Universität zu Köln

Eichen, Philipp Maximilian, Achilles, Nils, Koenig, Volker, Moesges, Ralph, Hellmich, Martin, Himpe, Bastian and Kirchner, Rainer (2014). Nucleoplasty, a Minimally Invasive Procedure for Disc Decompression: A Systematic Review and Meta-analysis of Published Clinical Studies. Pain Physician, 17 (2). S. E149 - 25. PADUCAH: AM SOC INTERVENTIONAL PAIN PHYSICIANS. ISSN 1533-3159

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Abstract

Background: Nucleoplasty, based on Coblation (R) technology, is a minimally invasive procedure used to decompress herniated discs. Reviews to date - exclusively systematic reviews - recommend nucleoplasty for treating chronic back pain, although with the restriction of limited to fair evidence. We therefore aimed to summarize and interpret our calculated results, where possible comprehensively and quantitatively, using statistical methods in the context of a meta-analysis supplementing a systematic review. In the process, the central question was to statistically determine whether, and to what extent, nucleoplasty can positively affect pain relief and functional mobility as well as lower the complication rate. Objective: Newly published studies made it possible to conduct a meta-analysis of the visual analog scale (VAS), a measuring instrument used to determine pain intensity, and the Oswestry Disability Index (ODI), a scale that reflects the degree of impairment in percent. In addition to having clearly sound evidence for analyzing VAS/NPS data, the present, newly compiled meta-analysis was able to summarize VAS and ODI data quantitatively and to calculate a total complication rate for the first time. It was thereby possible to make a first comparison between nucleoplasty and conservative therapy (including epidural steroid injection). Study Design: This meta-analysis examined all study data published in clinical trials involving the nucleoplasty procedure for plasma disc decompression. Methods: A systematic search using the terms nucleoplasty and/or plasma disc decompression was conducted for literature listed in MEDLINE. Twenty-seven eligible studies (22 prospective trials and 5 retrospective trials) were included, and pooled analyses as well as various subgroup analyses (differentiation between cervical and lumbar disc herniations, comparisons with alternative treatments such as epidural steroid injection) were performed based on their data. Results: Pain decreased from a baseline VAS value of 7.27 to 2.12 (postop/first day), 2.50 (one week), 2.70 (2 weeks), 3.23 (one month), 2.66 (6 weeks), 2.84 (3 months), 3.06 (6 months), 3.03 (12 months), 1.54 (18 months), and 3.69 (24 months) after nucleoplasty. The ODI value (baseline: 58.95) dropped to 28.60 (one week), 29.00 (2 weeks), 23.21 (one month), 30.00 (6 weeks), 18.30 (3 months), 22.54 (6 months), 24.43 (12 months), 12.82 (18 months), and 36.98 (24 months). Compared to baseline, significant pain reduction and improvement in functional mobility after nucleoplasty were observed at every time point. Nucleoplasty showed a total complication rate of 1.5%, with the individual rates being 0.8% for cervical and 1.8% for lumbar nucleoplasty. Nucleoplasty was superior to conservative therapy at every time point and for all 3 included parameters, at some measurement time points even significantly. Conclusions: Nucleoplasty reduces pain in the long term and improves patients' functional mobility. It is an effective, low-complication, minimally invasive procedure used to treat disc herniations.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Eichen, Philipp Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Achilles, Nils UNSPECIFIED UNSPECIFIED UNSPECIFIED Koenig, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Moesges, Ralph UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Himpe, Bastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kirchner, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-443658
Journal or Publication Title:	Pain Physician
Volume:	17
Number:	2
Page Range:	S. E149 - 25
Date:	2014
Publisher:	AM SOC INTERVENTIONAL PAIN PHYSICIANS
Place of Publication:	PADUCAH
ISSN:	1533-3159
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTRADISCAL ELECTROTHERMAL THERAPY; LOW-BACK-PAIN; PERCUTANEOUS CERVICAL NUCLEOPLASTY; INTERLAMINAR EPIDURAL INJECTIONS; MEDICINE PRACTICE GUIDELINES; LUMBAR HERNIATED DISC; CONTROLLED-TRIAL; DOUBLE-BLIND; COBLATION NUCLEOPLASTY; SURGICAL-TREATMENT Multiple languages Anesthesiology; Clinical Neurology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44365