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Efficacy of Nucleoplasty for Radiculopathy Caused by Foraminal Cervical Disc Herniation: Clinical Results of Case Series and Technical Note

Pain Physician. 2022 Oct;25(7):E1087-E1094.


BACKGROUND: Percutaneous cervical nucleoplasty (PCN) is a minimally invasive technique used for the treatment of cervical disc herniation. However, if the lesion is located at the neural foramen, complete access and effective neural decompression are often challenging because of the special anatomical condition of the uncovertebral joint, osteophyte, and facet joint of the cervical foraminal space.

OBJECTIVES: To investigate the effect of PCN on radiculopathy caused by foraminal cervical disc herniation (FCDH).

STUDY DESIGN: Retrospective case series.

SETTING: Single-center tertiary hospital.

METHODS: This study included 44 patients with radiculopathy caused by FCDH who were treated with PCN. Visual analog scale (VAS) scores, preoperative, 1 week, and 3 months postoperatively, and at the last follow-up, as well as the Macnab criteria, were used to evaluate clinical outcomes. A paired t-test was used to compare the preoperative and follow-up VAS scores. The percentage of patients with VAS scores <= 3 at each follow-up time point was also investigated. Statistical significance was set at P < 0.05.

RESULTS: Twenty-seven men (62.4%) and 17 women (38.6%) were enrolled in this study. The mean age was 54.5 years (range 31-81). The average follow-up period after the operation was 15.4 months (range 3.7-30.8). The mean preoperative VAS was 7.50 ± 1.21. The VAS scores at 1 week, 3 months, and the last follow-up were 4.36 ± 2.46, 3.20 ± 2.58, and 2.91 ± 2.74, respectively, showing a significant improvement in pain compared to before the operation (P < 0.001 for all). The number of patients (percentage) with a VAS score of <= 3 was 20 (45.5%), 28 (63.6%), and 31 (70.5%) of 44 patients at 1 week, 3 months, and the last follow-up, respectively. The number of patients (percentage) with excellent, good, fair, or poor satisfaction according to the Macnab criteria was 17 (38.6%), 9 (20.5%), 8 (18.2%), and 10 (22.7%) of 44, respectively. No patients experienced postoperative complications.

LIMITATIONS: This study was retrospective and included a small number of patients from a single center.

CONCLUSIONS: Although PCN for radiculopathy caused by FCDH is thought to have limitations because of the surrounding bony structure, the clinical outcome seemed favorable. If PCN is not contraindicated, it may be a viable treatment option for CR due to FCDH.


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