Nucleoplasty: Reliable Intradiscal Therapy in selected Lumbar Disc Herniations

This study was designed to determine the mid-term follow-up outcome of herniated intervertebral discs treated with NucleoplastyTM (Arthrocare spine, Sunnyvale, California, U.S.A.) which utilizes coblation technology for ablating and coagulating the nucleus for partial disc removal. Sixty-five patients underwent Nucleoplasty from August 2000 through February 2002. Sixty-one patients who had been followed-up more than 12 months were included in this study. Male was outnumbered female by 37 to 24 and their mean age was 32.3 years (21-46). Fifty-three patients underwent one level procedure and 8 patients underwent two level procedure. The L4-5 level was the most commonly involved. All patients had axial pain and 49 patients had accompanying radiating pain in the leg. Intraoperative discogram was performed to determine the symptomatic level. Most patients underwent the procedure under the local anesthesia and discharged same day or next day. Ruptured or migrated disc herniations, spinal stenosis, previous major spinal surgery and definite radiological spinal instability were contraindications. Mean follow-up period was 15.6 (12-27) months. Average operation time was 46 minutes. The surgical result according to the MacNab classification showed Excellent and Good in 51 cases, Fair in 7 cases and Poor in 3 cases. Most patients showed symptom improvement one or two days after surgery. There was no heat related nerve injury. Difficulties were found in targeting into L5-S level. Three patients underwent an open discectomy and three patients had an epidural steroid injection during the follow-up period. There was one discitis that treated with intravenous antibiotics as a surgery related complication. These results indicate that the Nucleoplasty is a safe and reliable armamentarium in minimally invasive disc surgery for the contained herniated intervertebral discs. Patient selection is the most important key for the successful surgical result