J Korean Soc Spine Surg.  2005 Dec;12(4):344-348.

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty

• Kim YW
• Chang HG
• Seo KN
• Lee KB
• Kim HS

Abstract

STUDY DESIGN: This is a retrospective study.
OBJECTIVES
We wanted to compare the early course of APLD with the long term follow-up after APLD and also the long term follow up after APLD with the short term follow-up after nucleoplasty. SUMMARY OF LITERATURE REVIEW: We evaluated the postoperative clinical course of both APLD and nucleoplasty. The evaluation of the postoperative clinical course was performed by using the Oswestry Disability Index (ODI).
MATERIALS AND METHODS
We studied 59 patients who underwent APLD and nucleoplasty from 1989 to 2004. We defined the 26 cases with less than 5 years follow up as the early course follow-up after APLD, the 20 cases with over 5 years follow up as the long term after APLD, and 13 cases with less than 5 years follow up as the short term follow up after nucleoplasty. We then compared three groups. We inspected the condition of the discs on MRI and the level of the operated disc.
RESULTS
The most common type of disc was a protruded disc (69.4%). Its ODI was lower than that of the extruded type. 5 cases out of the total group underwent open discectomy after APLD. In our study, the extruded type patients underwent a worse clinical course than protruded type patients. The patients who under went procedures at two affected disc levels had higher ODI scores compared to patients who underwent procedures at one level. The ODI score of the early course follow-up after APLD was 12.4%, the ODI of the long term follow up was 6.9% and that of the short term follow-up after nucleoplasty was 4.6%.
CONCLUSIONS
On the long term follow-up, the patients who underwent APLD had significant improvement for any of the clinical parameters, as compared with their preoperative status. The patients who underwent nucleoplasty had a better prognosis than those patient who underwent APLD with less than 5 years follow up.

Keyword

APLD; Nucleoplasty; ODI

MeSH Terms

Diskectomy*
Follow-Up Studies*
Humans
Magnetic Resonance Imaging
Prognosis
Retrospective Studies

Reference

1). Bonaldi G. Automated percutaneous lumbar discectomy: technique, indications and clinical follow-up in over 1000 patients. Neuroradiology. 2003; 45(10):735–743.

2). Quigley MR, Maroon JC. Automated percutaneous discectomy. Neurosurg Clin N Am. 1996; 7:29–35.

3). Smith L. Chemonucleolysis. Personal history, trials, and tribulations. Clin Orthop. 1993; 287:117–24.

4). Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years' experience. Clin Orthop. 1989; 238:9–23.

5). Onik G. Percutaneous lumbar discectomy using a new aspiration probe. Am J Neuroradiol. 1985; 6:290–296.

6). Choy DS, Ascher PW, Ranu HS, et al. Percu tan eous laser disc decompression, A new therapeutic modality. Spine. 1992; 17:949–956.

7). Saal JS, Saal JA. Management of chronic discogenic low back pain with a thermal intradiscal catheter. Spine. 2000; 25:382–389.

8). Chen YC, Lee SH, Chen D. Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers. Spine. 2003; 28:661–665.

9). Dullerud R, Amundsen T, Lie H, Juel NG, Abdelnoor M, Magnaes B. Clinical results after percutaneous automated lumbar nucleotomy. A follow-up study. Acta Radiol. 1995; 36(4):418–24.

10). Siebert W. Percutaneous nucleotomy procedures in lumbar intervertebral disc displacement. Orthopade. 1999; 28(7):598–608.

11). Ramberg N, Sahlstrand T. Early course and long-term follow-up after automated percutaneous lumbar discectomy. J Spinal Disord. 2001; 14:511–516.