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

Abstract

Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain [50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, -46.87 ± 2.71 vs. -15.26 ± 1.97; 3 months, -53.16 ± 2.74 vs. -30.45 ± 2.59; 6 months, -56.22 ± 2.63 vs. -40.26 ± 2.56; 1 year, -65.73 ± 2.24 vs. -36.45 ± 2.86; GEE, P \ 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: -9.15 ± 1.06 vs. -4.61 ± 0.53, P \ 0.0001) and 1 year (PDD vs. CC: -16.70 ± 0.29 vs. -12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 ? 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a ''relapse, showing signs of decline in most measurements, whereas PDD patients showed continued stable improvement.

Surgery versus conservative care for neck pain: a systematic review

“…Three studies performed nucleoplasty Eur Spine J (2013) 22:87-95 89 procedure [12,16,17] which seem largely comparable. In five studies, an ACDF procedure (anterior cervical discectomy with fusion) was described and in one study the surgical procedure was an occipitocervical fusion [20].…”

“…1). Six studies, four of which were CCTs, were identified which examined surgery versus non-surgical interventions in patients with radiculopathy [12][13][14][15][16][17]. Three studies, of which two CCTs, compared surgery versus nonsurgical interventions in myelopathy patients [18,19,20].…”

“…Mean duration of complaints was unknown in three studies and varied between 1 and 7 years in the other six studies. Mean sample size in the smallest study arm was 31.6 and varied between 20 [17] and 58 [16].…”

“…The most common item that was scored positively included the timing of the outcome assessment. One study [16] scored positive on the item 'allocation concealment', but none on 'patient blinding', 'blinding care provider', blinding outcome assessor' or 'were co-interventions avoided or similar'.…”

Morphological changes in disc herniation in the lower cervical spine: an ultrastructural study

“…Percutaneous PDD (plasma disc decompression) might offer a disc-preserving method resolving pain in patients with a painful disc herniation, where conservative treatments failed. This method might also offer a possibility to preserve the different disc cell morphologies in the disc [48]. This paper shows that the different disc cell morphologies changes significantly with increasing radiological degeneration grade.…”