An Update of the Systematic Assessment of Mechanical Lumbar Disc Decompression with Nucleoplasty

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low backproblems, but are the most common causes of nerve root pain and surgical interventions. The primaryrationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compressiondue to herniated disc material. The primary modality of treatment continues to be either open ormicrodiscectomy, although several alternative techniques are also utilized, including nucleoplasty,automated percutaneous discectomy and laser discectomy. There is a paucity of evidence for alldecompression techniques, specifically alternative techniques including nucleoplasty.Study Design: A systematic review of the literature of mechanical lumbar disc decompression withnucleoplasty.Objective: To determine the effectiveness and update the effectiveness of mechanical lumbar discdecompression with nucleoplasty.Methods: The available literature on mechanical lumbar disc decompression with nucleoplasty wasreviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane MusculoskeletalReview Group criteria as utilized for interventional techniques for randomized trials and the criteria developedby the Newcastle-Ottawa Scale criteria for observational studies.The level of evidence was classified as good, fair, and limited or poor based on the quality of evidencedeveloped by the U.S. Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 toSeptember 2012, and manual searches of the bibliographies of known primary and review articles.Outcome Measures: Pain relief and functional improvement were the primary outcome measures.Other outcome measures were improvement of psychological status, reduction in opioid intake, andreturn to work.Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was definedas greater than one year.Results: For this systematic review, 37 studies were considered for inclusion. Of these, there was onerandomized trial and 14 observational studies meeting inclusion criteria for methodological qualityassessment.Based on USPSTF criteria, the level of evidence for nucleoplasty is limited to fair in managing radicularpain due to contained disc herniation.Limitations: A paucity of literature with randomized trials.Conclusion: This systematic review illustrates limited to fair evidence for nucleoplasty in managingradicular pain due to contained disc herniation.Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion,radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, Coblation technology,nucleotomy