Percutaneous Nucleoplasty for the Treatment of a Contained Cervical Disk Herniation

Rooij, Judith D de; Gadjradj, Pravesh S.; Hoeve, John S. Soria van; Huygen, Frank; Aukes, Hans; Harhangi, Biswadjiet S.

doi:10.1097/bsd.0000000000000583

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…Due to these reasons and the excellent outcomes and safety of PCN, initial surgical treatments for cervical degenerative disc disease have steadily shifted away from ACDF and towards PCN. Although several PCN-related complications have been reported, such as intervertebral discitis, broken device tips, and postoperative hematoma, the complication rate is very low 3) . Among them, the incidence of intervertebral discitis is 1.8-5.3% 2,5) and that of CSD, which is thought to be preceded by discitis, is even rarer 13) .…”

Section: Discussionmentioning

confidence: 99%

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

et al. 2020

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Percutaneous cervical nucleoplasty (PCN) has proven to be a safe and effective technique for the management of the cervical herniated or bulging discs. The incidence of cervical spondylodicitis (CSD) after PCN is rare. Case 1: A 53-year-old male patient was admitted with right arm motor weakness, severe posterior neck pain. He diagnosed with a C5-6 bulging disc and underwent a PCN two months prior to admission to our hospital. Laboratory tests revealed WBC counts and CRP levels, but his erythrocyte ESR was mildly elevated to 42 mm/hr. MRI showed a CSD at the C5-6 level. The patient underwent an anterior cervical C5 corpectomy and fusion. A microbiological culture revealed the presence of Propionibacterium acnes. Case 2: A 51-year-old female patient was admitted with quadriparesis. She was diagnosed with a C6-7 bulging disc and underwent a PCN two weeks prior to admission to our hospital. Laboratory tests revealed and elevated WBC count of 13.1×10 3 /mm 3 , elevated ESR of 70 mm/hr, and elevated CRP of 10.1 mg/dL. The MRI showed a high signal intensity around the C5-6 vertebral body and epidural fluid collection on the axial image. The patient underwent a C6-7 anterior cervical discectomy and. No microbes were identified in blood or pus cultures. Clinicians should consider CSD, if a patient's neurologic symptoms have deteriorated within 8 weeks after PCN. If clinical and laboratory tests show any indication of CSD, MRI should be performed facilitating appropriately timed treatment in order to prevent neurological sequelae.

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Section: Discussionmentioning

confidence: 99%

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

et al. 2020

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“…But no correlation was detected between changes in disc height and PCN outcomes ( Fig 3 ), indicating that decreased disc height after PCN cannot be used as an indicator of poor outcome. At our center, we performed the standard three-point circular coblation technique for PCN (at 1/4, 2/4, and 3/4) in each cervical disc space ( Fig 4 ) [ 34 ]. We propose that some amount of decrease in disc height following PCN may represent an acceptable trade-off for apparent symptom improvements.…”

Section: Discussionmentioning

confidence: 99%

“…Our re-surgery rate was approximately 4.44% (4/90) within an average of 30.44 ± 24.36 months after surgery. This drastic difference in results between studies may be due to patient selection [ 34 , 37 ]. The decision making for performing PCN should be based on several parameters which including the patients’ age, symptoms, signs and the image characteristics.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Chiu

et al. 2022

PLoS ONE

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Background Percutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically. Purpose The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT. Methods The present study was designed as a case–control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2–7 Cobb’s angle, and C2–7 sagittal vertical axis. Results Compared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement. Conclusions To provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.

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“…Nucleoplasty releases the pressure on the outer AF, allowing the disk to return to normal size, thereby decompressing the nerve, with better therapeutic effects than non-surgical treatments. This procedure can be performed in the clinic, and the patient recovers quickly after the procedure, but the indications of this procedure are limited ( Eichen et al, 2014 ; Liliang et al, 2016 ; de Rooij et al, 2017 ).…”

Section: Current Ivdd Treatmentsmentioning

confidence: 99%

Intervertebral Disk Degeneration: The Microenvironment and Tissue Engineering Strategies

Dou

Sun

et al. 2021

Front. Bioeng. Biotechnol.

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Intervertebral disk degeneration (IVDD) is a leading cause of disability. The degeneration is inevitable, and the mechanisms are complex. Current therapeutic strategies mainly focus on the relief of symptoms, not the intrinsic regeneration of the intervertebral disk (IVD). Tissue engineering is a promising strategy for IVDD due to its ability to restore a healthy microenvironment and promote IVD regeneration. This review briefly summarizes the IVD anatomy and composition and then sets out elements of the microenvironment and the interactions. We rationalized different scaffolds based on tissue engineering strategies used recently. To fulfill the complete restoration of a healthy IVD microenvironment, we propose that various tissue engineering strategies should be combined and customized to create personalized therapeutic strategies for each individual.

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Percutaneous Nucleoplasty for the Treatment of a Contained Cervical Disk Herniation

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 3 publications

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

Cervical Spondylodiscitis with Neurologic Deterioration after Percutaneous Cervical Nucleoplasty

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

Intervertebral Disk Degeneration: The Microenvironment and Tissue Engineering Strategies

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