Percutaneous nucleoplasty

Abstract

Introduction. Sciatica is a common disease, between 73% and 85% of the general population will experience at least one episode of sciatica due to spinal disc herniation and nerve root irritation. Percutaneous intradiscal techniques of nucleoplasty can be applied as an intermediate measure between conservative treatment and surgery, with a view to avoiding the adverse events associated with surgical discectomy. In some specialist centers, good results were obtained with pure ethanol, mixed with ethylcellulose to increase its viscosity and enhanced with radio opaque material. Material and methods. A total of 49 patients were included in this study and treated with radio opaque gelified ethanol and intraarticular steroids of a lumbar and cervical intervertebral disk hernia. We evaluated each patient’s pain levels during the procedure itself and then after 3-4 and 8 weeks, and 4, 8, 12, 24 months after procedure. Results. Pain levels immediately after the procedure were markedly lower than before the procedure. There were no complications. Two months after procedure administration, the initial pain level had fallen by an average of 84 %. The outcome was quite stable over time (mean follow-up: 2 years). Short-term follow-up with magnetic resonance showed little or no changes in the intervertebral disk but there was discordance with clinical signs. Long-term follow-up magnetic resonance showed a dramatic reduction in hernia volume. Very good or good results were obtained in 42 (89,1%) of the 49 patients, fair - in 16 cases and bad in 3 cases ( 8.6%). Only 2 cases with a bad outcome at lumbar level went to surgery. Conclusion: This preliminary study shows the efficacy and inocuity of this substance. More especially, it demonstrated the absence of complications and recidivates in the immediate and long-term follow-up for more than 3 years for the first cases.