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

Abstract

Background 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. Purpose The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT. Methods 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. Results 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. Conclusions 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.

Machine Learning Assisting the Prediction of Clinical Outcomes following Nucleoplasty for Lumbar Degenerative Disc Disease

“…Furthermore, the patient's age is also a critical pathophysiological influencing factor. This is consistent with the mechanism of LNP, in which the younger and collage-richer the pulposus nucleus contained in the intervertebral disc, the more effective the disc coblation will be [36,46,47]. Compared to the radiomic features, the overall physiological parameters had a greater impact on building the ML models, which suggests that the AI-assisted image reading played the role of an assistant rather than a replacement.…”

“…Cincu et al's report, based on 10 year follow-up data, concluded that LNP might provide intermittent pain relief in contained disc herniation without significant complications [35]. These differences between studies may be due to variability in patient selection and decision-making [36]. Based on the therapeutic methods of LDDD, Huo et al compared the efficacy between LNP and endoscopic discectomy and showed that LNP is more appropriate for young and middle-aged patients, a finding consistent with our results [37].…”

Use of Navigable Ablation Decompression Treatment (L-DISQ) for Contained Cervical Disc Herniation – Technical Note and Literature Review

“…It uses a bipolar radiofrequency technology applied to a saline conducting medium, which vaporizes nuclear tissue, helping in the removal of herniated disc tissue. The primary disadvantage of the nucleoplasty device is the inability to access the herniated nucleus easily, limiting the direct removal of herniated disc tissue [ 1 , 2 ]. A new navigable percutaneous disc decompressor (L’DISQ-C, U&I Co., Uijeongbu, Korea), introduced in 2012, is designed to allow direct access to herniated disc material.…”