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Chen CH, Chiu YP, Ji HR, Wu CY, Guo JH, Jaw FS, Chiu CD. Analysis of the clinical and radiological outcomes of percutaneous cervical nucleoplasty: A case-control study. PLoS One 2022; 17:e0278883. [PMID: 36508407 PMCID: PMC9744319 DOI: 10.1371/journal.pone.0278883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Chien-Hua Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - You-Pen Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Hui-Ru Ji
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Chin-Ying Wu
- Department of Neurosurgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Jeng-Hung Guo
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
- Spine Center, China Medical University Hospital, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Fu-Shan Jaw
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Cheng-Di Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
- Spine Center, China Medical University Hospital, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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de Rooij JD, Gadjradj PS, Aukes H, Groeneweg G, Speksnijder CM, Huygen FJ. Long-Term Clinical Results of Percutaneous Cervical Nucleoplasty for Cervical Radicular Pain: A Retrospective Cohort Study. J Pain Res 2022; 15:1433-1441. [PMID: 35607408 PMCID: PMC9123892 DOI: 10.2147/jpr.s359512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Judith Divera de Rooij
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Orthopedics, Physiotherapy Unit, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Correspondence: Judith Divera de Rooij, Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Dr. Molenwaterplein 40, Rotterdam, 2040 CA, the Netherlands, Tel +31 (010) 704 01 40, Email
| | - Pravesh Shankar Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Hans Aukes
- Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - George Groeneweg
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Frank Johannes Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Percutaneous cervical discectomy: retrospective comparison of two different techniques. Radiol Med 2020; 125:569-577. [PMID: 32040719 DOI: 10.1007/s11547-020-01133-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
AIM To compare clinical success and patient satisfaction of percutaneous cervical nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation treatment. MATERIALS AND METHODS We retrospectively identified 50 consecutive patients in our institution: 24 underwent the PCD treatment and 26 patients were treated by the PCN procedure. All patients complained of radicular pain with or without neck pain; diagnosis of contained cervical disc herniation was obtained by MRI; all patients had received conservative therapy which did not result in symptom improvement. Exclusion from our series consisted of patients who had undergone previous surgery at the indicated level, or those with myelopathy, or those in whom more than a sole herniation was treated in the same session. Overall procedure time, fluoroscopy time, radiation dose and complications were recorded. The MacNab scale score was used to assess clinical success in terms of pain relief at 2- and 6-month follow-up. After 4-6 months, a cervical MRI was obtained in 24 patients. RESULTS Neither major nor minor complications were reported. Regarding patient satisfaction, overall median modified MacNab score was excellent both at 2 and 6 months after treatment. No significant statistical difference was found in mean modified MacNab score at 2 and 6 months among patients grouped by treatment choice (p = 0.319 and 0.847, respectively); radiation dose was inferior in PCN group than in PCD, with no significant statistical difference. CONCLUSION PCD and PCN were found to be safe and effective in terms of pain relief in contained cervical herniation treatment.
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Klessinger S. The Frequency of Re-Surgery After Cervical Disc Nucleoplasty. World Neurosurg 2018; 117:e552-e556. [DOI: 10.1016/j.wneu.2018.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
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Abrishamkar S, Salimi S, Pirmoradi H. Comparison the Postoperation Results of Discectomy with Nucleoplasty in Single Cervical Disc Herniation. Adv Biomed Res 2018; 7:29. [PMID: 29531927 PMCID: PMC5840971 DOI: 10.4103/abr.abr_159_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The standard treatment for cervical disc herniation is open discectomy surgery but some of techniques, such as nucleoplasty were applied by neurosurgeons in recent decade. The aim of this study was to compare the postoperation results of open discectomy and nucleoplasty methods in people suffering from single cervical disc herniation. MATERIALS AND METHODS In a clinical trial study that performed during 2012-2013, 70 patients who candidate for neck surgery were selected and randomly divided into two groups. The first group was operated with standard discectomia and the second group was operated with nucleoplasty method. All patients were followed neck pain, upper limb pain and common complications included discitis, infection and hematoma in 2 weak, 1, 2, 3, and 6 months after operation. All data were analyzed using SPSS software. RESULTS Cervical pain mean from before the operation to 6 months after operation had no significant difference between two groups, but radicular pain had significant difference in 2 and 3 months after operation (P < 0.05). It is notable that after operation it is not observed any discitis, infection and hematoma of operated place. CONCLUSION Doing nucleoplasty surgery in patients suffering from single cervical disc herniation causes decrease in cervical and radicular pain, at least as the same as discectomy method. Since now it is possible in our country to apply this method and on the other hand, in this method, time of surgery, postoperation complications, hospital costs, and period of convalescence is low, it is preferred in patients suffering from cervical disc and its application is advised.
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Affiliation(s)
- Saeid Abrishamkar
- Department of Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sohrab Salimi
- Department of General Anesthesiology, Imam-Hossein General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Pirmoradi
- Department of Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Jacobson RE, Granville M, Berti A. Minimally Invasive Anterior Cervical Discectomy Without Fusion to Treat Cervical Disc Herniations in Patients with Previous Cervical Fusions. Cureus 2017; 9:e1131. [PMID: 28473949 PMCID: PMC5415382 DOI: 10.7759/cureus.1131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Adjacent level cervical disc disease and secondarily progressive disc space degeneration that develops years after previously successful anterior cervical fusion at one or more levels is a common, but potentially complex problem to manage. The patient is faced with the option of further open surgery which involves adding another level of disc removal with fusion, posterior decompression, and stabilization, or possibly replacing the degenerated disc with an artificial disc construct. These three cases demonstrate that some patients, especially after minor trauma, may have small herniated discs as the cause for their new symptoms rather than progressive segmental degeneration. Each patient became symptomatic after minor trauma three to six years after the original fusion and had no or minimal radiologic changes of narrowing of the disc or spur formation commonly seen in adjacent level disease, but rather had magnetic resonance imaging (MRI) findings typical of small herniated discs. After failing multiple months of conservative treatment they were offered surgery as an option. Subsequently, all three were successfully treated with minimal anterior discectomy without fusion. There are no reports in the literature of using minimal anterior cervical discectomy without fusion in previous fused patients. This report reviews the background of adjacent level cervical disease, the various biomechanical explanations for developing a new disc herniation rather than progressive segmental degeneration, and how anterior cervical discectomy without fusion can be an option in these patients.
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Affiliation(s)
| | | | - Aldo Berti
- Miami Neurosurgery Institute, University of Miami Hospital
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Halim W, van der Weegen W, Lim T, Wullems JA, Vissers KC. Percutaneous Cervical Nucleoplasty vs. Pulsed Radio Frequency of the Dorsal Root Ganglion in Patients with Contained Cervical Disk Herniation; A Prospective, Randomized Controlled Trial. Pain Pract 2016; 17:729-737. [PMID: 27611826 DOI: 10.1111/papr.12517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/01/2016] [Accepted: 07/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cervical neck pain is often caused by cervical disk pathology and may cause severe symptoms and disability. Surgeons and patients are increasingly aware of postsurgery-related complications. This stimulated the clinical usage of minimally invasive treatments such as percutaneous nucleoplasty (PCN) and pulsed radio frequency (PRF). However, scientific evidence on both treatments is limited. OBJECTIVE Our objective was to evaluate the efficacy of PCN compared to PRF in patients with contained cervical disk herniation. METHODS A prospective randomized clinical trial was conducted including 34 patients with radicular pain due to a single contained cervical disk herniation who were treated with either PCN or PRF. Demographic data were collected, and the Medical Outcomes Study 12-Item Short Form (SF-12) Health Survey, visual analog scale (VAS), and the Neck Disability Index (NDI) were completed 1, 2, and 3 months after treatment. Treatment satisfaction and complications were recorded. RESULTS In the PCN group (n = 17, mean age 52.4 years, 10 female/7 male), patients were treated at C5 to C6 (8 cases) or C6 to C7 (9 cases). In the PRF group (n = 17, mean age 49.5 years, 8 female/9 male), patients were treated at C3 to C4 (1 case), C5 to C6 (10 cases), or C6 to C7 (6 cases). At 3 months, mean pain VAS improved significantly from baseline in the PCN group (mean improvement: 43.4 points) and in the PRF group (34.0 points). However, improvement in 1 group was not superior compared to the other group (P = 0.48). No serious complications were reported. CONCLUSION Within 3 months, both PCN and PRF show significant pain improvement in patients with contained cervical disk herniation, but none is superior to the other. Both treatment options appear to be effective and safe in regular clinical practice.
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Affiliation(s)
| | | | - Toine Lim
- Anna Hospital, Geldrop, The Netherlands
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de Rooij JD, Harhangi BS, Verhagen AP, Groeneweg JG, Fehlings MG, Huygen FJPM. Nucleoplasty for cervical radiculopathy or cervical radicular pain due to disc herniation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Judith D de Rooij
- Erasmus Medical Center; Pain Treatment Center; Postbox 2040 Rotterdam Netherlands 3000 CA
| | - B S Harhangi
- Erasmus Medical Center; Department of Neurosurgery; Postbox 2040 Rotterdam Netherlands 3000 CA
| | - Arianne P Verhagen
- Erasmus Medical Center; Department of General Practice; PO Box 2040 Rotterdam Netherlands 3000 CA
| | - J G Groeneweg
- Erasmus Medical Center; Pain Treatment Center; Postbox 2040 Rotterdam Netherlands 3000 CA
| | - Michael G Fehlings
- University of Toronto; Halbert Chair in Neural Repair and Regeneration; Toronto ON Canada
| | - F JPM Huygen
- Erasmus Medical Center; Pain Treatment Center; Postbox 2040 Rotterdam Netherlands 3000 CA
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