it has been estimated that about 80% of the western population would suffer some back pain in their lifetime .
ten million people per year are affected in the united states alone , costing roughly around $ 20 billion , in addition to loss of manpower due the absence from work.[24 ] mainstay of treatment for patients with radicular pain due to lumbar disc herniation involves open lumbar discectomy , and has provided excellent outcome in over six decades.[58 ] surgery ( discectomy ) , aims to alleviate pain ahead of the natural history . almost all patients report significant pain relief in the early post - operative period .
given the current trend of minimal access surgery which transcends all aspects of surgical practice , nucleoplasty has been described recently as a minimal - access procedure with good outcome .
it utilizes coblation technology that dissolves the soft tissue of nucleus pulposus , and therefore causes disc decompression and symptom improvement .
to evaluate the effectiveness of nucleoplasty in the management of radicular pain due to small lumbar disc herniation .
data collected include : age , gender , presence and duration of radicular symptoms or signs , previous procedures ( e.g. epidural injection ) , the level of disc herniation as seen on magnetic resonance imaging ( mri ) , and clinical assessment ( by the same assessor ) pre - procedure and at 1 and 3 months following the procedure .
clinical inclusion criteria : radicular symptoms and signs for 6 months or more , and failing to respond to conservative management ( e.g. physiotherapy , analgesia , epidural injection , and selective nerve root blocks ) .
table 1 ] inclusion and exclusion criteria radiological inclusion criteria : single - level , small - size , contained lumbar disc herniation ( that is clinically relevant ) with neural compression as seen on a lumbosacral spine mri , preservation of disc trilaminar appearance , preservation of at least 50% of the disc height when compared to adjacent discs . [ table 1 ] exclusion criteria : previous lumbar disc procedure ( surgery , intradiscal electrothermal therapy idet , nucleoplasty ) , history of uncontrolled psychological disorder , radiological evidence of annular tear and disc sequestration ( i.e. uncontained herniation ) , multilevel disc herniation , spinal stenosis , other pathologies ( e.g. tumor ) that explain the clinical presentation . the procedure was performed by the same surgeon as a day case under local anesthesia in prone position .
annular integrity was confirmed by non - passage of the contrast into the epidural space .
the disc was penetrated from the symptomatic side . the surgical probe ( perc - dle spine wand , arthrocare corp .
austin , texas ) was placed into the assess cannula and advanced until the tip of the catheter was approximately 5 mm beyond the tip of the spinal needle , till it came into contact with the annulus on the contralateral side .
the process of disc decompression involved advancing the catheter , in ablation mode , at a speed of 0.5 cm / s and withdrawing the wand in coagulation mode at a speed of 0.5 cm / s .
since this was a retrospective study , the outcome measures employed in this study were patient satisfaction with symptoms and self - reported improvement .
the procedure was performed by the same surgeon as a day case under local anesthesia in prone position .
annular integrity was confirmed by non - passage of the contrast into the epidural space .
the disc was penetrated from the symptomatic side . the surgical probe ( perc - dle spine wand , arthrocare corp .
austin , texas ) was placed into the assess cannula and advanced until the tip of the catheter was approximately 5 mm beyond the tip of the spinal needle , till it came into contact with the annulus on the contralateral side .
the process of disc decompression involved advancing the catheter , in ablation mode , at a speed of 0.5 cm / s and withdrawing the wand in coagulation mode at a speed of 0.5 cm / s .
since this was a retrospective study , the outcome measures employed in this study were patient satisfaction with symptoms and self - reported improvement .
twenty - seven patients had undergone the procedure with no complications and six procedures were abandoned due to anatomical reasons .
the mean age of the 27 patients was 37 years ( range 19 - 83 , median 31 ) .
there were 16 males and 11 females , with a mean duration of symptoms of 16 months ( range 6 - 72 , median 8) . at 1-month follow - up , 13 patients reported significant improvement in symptoms , and in 14 , the symptoms remained the same .
chronic back pain is fast becoming one of the major debilitating ailments in modern society , with its attendant social and financial consequences .
initial management for patient with this condition is conservative , by way of analgesia , anti - inflammatory medications , physiotherapy , and bed rest .
those who do not respond to the above can go a step further to have epidural injections or specific nerve blocks . in most cases , patients improve in a few weeks with these measures , reflecting the natural history of discogenic radicular pain . in some patients who do not improve with conservative measures or those who present at first contact with large , uncontained disc herniation , surgery by way of open lumbar microdiscectomy
is offered and has remained the mainstay for over six decades [ figure 1 ] .
sagittal view of mri lumbar spine showing disc herniation at l5/s1 level however , in view of the changing trends in surgical practice toward  achieving much , however , doing so little ,  the so - called  minimalization , 
it is a minimally invasive technique for treating patients with contained herniated disc ( see the technique described above ) .
however , in 40% of patients , the symptoms remained 2 weeks post - procedure .
there was no correlation between outcome and the level of disc herniation , gender , or duration of symptoms .
the median age of patients who improved following nucleoplasty and of those in whom the symptoms remained was 29 and 35 years , respectively .
eight of the 11 patients ( 73% ) aged 29 years or less improved following the procedure .
however , the statistical significance of this finding remains weak due to the small sample size .
all , except one , of those who remained symptomatic following nucleoplasty underwent discectomy at a later date and improved at 1-month follow - up thereafter . we tend to offer surgery to patients with moderate or large herniation with neural compression and when significant symptoms persist beyond 2 months despite conservative management . in patients with small herniation
, a conservative approach is adopted for a longer period of time before surgery is considered .
as much as 60 - 80% of patients with radicular pain due to small herniated disc showed remarkable improvement overtime with conservative treatment . in this study ,
various clinical and radiological studies have shown that in the majority of patients with symptomatic herniated disc , symptoms and disc herniation subside over a period of time without intervention ( surgery or nucleoplasty ) .
although nucleoplasty is a safe minimal - access procedure , it is no longer recommended for this group of patients for two reasons .
first , outcome at 1 month is more predictable and a greater proportion of patients improve following surgery than nucleoplasty .
second , at further follow - up , outcome following nucleoplasty is not significantly different than the history or surgery .
 background : nucleoplasty ( percutaneous lumbar disc decompression ) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation , against open microdiscectomy , which would be the mainstay treatment modality . 
 the literature reports a favorable outcome in up to 77% of patients at 6 months.aim:to evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain.materials and methods : the medical notes of 33 patients , admitted for nucleoplasty between june 2006 and september 2007 , were reviewed retrospectively . 
 all had radicular pain , and contained herniated disc as seen on magnetic resonance imaging ( mri ) of lumbosacral spine . 
 patients were followed up at 1 and 3 months post - procedure . 
 the outcome measures employed in this study were satisfaction with symptoms and self - reported improvement.results:thirty-three cases were examined ( 18 males and 15 females ) . 
 twenty - seven procedures were performed with no complications and six were abandoned due to anatomical reasons . 
 there were 18 and 15 cases of disc herniation at l5/s1 and l4/5 levels , respectively . 
 four weeks following the procedure , 13 patients reported improvement in symptoms , and 14 remained symptomatically the same and subsequently had open microdiscectomy.conclusion:nucleoplasty has been shown to be a safe and minimal - access procedure . 
 less than half of our selected cohort of patients reported symptomatic improvement at 1-month follow - up . 
 we no longer offer this procedure to our patients . 
 possible reasons are discussed . 
INTRODUCTION
AIM
MATERIALS AND METHODS
Nucleoplasty technique
Outcome instrument
RESULTS
DISCUSSION
CONCLUSION