Percutaneous Cervical Nucleoplasty vs. Pulsed Radio Frequency of the Dorsal Root Ganglion in Patients with Contained Cervical Disk Herniation; A Prospective, Randomized Controlled Trial

• Published in: Pain practice 2017-07, Vol.17 (6), p.729-737
• Main Authors: Halim, Willy, Weegen, Walter, Lim, Toine, Wullems, Jorgen Antonin, Vissers, Kris Christiaan
• Format: Article
• Language: English
• Subjects: Adult; cervicobrachial neuralgia; Diskectomy, Percutaneous - methods; evidence‐based medicine; Female; Ganglia, Spinal - diagnostic imaging; Ganglia, Spinal - surgery; Humans; Intervertebral Disc Displacement - diagnostic imaging; Intervertebral Disc Displacement - therapy; Male; Middle Aged; Neck Pain - diagnosis; Neck Pain - epidemiology; Neck Pain - therapy; nerve pain; pain clinics; Pain Measurement - methods; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prospective Studies; pulsed radiofrequency; Pulsed Radiofrequency Treatment - methods; Treatment Outcome
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.12517

Background Cervical neck pain is often caused by cervical disk pathology and may cause severe symptoms and disability. Surgeons and patients are increasingly aware of postsurgery‐related complications. This stimulated the clinical usage of minimally invasive treatments such as percutaneous nucleoplasty (PCN) and pulsed radio frequency (PRF). However, scientific evidence on both treatments is limited. Objective Our objective was to evaluate the efficacy of PCN compared to PRF in patients with contained cervical disk herniation. Methods A prospective randomized clinical trial was conducted including 34 patients with radicular pain due to a single contained cervical disk herniation who were treated with either PCN or PRF. Demographic data were collected, and the Medical Outcomes Study 12‐Item Short Form (SF‐12) Health Survey, visual analog scale (VAS), and the Neck Disability Index (NDI) were completed 1, 2, and 3 months after treatment. Treatment satisfaction and complications were recorded. Results In the PCN group (n = 17, mean age 52.4 years, 10 female/7 male), patients were treated at C5 to C6 (8 cases) or C6 to C7 (9 cases). In the PRF group (n = 17, mean age 49.5 years, 8 female/9 male), patients were treated at C3 to C4 (1 case), C5 to C6 (10 cases), or C6 to C7 (6 cases). At 3 months, mean pain VAS improved significantly from baseline in the PCN group (mean improvement: 43.4 points) and in the PRF group (34.0 points). However, improvement in 1 group was not superior compared to the other group (P = 0.48). No serious complications were reported. Conclusion Within 3 months, both PCN and PRF show significant pain improvement in patients with contained cervical disk herniation, but none is superior to the other. Both treatment options appear to be effective and safe in regular clinical practice.