Long-Term Clinical Results of Percutaneous Cervical Nucleoplasty for Cervical Radicular Pain: A Retrospective Cohort Study

Abstract

Purpose Percutaneous cervical nucleoplasty (PCN) is a minimally invasive treatment for cervical radicular pain due to a disc herniation. Preliminary results show equivalent patient-reported outcomes of PCN as compared to conventional anterior cervical discectomy. However, there is a paucity of long-term outcome data. Therefore, the primary objective of this study is to investigate the long-term clinical results of PCN. Patients and Methods A retrospective analysis was conducted on patients who underwent PCN at a secondary referral center between 2010 and 2014. Before surgery and five days after surgery, numeric rating scales (NRS) for arm pain and neck pain and data on complications were collected. To determine long-term follow-up outcomes, patients were sent a questionnaire booklet containing the Core Outcome Measures Index-Neck (COMI-Neck), NRS for arm pain and neck pain, Likert-scales on patient satisfaction and questions regarding the incidence of reoperations and complications. Results The baseline characteristics were collected for 158 patients. At a median follow-up of 41.5 months (interquartile range (IQR) 27.0 to 57.5), data were available for 118 patients (74.7%). At short-term follow-up, patients that underwent PCN had a mean decrease of 3.0 on the NRS for arm pain (95% CI 2.5 to 3.6) compared to baseline, while at long-term follow-up, a mean decrease of 2.8 (95% CI 1.0 to 3.6) was observed. At the long-term follow-up, 67.8% of the patients were fully recovered from all symptoms and 93.3% remained satisfied with the PCN treatment results. The reoperation rate for recurrent disc herniation was 21.4% at long-term follow-up. Conclusion PCN appears to be a safe and effective treatment at short-term and long-term follow-up of a specific selection of cervical herniated discs, with an acceptable long-term reoperation rate. These study results suggest a potential role of PCN as a less invasive treatment option for cervical radicular pain due to a soft disc herniation, before anterior cervical discectomy should be considered.

Analysis of the clinical and radiological outcomes of percutaneous cervical nucleoplasty: A case–control study

“…However, in their retrospective cohort study, Rooij et al reported that the reoperation rate of 158 patients over 41.5 months was 21.4%. They concluded that the reoperation rate was acceptable and suggested a potential role for PCN as a less invasive treatment option before ACD [ 36 ]. Our data show that 90 PCN patients were recruited in our series, and only one patient received ADR three months after PCN due to a lack of improvement.…”

“…We believe that PCN does not represent an alternative to PCD, ACD and ADR [ 24 ], but may be used to postpone or to decrease the need for eventual-step cervical fusion surgery to treat degenerative cervical disc disease [ 16 ]. However, it may have a potential role as a less invasive treatment option, before ACD is considered, for cervical radicular pain due to soft disc herniation [ 36 ].…”