Current Evidence of Percutaneous Nucleoplasty for the Cervical Herniated Disk: A Systematic Review

• Published in: Pain practice 2014-07, Vol.14 (6), p.559-569
• Main Authors: Wullems, Jorgen A., Halim, Willy, van der Weegen, Walter
• Format: Article
• Language: English
• Subjects: cervical herniated disk; cervical pain; Cervical Vertebrae - surgery; coblation; Diskectomy, Percutaneous - adverse effects; Humans; Intervertebral Disc Displacement - surgery; neck pain; nucleoplasty; percutaneous nucleoplasty; Randomized Controlled Trials as Topic; systematic review
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.12122

Background Although percutaneous cervical nucleoplasty (PCN) has been shown to be both safe and effective, its application is still debated. PCN applied in disk herniation has not been systematically reviewed before, resulting in a limited insight into its effectiveness and safety, and the quality of available evidence. Therefore, we systematically reviewed the evidence on the efficacy and safety of PCN in patients with a (contained) herniated disk. Methods MEDLINE, EMBASE, and the Cochrane Library (Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and nonrandomized studies using the following keywords: “Nucleoplasty,” “Cervical,” “Hernia,” “Herniation,” “Prolapse,” “Protrusion,” “Intervertebral disk,” and “Percutaneous disk decompression.” First, all articles were appraised for methodological quality, and then, RCTs were graded for the level of evidence according a best‐evidence synthesis, because a meta‐analysis was not possible. Finally, the RCTs' applicability and clinical relevance also was assessed. Results Of 75 identified s, 10 full‐text articles were included (3 RCTs and 7 nonrandomized studies). These studies represented a total of 1021 patients: 823 patients (≥ 892 disks) were treated by PCN. All studies showed low methodological quality, except for two. The level of evidence of the RCTs was graded as moderate, with low to moderate applicability and clinical relevance. Conclusion All included studies showed PCN to be an effective and safe procedure in the treatment of (contained) herniated disks at short‐, mid‐, and long‐term follow‐up. However, the level of evidence is moderate and shows only low to moderate applicability and clinical relevance.