INTRODUCTION: Nucleoplasty is a minimally invasive procedure that utilizes the principle of radiofrequency ablation to achieve volumetric reduction, reduction of intradiscal pressure & decompression. Back pain still remains a major disabling problem which is yet to be addressed in a minimally invasive way.
OBJECTIVE: To evaluate the effectiveness of nucleoplasty in the treatment of chronic discogenic axial low back pain in patients who failed conservative treatment for a period of 3 mths.
SUBJECTS: 30 patients undergoing nucleoplasty performed by a single surgeon at one or more levels from Oct 2008 to Dec 2009 were included in the study. Patients with clinically symptomatic back pain were included. The patients with working diagnosis of infection or malignancy, clear cut nerve root pain with working diagnosis of disc prolapse, pregnancy & children were excluded All patients who underwent the procedure had discography for the levels in question.
STUDY DESIGN: Patients were assessed clinically with using the Visual analog Scale (VAS) back and leg, Oswestry disability index (ODI), and Short Form‐36 (SF‐36) preoperatively. MRI was studied for evaluation of degenerate disc with regards to disc height, presence and location of annular tear. In the post operative period they were followed at 6 weeks, 3 month, 6 month and 1 year.
RESULTS: Significant improvements was noted only in 66% (20/30) of the treated patients. The ones that improved showed significant improvement in outcome indicators of ODI, VAS (back) and SF‐36.
We analysed the reason for success in the population that improved after the procedure. Presence of ‘high intensity zone (HIZ)’ indicating annular tear was associated with poor outcome. Patients with positive discography (11/18) surprisingly did not show an improvement as against the ones with negative discography (9/12).
CONCLUSIONS: Nucleoplasty has an effective role in the treatment of patients with chronic discogenic back pain in a select group.