

Percutaneous discectomy and drainage for postoperative intervertebral discitis

Postoperative intervertebral discitis occurs following spinal surgery. This study was done to evaluate the effect of percutaneous discectomy and drainage (PDD) for postoperative intervertebral discitis. A retrospective study of postoperative intervertebral discitis treated by PDD procedures was conducted from January 1997 to June 2006. There were 34 patients (24 males, 10 females); 10 cases of after lumbar discectomy (L3-4 in 3 patients, L4-5 in 7 patients), 21 cases of after percutaneous lumbar discectomy (L3-4 in 7 patients, L4-5 in 14 patient), 2 cases of after percutaneous cervical discectomy (C5-6 in 1 patient, C6-7 in 1 patient), and 1 case of C5-6 after percutaneous cervical nucleoplasty. All patients tolerated the procedure well and there were 31 cases had followed up. VAS scores demonstrated statistically significant improvement after PDD when compared with preoperational values (P < 0.01). Elevated CRP and ESR values returned to normal range within 3-8 weeks. CRP and ESR values demonstrated statistically significant improvement after PDD when compared with preoperative values (P < 0.01). Biopsies of the disc were performed in all patients and pus was seen in 17 patients at the pathology levels. Inflammatory cells were observed nine cases (4 cases showed infiltration of lymphocytes and plasmacytes, 5 cases showed infiltrate of polymorphonuclear leucocytes). Cultures of disc and bone tissue showed 17 cases of sterile and 14 had positive culture. Spine X-rays films showed narrowed disc space in 29 cases, and bridging osteophytes were noted in 19 patients. Destructive and sclerotic changes of vertebral bodies with narrowing of disc spaces were observed in 14 patients. The results show that PDD is a minimally invasive procedure for obtaining sufficient biopsy material for histological analysis and culture in cases of discitis, and has a good clinical outcome recommended for patients with early stage postoperative intervertebral discitis without neurologic deficit.

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation. A retrospective of patients with symptomatic contained cervical disc herniated were operated on with PCN and PCD from June 2003 to July 2005. Two-hundred and four patients initially fulfilled the study criteria, and 28 patients were lost in follow-up. The patients were categorized into different groups depending on the procedure by PCN (81 cases) or PCD (95 cases). The clinical outcomes, pain reduction, and segment stability were recorded during this study. Puncture of the needle into the disc space was accurately performed under C-arm fluoroscopy guidance in all cases and no intraoperative deaths were reported in our study. At the end, 176 cases had follow-up and 28 cases were lost, and the follow-up rate was 88.0% (81/92) in the PCN group and 84.8% (95/112) in the PCD group. The follow-up time ranged from 16 to 48 months (average 29 months), and on an average of 28.86 ± 4.52 months on PCN and 8.42 ± 3.21 months on PCD (t = -0.24, P = 0.81, >0.05). The operation time averages of PCN and PCD are 4.67 ± 1.16 and 11.95 ± 1.80, respectively (P < 0.01). The pain index improved from 7.12 ± 1.13 to 2.74 ± 0.89 (t = 27.03, P = 0.0000, <0.001) in PCN patients and from 7.18 ± 1.09 to 2.71 ± 0.91 (t = 29.57, P = 0.0000, <0.001) in PCD patients. Clinical results of PCN were excellent in 31 cases, good 32 cases, fair 13 cases, and poor 5 cases; for PCD, the results were 33, 42, 12, and 7 cases, respectively, and 1 in discitis. Good and excellent was 78.4% (77.8% in PCN and 79.5% in PCD, P > 0.05). There was one case of PCN that had the partial Perc-D SpineWand broken in the disc space, cannot be moved by the percutaneous cervical discectomy, and remained there itself. One of the cases had discitis in this study after PCD. Patient presented with neck pain and associated radicular pain and numbness in the left upper-limb after 8 days of PCD. There were no instable cases after procedures of PCN and PCD. There were no significant difference in stability of preoperatively and postoperatively between PCN and PCD (P > 0.05). PCN and PCD treatments of contained cervical disc herniation show good outcomes and there was no difference in the stability of cervical spine. PCN and PCD are safe, minimally invasive, and no differences were observed between the methods in clinical outcome.

Reviewer’s comment concerning “Percutaneous cervical nucleoplasty treatment in the cervical disc herniation” (Jian Li et al. MS-no: ESJO-D-08-00079R2)

The article of Jian Li et al. describes the clinical results in a series of 126 patients with ‘contained’ cervical disc herniations treated by percutaneous nucleoplasty. The principle of this procedure is to introduce a small fiber (Perc D Spine Wand™) into the cervical disc. Then radiofrequency energy is applied to coagulate parts of the disc in a controlled way. It is postulated that this leads to a decompressive effect with a consecutive relief of the patient’s symptoms. This procedure is on the market in the US and outside US for a couple of years but never made it to become a generally accepted routine procedure. One of the reasons for this is the fact that there can be doubts whether the clinical success rates are really based on a therapeutic effect rather than on a ‘modulation’ of the spontaneous course. The procedure is also characterized by an occasionally uncritical application in patients who would otherwise not have been surgical candidates. The paper by Jian Li et al. describes a series of patients with favorable clinical result after cervical nucleoplasty. However, again there is a lack of information and some methodological flaws which should lead to a careful interpretation of these results. The diagnostic criteria as stated in the paper were CT scan and/or MRI which means that in some patients no MRI was performed. This makes it difficult to show all morphological inclusion/exclusion criteria in an adequate way. Considering that severe vascular (carotid artery) or esophageal injury is one of the rare but potential complications of percutaneous puncturing of a cervical disc, it is amazing and irritating that the patients left the hospital within 1 h postop. without any postop. surveillance. Figure 3 shows different sagittal planes pre- and postop. so it is not exactly comparable. Moreover, it looks like there is an epidural fragment at C3-4 in Fig. 3a which is considered a contraindication for nucleoplasty but which is known to occasionally disappear over time by itself. The MRI in Fig. 4 is interpreted as a discitis C5-6, however in T2-weighed images the disc is hypointense suggesting that these are Modic type I changes and not inflammatory. In summary, I congratulate the authors for their good and favorable clinical results and their low complication rate. Whether this has been the therapeutic effect of percutaneous nucleoplasty is, however, not proven in their paper.

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

The Intraoperative Nursing of Percutaneous cervical Nucleoplasty Treatment the Cervical disc Herniation

目的 探讨经皮等离子体髓核成形术治疗颈椎间盘突出症的手术配合.方法 我院2003年7月～2005年6月采用经皮等离子体髓核成形术治疗颈椎间盘突出症62例,对患者术前心理护理、手术配合及术后效果进行患者回顾性分析.结果 所有病例获得随访,随访时间6～24个月(平均17.34±6.41月).所有手术均获得成功,手术进行顺利,术中病人情绪稳定.手术后疼痛明显缓解或消失,VAS评分术前程度(7.24±2.38),术后(1.02±0.36),有显著性差异(P＜0.001).手术临床效果显著,JOA评分术前(9.19±1.64),术后(15.37±1.22),有显著性差异(P＜0.001).结论 经皮等离子体髓核成形术治疗颈椎间盘突出症的手术效果良好,术前心理护理解除病人紧张情绪及术中良好的肢体语言交流是手术顺利进行的重要保证。