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

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 o...

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Published in:Pain practice 2014-07, Vol.14 (6), p.559-569
Main Authors: Wullems, Jorgen A., Halim, Willy, van der Weegen, Walter
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Language:English
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description 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.
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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.</description><identifier>ISSN: 1530-7085</identifier><identifier>EISSN: 1533-2500</identifier><identifier>DOI: 10.1111/papr.12122</identifier><identifier>PMID: 24131742</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>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</subject><ispartof>Pain practice, 2014-07, Vol.14 (6), p.559-569</ispartof><rights>2013 World Institute of Pain</rights><rights>2013 World Institute of Pain.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4002-5049a02a1389f76ab5552361fa6ddd749def0d64d43bd62139e018ab250a66353</citedby><cites>FETCH-LOGICAL-c4002-5049a02a1389f76ab5552361fa6ddd749def0d64d43bd62139e018ab250a66353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24131742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wullems, Jorgen A.</creatorcontrib><creatorcontrib>Halim, Willy</creatorcontrib><creatorcontrib>van der Weegen, Walter</creatorcontrib><title>Current Evidence of Percutaneous Nucleoplasty for the Cervical Herniated Disk: A Systematic Review</title><title>Pain practice</title><addtitle>Pain Pract</addtitle><description>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. 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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.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24131742</pmid><doi>10.1111/papr.12122</doi><tpages>11</tpages></addata></record>
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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
title Current Evidence of Percutaneous Nucleoplasty for the Cervical Herniated Disk: A Systematic Review
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