Coblation nucleoplasty and open microdiscectomy are compared in treating lumbar disc protrusions. 80 patients underwent each procedure. Leg pain, as measured by VAS scores, improved more for microdiscectomy patients initially but steadily improved for nucleoplasty patients as well over 12 months. Nucleoplasty allowed nearly all patients to return to work within 3 days while most microdiscectomy patients remained on medical leave for over 3 months. Both procedures provided significant pain relief, but nucleoplasty had advantages of less invasiveness and quicker return to work.

1. Percutaneous Nucleoplasty versus Open Discectomy in
Patients with Lumbar Disc Protrusions
Danil ADAM1.2
1
“Carol Davila” Medicine and Pharmacy University, Bucharest, Romania
2
“Victor Babes” Clinic, Bucharest, Romania

2. - DISK DEGENERATION or anatochronesis is a normal evolutive process,
which is characterized by
deshydratation
lactic acid ⇑
glycosaminoglycans ⇓
- DDD is a real socio-economic problem, whith high prevalence

3. - MECHANICAL FACTORS : compression and shearing forces produce
fissuration of the disk and disk herniation
- This condition can be treated conservative or operative by many approaches
- MINIMALLY INVASIVE PROCEDURES are increasingly applied for
treatment of LDH (Lumbar Disk Herniation)
- The results of
NUCLEOPLASTY BY COBLATION vs. MICRODISCECTOMY
are presented.

4. CARDINAL SIGNS in LDH
- LOW BACK PAIN Symptoms of LDH may start as
LBP, which then develop to
- LEG PAIN radicular pain

5. PATHOPHISIOLOGY
DISCOGENIG PAIN
BACK PAIN RADICULAR PAIN
- In DDD granulation tissue with C - Mechanical compression by
fibers invade the disk herniated disk
-High pressure on external ring. - Chronic inflammation of the root

6. TREATMENT of LDH
An initial non-operative management
is applied for LBP.
Cauda equina syndrome or motor
deficit are absolute indication for
open surgery.
Between these two extreme
modalities is coblation.

7. INCLUSION CRITERIA
NUCLEOPLASTY OPEN DISCECTOMY
- One level protrusion
- Failed of conservative therapy
- Absence of previous spine procedures
- Leg pain ≥ Back pain - Progressive motor deficit
- LDH contained - Cauda equina syndrome
- Disk protrusion ≤ 6 mm - Disk protrusion > 6 mm

8. CONTRAINDICATIONS
NUCLEOPLASTY OPEN DISCECTOMY
- Sequestration - Back pain only
- Disk protrusion > 6 mm - Disk protrusion < 6 mm
- Spondylolisthesis
- Spinal
Infections
Tumors
Fractures

9. MATERIAL
Two cohort of 80 patients treated with coblation and microdiscectomy
between september 2009 – september 2010 are analysed.
There are not significant differences regarding sex distribution, age or
level of disease.

10. SEX DISTRIBUTION
COBLATION MICRODISCECTOMY

11. Patients in the 4th and 5th decade of age are most affected.

12. The majority of procedures were at L4-5 and L5-S1 level.

13. TECHNIC OF COBLATION
Position and marking of the entry point and direction of the disk of interest
Local anesthesia Incision of the skin

14. Introduction of the quide wire AP Image Lateral Image

15. COBLATION

16. Epidural Injection of Depo-Medrol

17. RESULTS
LEG PAIN
COBLATION:
- VAS score decrease from pre-
operative 7.9 in average to 5.0, 3.7
and 2.2 at 3, 6 and 12 months
respectively, post-operative
DISCECTOMY :
- VAS score decrease from pre-
operative 8.0 in average to 2.8, 2.0
and 1.8 at 3, 6 and 12 months
respectively, post-operative

18. VAS score
- Improvement of VAS score is bigger for Discectomy patients, but in fact we
compare “apples with peaches” because the size of protrusion differ in the two
arms of the study
- Decrease of VAS score in Coblation patients is due to intradiscal pressure
decrease followed in time by retraction of protrusion
- Downward trend of VAS score is maintained in 1 year follow-up period

19. IMPROVEMENT OF VAS SCORE FOR BACK PAIN
AFTER NUCLEOPLASTY

21. EMPLOYMENT STATUS
- All patients with Coblation return to work 3 days later
- Only 2 (2.82 %), 7 (9.90%), 15 (21.13%) and respectively 20 (28.17%) patients in the
Discectomy group are return to work at 1, 3, 6 and 12 months respectively. Most of them
remain in medical leave for 90 days followed by temporally retirement.

22. NUCLEOPLASTY RESULTS APRECIATED BY PATIENTS

23. CONCLUSIONS
1. Nucleoplasty is efficacy and safe procedure without complications
2. Improvement of back pain and leg pain are significant and
constant in the follow-up period of 1 year
3. All but 1 patient return to work immediately