4) what's the latest on nucleoplasty? I found this study of nucleoplasty, but I think it is still not popular on the board, but not real certain....best to ask it of others publicly....The results of the study are probably dependent on who is doing the study as well...

Abstract ID: A-38
Abstract Title: The Efficacy of Nucleoplasty™ in the Treatment of Contained Herniated Lumbar Intervertebral Discs
Authors: Provenzano D1, Dellapiazza D2, Gaughan J3, Kabazie A4
Ohio Valley General Hospital1, Ohio Valley General Hospital2, Temple University School of Medicine3, The Western Pennsylvania Hospital4
Poster Type:

ABSTRACT BODY
Introduction: Sixty to 80% of adults will experience low back pain, the leading cause of both time lost from work and permanent disability in North America.(1) Technologies for percutaneous disc procedures have been introduced to treat both low back and radicular pain. Disc nucleoplasty™ utilizing coblation technology™ was FDA cleared in 2001 and to date greater than 35,000 procedures have been performed. Safety and efficacy data published on this technique are relatively scarce. To assess the safety and efficacy profile of nucleoplasty, we performed a retrospective review.

Materials and Methods: Following IRB approval, a retrospective review was performed of perioperative clinical records and procedure notes of all patients who underwent nucleoplasty from 2001 to 2004 by the senior author (AJK). Assessment of long-term safety and efficacy occurred via a prospective telephone follow-up. Previously, some patients received conservative therapy including modalities such as opioid and non-opioid medications, physical therapy and epidural steroids. Patients were divided into three groups based on length of follow-up: less than 6 months, 6 months to 1 year, and greater than 1 year. A clinically important reduction in pain was considered to be ≥30% on a 0 to 10 verbal numerical rating scale.(2)

Results: 121 patients (133 procedure levels) underwent nucleoplasty from 2001 to 2004 with a mean duration of symptoms of 1276 ± 1454 (s.d.) days and a mean follow-up of 511 ± 571 days. The mean age was 40 ± 11 years (64 males & 57 females). Prior to the procedure 75% of patients had constant pain. The primary pain was axial lumbar spine in 91 (75%), radicular in 16 (13%), and both in 14 (12%) patients. No difference in outcome was noted among the areas of primary pain. 43% of patients were associated with workers compensation claims with no statistically significant difference in improvement compared to non-workers compensation patients. 69 patients (57%, 95% CI 48%-66%) had ≥30% pain relief and 53 patients (44%, 95% CI 35%-53%) had ≥50% pain relief. Pain relief achieved did not decrease with time. There was no difference in pain reduction between the three time frame groups. No complications were associated with this procedure including discitis or neurological injury.

Discussion: Over 500,000 percutaneous decompressions for herniated discs have been performed in the last 20 years, often allowing patients to avoid a more invasive technique.(3) The nucleoplasty procedure is a safe technique providing an improvement in verbal numerical rating scales. Future studies on nucleoplasty would benefit from randomized controlled studies with direct comparison to conservative therapy, other percutaneous disc decompression technologies, and microdiscectomy. In addition, defining selection criteria is warranted.

All work was completed at Western Pennsylvania Hospital.

1. Garfin, et al. 1997. Orthopaedic Knowledge Update: Spine. Rosemont: American Academy of Orthopaedic Surgerons.
2. Farrar, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149-158.
3. Reddy, et al. New approach to the management of acute disc herniation. Pain Physician. 2005;8:385-389.

ATTACHED FILES
Reg Anesth Pain Med 2006; 30(3):A-38