Author/Authors :
Mahabadi, Amir Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Abrishamkar, Saeid Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Kouchakzadeh, Masih Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Mirhosseini, Ahmad Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Tabesh, Homayoun Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Rezvani, Majid Departments of Neurosurgery - Isfahan University of Medical Sciences, Isfahan , Moayednia, Amir Department of Physical Medicine and Rehabilitation - Isfahan University of Medical Sciences, Isfahan , Ganjeifar, Babak Department of Neurosurgery - Mashhad University of Medical School - Emam Reza Hospital, Mashhad , Yousefi, Elham Department of Neurosurgery - School of Medicine - Isfahan University of Medical Sciences, Isfahan , Mehrabi Kooshki, Ali Departmentt of Epidemiology - Alzahra Hospital - Isfahan University of Medical Sciences, Isfahan
Abstract :
Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc
herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The
high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared
the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This
study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The
Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the
treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as
the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following
variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of
herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty
group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically
significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year
after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the
nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was
no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while nucleoplasty is as effective
as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such
as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty
as an effective method of treatment in patients with single-level disc herniation.
