Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation

Abstract

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) C11°or horizontal displacement (HD) C3 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.

Plasma disc decompression for contained cervical disc herniation: a randomized, controlled trial

“…Though pain as measured by VAS was significantly reduced in both the CC and PDD patients, the PDD group displayed statistically significantly greater pain reduction at all follow-up time points. In their patient series, Li et al [28] similarly reported statistically significant VAS pain reduction (P \ 0.01) after PDD when compared to preoperative values through all time points (2 weeks, 1, 3, 6, and 12 months). In our study, by just 6 weeks post-procedure, 84% of PDD patients had achieved a clinically important (MCID) reduction in radicular and neck pain; at no time points did an equivalent proportion of CC patients achieve a MCID reduction in their pain.…”

“…Bonaldi et al [3] performed a prospective case study utilizing PDD to treat 55 patients with cervical disc herniations and symptoms of neck and arm pain; 85% of these patients had a good to excellent clinical outcome by 6 months post-procedure. More recently, Li et al [28] performed cervical PDD on 126 consecutive patients with similar results: a good to excellent clinical outcome of 83.73% by 1-year post-procedure. These early results suggest that cervical PDD may be an appropriate method to resolve pain symptoms in these patients before attempting open surgery, which can be accompanied by severe complications [2,15,16,43,56].…”

“…We experienced no complications when treating patients with cervical PDD. In a series of 126 patients treated with cervical PDD, Li et al [28] had no complications and no recurrent cases, save an incident where the tip of the SpineWand broke in the disc space and remained there with no clinical consequence. A similar complication was encountered by Bonaldi et al [3] when performing cervical PDD on their first patient in a 55-patient series, and their patient remained asymptomatic and had excellent clinical results through 29 months of follow-up.…”

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

“…1 Epstein suggests that there is negative risk-benefit ratio in the use of MIS cervical foraminotomies and favors the use of open techniques, 30 but it is our opinion that complications are avoided by eliminating use of guidewires to begin the process of soft tissue dilation. In 2008, MIS-ACDF using endoscopic techniques was reported by Ruetten et al 111 In the same year, anterior cervical nucleoplasty using percutaneous techniques in cadavers was described by Li et al 76 The use of MAST for cervical instrumentation has been described. Wang and colleagues 130 were the first to report on its clinical use in the placement of lateral mass screws.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…Only 2 out of 30 required surgical treatment, and this was apparent at 6 weeks. One can compare these results to those achieved by Li et al [39], in their paper describing percutaneous cervical nucleoplasty in the treatment of cervical disc herniation, I suspect that most patients and surgeons would opt for a selective root block, rather then having the inside of the disc burnt, and the risk of a piece of equipment being left in the disc! Kumar in his preoperative assessment measures the neck disability index, and shows that it reduces from an average of 66.9 to 31 at 6 weeks, with little reduction afterwards at a year.…”