Percutaneous cervical laser diskectomy, thermoannuloplasty, and thermonucleoplasty; comparable results without surgery
- Chief of Neurosurgical Spine/Education, NYU Winthrop Hospital, Mineola, New York, USA
Nancy E. Epstein
Chief of Neurosurgical Spine/Education, NYU Winthrop Hospital, Mineola, New York, USA
DOI:10.4103/sni.sni_164_17Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nancy E. Epstein. Percutaneous cervical laser diskectomy, thermoannuloplasty, and thermonucleoplasty; comparable results without surgery. 21-Jun-2017;8:128
How to cite this URL: Nancy E. Epstein. Percutaneous cervical laser diskectomy, thermoannuloplasty, and thermonucleoplasty; comparable results without surgery. 21-Jun-2017;8:128. Available from: http://surgicalneurologyint.com/surgicalint-articles/percutaneous-cervical-laser-diskectomy-thermoannuloplasty-and-thermonucleoplasty-comparable-results-without-surgery/
Background:Utilizing the literature, the results of three different minimally invasive surgery (MIS) anterior cervical percutaneous operations for neck/mild radicular pain and magnetic resonance (MR)-documented “contained” (not extruded/sequestrated) discs were evaluated. Results were compared with patients treated nonsurgically for comparable/greater neurological compromise, and even more severe cervical disc disease.
Methods:There were three MIS percutaneous anterior cervical discectomy procedures. Anterior cervical laser discectomy ablated and vaporized disc tissue. The thermoannuloplasty used heat to contract collagen fibers to reduce disc volume. Thermonucleoplasty employed a low-temperature resister probe to promote disintegration and evacuation of small volumes of disc (e.g., some studies cited an average of just 0.09 mL of disc removed). These results were compared to those for the nonsurgical management of patients with comparable/greater neurological deficits, and more severe cervical disc herniations.
Results:The three MIS anterior cervical operations resulted in 80–90%+ improvement using Macnab's criteria. However, although the literature demonstrated similar 80–90+% improvement without cervical surgery, the latter patients were more neurologically compromised.
Conclusions:For patients with pain alone/mild radiculopathy and “contained” discs on MR, three MIS percutaneous anterior cervical disc operations resulted in 80–90%+ improvement. Notably, similar 80–90%+ improvement was observed for comparable/more neurologically impaired patients with even larger cervical disc herniations treated nonsurgically. With such findings, where is the “value added” for these three MIS cervical operations?
Keywords: Cervical, laser discectomy, minimal indications, cervical nucleoplasty, percutaneous, thermoannuloplasty
Utilizing the literature, outcomes of three percutaneous minimally invasive surgery (MIS) anterior cervical operations were evaluated. Patients presented with neck pain/mild radiculopathy and MR-documented “contained” (e.g., neither extruded or sequestrated) cervical disc herniations. The anterior cervical laser discectomy ablates, vaporizes, and decompresses the posterior/central nucleus pulposus. The thermoannuloplasty heats the posterior disc near the annulus, producing contraction of collagen fibers, and thereby, reduces the disc volume. The thermonucleoplasty low-temperature resister probe promotes disintegration and evacuation of disc material (e.g., reported in some studies to average just 0.09 mL) [Tables
Early clinical and animal studies for minimally invasive anterior cervical laser disc ablation
Between 1995–1998, three studies evaluated the early experience with cervical laser disc ablations in patients with pain alone/mild radiculopathy without focal neurological deficits for “contained cervical discs” [Tables
Comparable efficacy of two lasers for anterior cervical disc ablation
In 2000 and 2001, Knight et al. documented that two lasers were comparably effective in performing anterior cervical laser disc ablations in patients with neck pain alone with MR-documented “contained” discs [
Percutaneous laser discectomy, thermoannuloplasty, thermonucleoplasty
Several studies utilized percutaneous laser discectomy, thermoannuloplasty, or thermonucleoplasty to treat patients with pain alone/mild radiculopathy and MR-documented “contained” discs; in these series, patients exhibited 85–88.3% improvement [Tables
One commercial device for percutaneous laser disc ablation
In two studies without control groups, Deukmedjian et al. (2012, 2013) introduced the Cervical Deuk Laser Disc Repair® for percutaneous laser disc ablation utilized in patients with pain/mild radiculopathy and “contained discs” [
Minimal changes in disc height or variable improvement following anterior cervical laser discectomy or thermonucleoplasty
Three studies looked at the results of anterior cervical percutaneous laser discectomy or nucleoplasty [
Low/moderate clinical relevance of percutaneous cervical nucleoplasty/coblation
Utilizing multiple databases to identify randomized clinical trials (RCTs), Wullems et al. (2014) evaluated the outcomes for patients with pain/mild radiculopathy and “contained” cervical discs undergoing percutaneous anterior cervical nucleoplasty/coblation [Tables
Review of comparable results for nonsurgical management of cervical discs
A review of multiple studies documented the successful nonsurgical management (e.g., up to 80 –90%+ improvement) of cervical disc herniations in patients with pain alone/more severe neurological deficits, and larger cervical disc herniations [
Utilizing the literature, we compared the outcomes for patients with neck pain/mild radiculopathy and MR-documented “contained” cervical disc herniations treated with three MIS percutaneous anterior cervical operations versus those managed nonsurgically. Notably, those treated without surgery originally demonstrated even greater neurological deficits and radiographic/MR neurological compromise. For both groups, outcomes were comparably good/excellent up to 80–90%+ of the time. Since nonsurgical management was so successful in these patients, shouldn't we question whether there is a “value added” or in fact, any value for the three MIS for any of the three MIS cervical disc operations under discussion?
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Conflicts of interest
There are no conflicts of interest.
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