Evaluation of nucleoplasty in patients of low back pain with radiculopathy: A preliminary report

Introduction: Low back pain (LBP) has a point prevalence of 11.9 +/- 2% worldwide. Nucleoplasty is a minimally invasive procedure, combining disc removal and thermal coagulation using radiofrequency waves in the nucleus pulposus. The purpose of this preliminary study was to evaluate the efficacy of nucleoplasty in patients with low back pain and radiculopathy, and to have comparative evaluation of the disc appearance on MRI pre-and post-procedure. Methodology: We enrolled 20 patients, suffering with low back pain along with radiculopathy undergoing nucleoplasty from June 2010 to June 2012. Inclusion criteria were; patients of either sex, age 18-60 yrs, one or two level herniated disc (contained), failed conservative therapy for six weeks. Exclusion criteria were loss of >50% disc height and severe disc degeneration. Post nucleoplasty patients were called for follow up at 3, 6 and 12 months. Repeat MRI was done after 3 months of nucleoplasty to look for changes in the intervertebral disc. Pain was assessed using the visual analogue scale (VAS) and patient's satisfaction was evaluated by Macnab's outcome assessment. Statistical analysis was done with Friedman ANOVA using the package SPSS 21.0 (SPSS Inc., Chicago, IL). A p-value of < 0.05 was considered significant. Result: There were 4 drop outs and thus we present results of 16 patients only. In 13 patients single disc decompression was done, whereas in the remaining 3 patients it was done at two levels. Post procedure MRI was evaluated in 8 patients. Following nucleoplasty 81% of patients experienced pain relief and improvement in patient satisfaction. MRI performed 3 months after the procedure revealed appreciable reduction in the disc bulge in 3 out of 8 (37.5%) patients. Conclusion: Nucleoplasty appears to be a safe and favorable day care minimally invasive procedure in selected patients. Large randomized, controlled studies are required to correlate MRI findings to clinical outcomes.