Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial.

Background: Chronic low back pain is a major social, economic and healthcare issue in the Thailand. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression and fusion. The percutaneous access to the disc was first used in the 1950s to biopsy the disc with needles. Percutaneous access to the disc using endoscopic techniques was developed in the 1970s. Nucleoplasty has emerged as one of the minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs which utilizes coblation technology for ablating and coagulating the nucleus for a partial disc removal.

Objective: Evaluate the effectiveness of Nucleoplasty on pain in activity and improvement in MRI in patients with radicular or axial low back pain secondary to contained herniated discs.

Design: Prospective, Randomized, Control Trial.

Material And Method: Sixty-four patients were randomized in two groups equally. Thirty-two patients had undergone Nucleoplasty and another thirty-two patients had undergone conservative treatment. Patients were evaluated at 1, 3, 6 and 12 months postoperatively and were asked to quantify their pain using a visual analog scale ranging from 0 to 10. Data were compared between baselines and at 1, 3, 6 and 12 months post-treatment. Pre-nucleoplasty MRI and Post-nucleoplasty 3 months were compared to evaluate the decrease of bulging disc.

Results: Reported pain and medication use were significantly decreased and functional status was improved at 1, 3, 6 and 12 months following Nucleoplasty (p-values < or = 0. 001 for all outcome measures at all time periods) and also the bulging disc was significantly decreased 3 months following nucleoplasty.

Conclusion: Nucleoplasty appears to be safe and effective in Thailand. Is an effective procedure for patients presenting with discogenic back and/or radicular pain that have failed conservative therapies and are not considered candidates for open surgical interventions. A result of this analysis indicated that PDD using Coblation technology, also referred to as nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.