Differential Treatment of Nerve Root Compression Pain Caused by Lumbar Disc Herniation Applying Nucleoplasty

Background: Nucleoplasty is a minimally invasive intervention use to perform discdecompression in cases of nerve root compression caused by disc herniation. It is importantto find rational guidelines for choosing between nucleoplasty and microsurgery.Objective: To analyze factors that may impact the results of nucleoplasty, and to validatethe rational guidelines between minimally invasive treatment and open surgery.Study Design: Prospective, non-randomized, cohort study with a minimal follow-upperiod of 18 months.Methods: Patients were given a neurological examination, visual analogue scale andOswestry disability questionnaire, obligatory MRI, optional RCT, and discography, onlybefore nucleoplasty. Patients have been divided into the following groups: Group 1 –patients with a disc protrusion treated with nucleoplasty (n = 46), which has been dividedinto Subgroup 1A, those with a disc protrusion size ≤ 5 mm (n = 24), and Subgroup 1B,those with a disc protrusion size 6 – 9 mm (n = 22); Group 2 – patients with a disc extrusiontreated with nucleoplasty (n = 27); Group 3 – patients with a disc extrusion or sequestertreated with microdiscectomy (n = 65).Outcome Measures: Clinically significant outcomes were a 50% relief of pain intensityand a 40% decrease of Oswestry Disability Index (ODI).Results: A decrease of pain intensity and disability was found in all groups of patients, P< 0.0001; SP (statistical power) = 99 – 100%. Subgroups 1A and 1B showed no clinicallysignificant differences in outcome, P = 0.99; SP = 5.3. Clinically significant results: Group 1– 78%; 95% CI (confidence interval) [66; 90%], Group 2 – 44%; 95% CI [25; 65%], Group3 – 93%; 95% CI [85; 98%]. Total annulus disruption increases the rate of unsatisfactoryresults of nucleoplasty, OR (odds ratio) = 4.5; 95% CI [1.57; 12.87] (logistic regressionmodel, P = 0.0034). Nucleoplasty performed in cases of uncontained disc herniation (discextrusion) have a significantly higher rate of unsatisfactory results versus microdiscectomy,OR = 19.06; 95% CI [2.29; 68.73] (logistic regression model, P < 0.0001).Limitations: This study was limited by the small number of patients in each group.Conclusion: The size of the disc protrusion does not significantly affect the outcomeof nucleoplasty. The rational guideline for choosing between the 2 types of surgery is theintegrity of the annulus.Key words: disc herniation, nucleoplasty, microdiscectomy, annulus integrity