Cervical decompressive nucleoplasty

Dr Manish RajMD,DA,FISP,FENSS

Fellow endoscopic spine surgery(S.korea)Deptt of Interventional spine & PainMax smart superspeciality hospital,

Jaypee hospital

A 35 year old male suffering from neck pain with radiation to left arm

Duration-6 months with tingling & numbness Vas- 6-7/10,( initial Vas 8-9/10), Power – 4/5, DN4Q- 2Rx- conservative for 8 weeks, One shot of CESI(4 months back)

Treatment Options for Contained Disc herniations

Conservative care - rest, medications, physical therapy

Steroid injection(s)

Percutaneous Disc Decompression / Nucleoplasty for contained protrusions

Endoscopic discectomy

Microdiscectomy/ACD for large protrusions or extrusions

Fusion/ACDF

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Optimal Patient SelectionRadicular/Axial Pain (lateral

herniation) Arm pain > neck pain MRI evidence of contained disc protrusion Discography positive, if indicated Failed selective nerve root block x 1

Axial Neck Pain (central focal herniation) Failed conservative therapy

X 3 months Discography positive for

concordant pain Disc height > 75%

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3 2 1

Technique.....5

Technique (modification )

Results….

Pre-op 3 months follow up

Results….

Pre-op 3 months follow up

Results Plasma disc decompression for contained cervical disc

herniation: a randomized, controlled trial” This RCT study concluded that PDD offered improved pain relief as well as superior immediate and long-term gains in functional ability and quality of life when compared to conservative care. PDD is a minimally invasive treatment option for symptomatic contained disc herniation that provides an excellent medium for both results and safety..”

Alessandro Cesaroni, Pier Vittorio Nardi , Eur Spine J, November 2009

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A Retrospective 3 year follow up evaluation of 480 patients treated with Cervical Plasma Disc Decompression

“PDD is a quick and safe MIS procedure with excellent clinical results. Significant pain relief was observed postoperatively during the first 4 weeks after the PDD procedure and continued pain relief at follow up.”Sebastian Gitter et al ,

Results

Experiences• More than 80cervical Nuceloplasty in

contained disc herniation • Arm pain > neck pain• With or without neuropathic component• With or without Motor Involvement

• Note: Significant /complete reduction of pain, improvement of motor function & QOL.

SummaryCervical Nucleoplasty is a method of disc

decompression.It provides a safe and controlled therapy by using

Coblation® technology.The first patient was treated in July 2000.To date (June 2016), over 980,000 patients have

been treated world-wide.Nucleoplasty has a strong clinical portfolio. Over 100

relevant peer-reviewed articles have been published to date (highest for any percutaneous disc decompression).

Good option in patient with failed conservative management in well selected patients

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Thank you