1. 2022;25;E1095-E1103Comparison of the Effect of Balloon Catheter vs Nucleoplasty vs Balloon Catheter and Nucleoplasty in Patients With Lumbar Spinal Stenosis
   Retrospective Study
   Na Eun Kim, MD, Jong Bum Choi, PhD, Hye Rim Kwon, MD, Hee Tae Chung, MD, Eun Soo Jang, MD, Chang Yik Moon, MD, and Byung Gun Kim, PhD.

BACKGROUND: Nucleoplasty and neuroplasty are often performed in patients with refractory lower back pain when conservative treatment is ineffective. Lumbar spinal stenosis (LSS) is caused by multiple factors; in some cases, a single procedure of nucleoplasty or neuroplasty alone does not provide sufficient treatment effect.

OBJECTIVES: This study aimed to investigate and compare the pain relief and pain-free interval among patients with LSS who underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty.

STUDY DESIGN: Retrospective study.

SETTING: In-ha University hospital pain clinic.

METHODS: This is a retrospective study of the medical records and survey of 98 patients with LSS who visited a pain clinic between 2019 and 2020 and underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty. Patients with disc height < 50% of the adjacent disc on magnetic resonance imaging and those with moderate and severe extraforaminal stenosis were excluded. Thus, 60 patients who underwent nucleoplasty (n = 20), neuroplasty (n = 20), and combined balloon neuroplasty and nucleoplasty (n = 20) for LSS were analyzed. The patients were instructed to rate their pain intensity via an 11-point numeric rating score (NRS) before and after the procedure. The Korean version of the Oswestry Disability Index (ODI) questionnaire was checked before and after the procedure.

RESULTS: The pain intensity decreased to NRS 3 ± 0.14 and 1.85 ± 0.19 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, indicating a significant difference (P = 0.003). ODI was significantly decreased after the procedure compared with that before the procedure in all groups. After the procedure, ODI decreased to 13.89 ± 0.20 and 11.21 ± 0.33 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, with a significant difference between the 2 groups (P < 0.05). The patients in the nucleoplasty group achieved pain relief for 4.93 ± 1.22 months after the procedure, whereas those in the balloon neuroplasty group achieved pain relief for 5 ± 1.37 months. In the combined balloon neuroplasty and nucleoplasty group, pain relief was maintained for 10.2 ± 1.11 months (P = 0.003).

LIMITATIONS: The pain was assessed with NRS without considering the patients’ pain medication. There may be differences in the outcome of the procedure depending on the surgeon.

CONCLUSION: The pain reduction effect was greater and was retained for a longer period with combined balloon neuroplasty and nucleoplasty than with nucleoplasty or neuroplasty alone.

KEY WORDS: Neuroplasty, nucleoplasty, balloon catheter, spinal stenosis, Numeric Rating Score, Oswestry Disability Index, pain relief, pain-free interval