1. 2005;8;385-390New Approach to the Management of Acute Disc Herniation
   A Retrospective Evaluation
   Arra S. Reddy, MD, Shaun Loh, BS, Jennifer Cutts, MD, Jacob Rachlin, MD, PhD, and Joshua A. Hirsch, MD.

Background: Over 500,000 percutaneous disc decompression procedures have been performed in the past 20 years. Various percutaneous techniques include chemonucleolysis, percutaneous lumbar discectomy, and laser discectomy which have reported success rates in the 70% to 75% range. This retrospective evaluation of 49 patients who underwent nucleoplasty procedures for treatment of herniated discs, evaluates the effectiveness of nucleoplasty in the reduction of pain, improvement of functional activity, and reduction of pain medication.

Objective: To illustrate the effectiveness of nucleoplasty in reducing low back pain in symptomatic patients with contained herniated discs.

Study design: A retrospective, non-randomized study.

Methods: Forty-nine patients with either axial or radicular low back pain who had undergone the nucleoplasty procedure were included in this analysis. Patients were categorized in one of three different groups depending on time elapsed since the procedure was performed: less than 6 months, between 6 months and 1 year, and greater than 1 year.

Pain reduction, work impairment, leisure impairment, medication use and patient satisfaction were all recorded during this study. Pain was quantified using a numeric pain scale from 0 to 10. Work and leisure impairment were measured on a scale of 1 to 5, with 1 signifying no impairment and 5 signifying extreme impairment. Medication use and patient satisfaction were also measured on a scale of 1 to 5.

Results: Significant pain relief, functional improvement, and a decrease in medication use were achieved following nucleoplasty. There were no complications associated with the procedure.

Conclusion: Nucleoplasty should be used in those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Keywords: Nucleoplasty, disc herniation, Coblation, low back pain