For more than five decades despite various disadvantages, open nucleotomy has been a beneficial treatment for prolapse of the intervertebral disc. Hence minimally invasive treatment for vertebral disc diseases has increasingly been applied in the last three decades, starting with chemonucleolysis, followed by endoscopic nucleotomy, automated draw-o¤ nucleotomy and percutaneous mechanical nucleotomy. However these methods are limited. Choy and Ascher experimentally produced the non-endoscopic percutaneous laser disc decompression and nucleotomy with good results, beneath its potential complications regarding the high level of temperatures reached.

Conventional open cervical discectomy in common neurosurgical knowledge, with or without bony fusion, is considered the standard treatment for cervical disc herniation. However, open discectomy with fusion is associated with significant local inflammation, graft donor site pain (when autologous bone graft is used), and lenghty period of convalescence. Percutaneous procedures are minimally invasive and o¤er decreased morbidity, require no bone graft and promise a shorter recuperation time. Nevertheless patient candidates for a percutaneous
procedure as inclusion criteria must complain of symptoms with regard to contained herniated disc or focal protrusion. It does not substitute conventional open procedures required for extruded discs.

Percutaneous decompression for treating lumbar disc herniation is a well-established technique which has demonstrated good clinical success in properly selected patients. Plasma-mediated electrosurgery, used in other medical fields, has proven useful for this application.

See reference

Nardi, P & Cabezas, Daniel & Cesaroni, A. (2005). Percutaneous cervical nucleoplasty using coblation technology. Clinical results in fifty consecutive cases. Acta neurochirurgica. Supplement. 92. 73-8. 10.1007/3-211-27458-8_16.

The low temperatures used during the coblation technique is one of the most important factors for the low percentage of possible complications during surgery when compared to other methods. The three channels created with the ablative energy of the wand allow an internal decompression of the target disc with secondary reduction of intradiscal pressure. Spontaneous regression of herniated disc is a common natural history in lumbar spine; in cervical spine this incident is rare and respective reports are few. The control group of this study confirms the importance of
nucleoplasty and the non-relevant role of conservative medical or physical treatments. The rate of patients who returned to normal quality of life and work is almost double for patients operated
on with nucleoplasty than for those treated conservatively. Clinical improvement is not always followed by complete regression of the herniated disc on MRI, nevertheless the follow-up confirms stabilization of recovery and clinical healing. Statistical analysis of these data confirmed the clinical results revealing a significant improvement in percentage of patients treated with nucleoplasty
(pa0,001) as if compared to the control group where clinical resolution was not always reached (p ¼ 0,172).  The possibility for the surgeon to observe neural tissue or vascular damage is almost zero. In spite of the relatively low case numbers and the limited follow-up the encouraging results induce us to utilize this technique in well-selected cases.

See reference

Nardi, P & Cabezas, Daniel & Cesaroni, A. (2005). Percutaneous cervical nucleoplasty using coblation technology. Clinical results in fifty consecutive cases. Acta neurochirurgica. Supplement. 92. 73-8. 10.1007/3-211-27458-8_16.

Nucleoplasty reduces pain in the long term and increases patients’ functional mobility. Compared to other treatments, it is an effective, low-complication, minimally invasive procedure used to treat cervical and lumbar disc herniations. Under the given catalog of indications, it appears to be superior to conservative therapy.

Dang, L. & Liu, Z. Eur Spine J (2010) 19: 205. https://doi.org/10.1007/s00586-009-1202-7

Nulla varius eros vitae justo facilisis, et dictum magna aliquam. Duis varius ipsum vel congue aliquet. Aliquam a purus aliquet, fermentum diam non, facilisis est. Etiam porta odio quis tellus mollis pulvinar. Praesent vitae nulla pellentesque, efficitur augue vitae, egestas magna. Sed vitae condimentum lorem, sed commodo augue. Nulla in ante non metus ultrices maximus. Maecenas interdum sollicitudin suscipit.

ODI values after nucleoplasty (lumbar) and conservative therapy.

  • Plasma Nucleoplasty
  • Conservative treatment

See reference

Eichen, Philipp & Achilles, Nils & König, Volker & Mosges, Ralph & Hellmich, Martin & Himpe, Bastian & Kirchner, R.. (2014). Nucleoplasty, a Minimally Invasive Procedure for Disc Decompression: A Systematic Review and Meta-analysis of Published Clinical Studies. Pain physician. 17. E149-73.

VAS/NPS values after nucleoplasty total and conservative therapy.

  • Plasma Nucleoplasty
  • Conservative treatment

See reference

Eichen, Philipp & Achilles, Nils & König, Volker & Mosges, Ralph & Hellmich, Martin & Himpe, Bastian & Kirchner, R.. (2014). Nucleoplasty, a Minimally Invasive Procedure for Disc Decompression: A Systematic Review and Meta-analysis of Published Clinical Studies. Pain physician. 17. E149-73.

Comparison of functional increase for sustained activity

In percentage
  • Sitting
  • Standing
  • Walking

See reference

Singh, Vijay & Piryani, Chandur & Liao, Katherine. (2004). Role of percutaneous disc decompression using Coblation in managing chronic discogenic low back pain: A prospective, observational study. Pain physician. 7. 419-25.

METHODS:

Patients <18 years old undergoing adenoidectomy without tonsillectomy were selected for this prospective, single-blinded, randomized controlled trial. Participants were enrolled into one of two groups based on birth date: coblation or ME. The surgeons completed a standard survey about intraoperative factors for each method. Recovery nurses filled out a standardized survey postoperatively. A third standardized survey was completed via a phone interview with the parent or patient caregiver on postoperative day 3 to assess procedure outcomes. The survey results were then compared using ANOVA statistical analysis.

RESULTS:

50 patients were enrolled in the coblation group and 51 were enrolled in the ME group. There was no significant difference in mean age between the coblation (4.96 years) and ME groups (4.58 years) (p = 0.525). The mean time (in minutes) for coblation (5.50) was significantly lower than ME (9.47) when controlling for the confounder: surgical site exposure (p < 0.001). The surgical time was significantly influenced by the quality of exposure/visualization (p = 0.037). The coblator method had significantly less intraoperative blood loss compared to ME (p < 0.001). There was a statistically significant difference between coblation (1.53) and ME (2.05) for days of pain (p = 0.045) when controlling for the confounder adenoid size.

CONCLUSION:

In our study we found that coblation demonstrated significantly less intraoperative time and less blood loss, as well as a shorter duration of postoperative pain, when compared to ME for adenoidectomy.

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Praesent vitae nulla pellentesque, efficitur augue vitae, egestas magna. Sed vitae condimentum lorem, sed commodo augue. Nulla in ante non metus ultrices maximus. Maecenas interdum sollicitudin suscipit.

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