Long-Term Clinical Results of Percutaneous Cervical Nucleoplasty for Cervical Radicular Pain: A Retrospective Cohort Study

Abstract

Judith Divera de Rooij,1,2 Pravesh Shankar Gadjradj,3 Hans Aukes,4 George Groeneweg,1 Caroline Margina Speksnijder,5 Frank Johannes Huygen1 1Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2Department of Orthopedics, Physiotherapy Unit, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 3Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA; 4Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands; 5Department of Oral and Maxillofacial Surgery, Utrecht Medical Center, Utrecht, the NetherlandsCorrespondence: Judith Divera de Rooij, Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Dr. Molenwaterplein 40, Rotterdam, 2040 CA, the Netherlands, Tel [phone], Email [email protected]: Percutaneous cervical nucleoplasty (PCN) is a minimally invasive treatment for cervical radicular pain due to a disc herniation. Preliminary results show equivalent patient-reported outcomes of PCN as compared to conventional anterior cervical discectomy. However, there is a paucity of long-term outcome data. Therefore, the primary objective of this study is to investigate the long-term clinical results of PCN.Patients and Methods: A retrospective analysis was conducted on patients who underwent PCN at a secondary referral center between 2010 and 2014. Before surgery and five days after surgery, numeric rating scales (NRS) for arm pain and neck pain and data on complications were collected. To determine long-term follow-up outcomes, patients were sent a questionnaire booklet containing the Core Outcome Measures Index-Neck (COMI-Neck), NRS for arm pain and neck pain, Likert-scales on patient satisfaction and questions regarding the incidence of reoperations and complications.Results: The baseline characteristics were collected for 158 patients. At a median follow-up of 41.5 months (interquartile range (IQR) 27.0 to 57.5), data were available for 118 patients (74.7%). At short-term follow-up, patients that underwent PCN had a mean decrease of 3.0 on the NRS for arm pain (95% CI 2.5 to 3.6) compared to baseline, while at long-term follow-up, a mean decrease of 2.8 (95% CI 1.0 to 3.6) was observed. At the long-term follow-up, 67.8% of the patients were fully recovered from all symptoms and 93.3% remained satisfied with the PCN treatment results. The reoperation rate for recurrent disc herniation was 21.4% at long-term follow-up.Conclusion: PCN appears to be a safe and effective treatment at short-term and long-term follow-up of a specific selection of cervical herniated discs, with an acceptable long-term reoperation rate. These study results suggest a potential role of PCN as a less invasive treatment option for cervical radicular pain due to a soft disc herniation, before anterior cervical discectomy should be considered.Keywords: percutaneous cervical nucleoplasty, minimally invasive treatment, cervical radicular pain

Keywords

• percutaneous cervical nucleoplasty
• minimally invasive treatment and cervical radicular pain